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Optimizing early upper gastrointestinal cancer detection at endoscopy

Abstract

Survival rates for upper gastrointestinal cancers are poor and oesophageal cancer incidence is increasing. Upper gastrointestinal cancer is also often missed during examinations; a predicament that has not yet been sufficiently addressed. Improvements in the detection of premalignant lesions, early oesophageal and gastric cancers will enable organ-preserving endoscopic therapy, potentially reducing the number of advanced upper gastrointestinal cancers and resulting in improved prognosis. Japan is a world leader in high-quality diagnostic upper gastrointestinal endoscopy and the clinical routine in this country differs substantially from Western practice. In this Perspectives article, we review lessons learnt from Japanese gastroscopy technique, training and screening for risk stratification. We suggest a key performance indicator for upper gastrointestinal endoscopy with a minimum total procedure time of 8 min, and examine how quality assurance concepts in bowel cancer screening in the UK could be applied to upper gastrointestinal endoscopy and improve clinical practice.

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Figure 1: Systematic screening protocol for the stomach.
Figure 2: Endoscopic features of early gastric cancer.
Figure 3: Endoscopic features of oesophageal squamous cell carcinoma.
Figure 4: Algorithm for the systematic examination of the upper gastrointestinal tract at endoscopy.

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The authors contributed equally to all aspects of this manuscript.

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Correspondence to Andrew M. Veitch.

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J.E.E has been an advisory board member and received research support from Cosmo Pharmaceuticals and honoraria for speaking for Abbvie and Olympus. The other authors declare no competing interests.

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Veitch, A., Uedo, N., Yao, K. et al. Optimizing early upper gastrointestinal cancer detection at endoscopy. Nat Rev Gastroenterol Hepatol 12, 660–667 (2015). https://doi.org/10.1038/nrgastro.2015.128

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