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An Asian consensus on standards of diagnostic upper endoscopy for neoplasia
  1. Philip Wai Yan Chiu1,
  2. Noriya Uedo2,
  3. Rajvinder Singh3,
  4. Takuji Gotoda4,
  5. Enders Kwok Wai Ng1,
  6. Kenshi Yao5,
  7. Tiing Leong Ang6,
  8. Shiaw Hooi Ho7,
  9. Daisuke Kikuchi8,
  10. Fang Yao9,
  11. Rapat Pittayanon10,
  12. Kenichi Goda11,
  13. James Y W Lau1,
  14. Hisao Tajiri12,
  15. Haruhiro Inoue13
  1. 1Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  2. 2Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
  3. 3Department of Gastroenterology, Lyell McEwin and Modbury Hospital, University of Adelaide, Adelaide, South Australia, Australia
  4. 4Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
  5. 5Department of Endoscopy, University Chikushi Hospital, Fukuoka, Japan
  6. 6Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  7. 7Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  8. 8Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
  9. 9Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
  10. 10Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand
  11. 11Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
  12. 12Department of Innovative Interventional Endoscopy Research, Jikei University School of Medicine, Tokyo, Japan
  13. 13Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
  1. Correspondence to Professor Philip Wai Yan Chiu, Department of Surgery, The Chinese University of Hong Kong, Hong Kong; philipchiu{at}surgery.cuhk.edu.hk

Abstract

Background This is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers.

Method The Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement.

Results Risk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy.

Conclusion This consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.

  • endoscopy
  • gastric neoplasia
  • oesophageal cancer

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Footnotes

  • Contributors PWYC is responsible for overall coordination and planning of the consensus meetings, drafting and critical appraisal of statement 6, writing and editing of the manuscript. NU is responsible for drafting and critical appraisal of statement 1 as well as writing and editing of the manuscript. RS is responsible for drafting and critical appraisal of statement 1 and the manuscript, as well as participation as an expert in the consensus meeting. TG is responsible for drafting and critical appraisal of statement 2 and the manuscript, as well as participation as an expert in the consensus meeting. EKWN is responsible for drafting and critical appraisal of statement 3 and the manuscript, as well as participation as an expert in the consensus meeting. KY is responsible for drafting and critical appraisal of statement 9 and the manuscript, as well as participation as an expert in the consensus meeting. TLA is responsible for drafting and critical appraisal of statement 7 and the manuscript, as well as participation as an expert in the consensus meeting. SHH is responsible for drafting and critical appraisal of statement 5 and the manuscript, as well as participation as an expert in the consensus meeting. DK is responsible for drafting and critical appraisal of statement 8 and the manuscript, as well as participation as an expert in the consensus meeting. FY is responsible for drafting and critical appraisal of statement 4 and the manuscript, as well as participation as an expert in the consensus meeting. RP is responsible for drafting and critical appraisal of statement 10 and the manuscript, as well as participation as an expert in the consensus meeting. KG is responsible for drafting and critical appraisal of statement 8 and the manuscript, as well as participation as an expert in the consensus meeting. JYWL, HT, HI is responsible for drafting and critical appraisal of the manuscript, as well as participation as an expert in the consensus meeting.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The consensus meeting is supported by a non-government organisation named Asian Novel Bio-Imaging and Intervention Group (ANBIG) which focused on training and education of endoscopic diagnosis and management of early gastrointestinal cancers in Asia. All the authors are members of ANBIG. The manuscript underwent editorial review by a professional academic English editor.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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