Effectiveness of gastric cancer screening programs in South Korea:Organized vs opportunistic models

AIM:To investigate the outcome and effectiveness of two screening programs,National Cancer Screening Program(NCSP)and opportunistic screening(OS),for the detection of gastric cancer. METHODS:A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010.The study population was comprised of subjects over the age of 40 years.More specifically,subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation.Still photo-graphs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists. RESULTS:The mean age of the screened subjects was 55 years for men and 54 years for women.A total of 126 cases(0.28%)of gastric cancer were detected from both screening programs;100 cases(0.3%)from NCSP and in 26 cases(0.2%)from OS.The proportion of early gastric cancer(EGC)detected in NCSP was higher than that in OS(74.0%vs 53.8%,P=0.046). Among the 34 416 screenees in NCSP,6585(19.1%) underwent upper endoscopy every other year as scheduled.Among the 11 238 screenees in OS,3050(27.1%) underwent upper endoscopy at least once every two years during the study period.The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs(0.3%vs 0.2%,P=0.036).A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up. CONCLUSION:Compliance to the screening program is more important than the type of screening system used.

Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm

AIM: The clinical value of second-look endoscopy(SLE) after endoscopic submucosal dissection(ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD. METHODS: A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of postprocedural bleeding estimated by Forrest classification. The high risk of rebleeding group(Forrest?Ⅰa,?Ⅰb and Ⅱa) required endoscopic treatment, while the low risk of rebleeding group(Forrest Ⅱb, Ⅱc and Ⅲ) did not. Delayed bleeding after ESD was investigated. RESULTS: Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group(1/66) and the low risk group(1/244)(P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group(P = 0.004 and P = 0.006, respectively). CONCLUSION: SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.

Measurement of biological age may help to assess the risk of colorectal adenoma in screening colonoscopy

AIM To investigate the clinical utility of biological age(BA) measurement in screening colonoscopy for the detection of colorectal adenomas in the average-risk population.METHODS A consecutive series of asymptomatic subjects aged ≥ 30 years who underwent colonoscopy in routine check-ups were enrolled. Colorectal adenoma was classified according to size, number, and location. BAs were calculated using the MEDIAGETM Biological Age Measurement System.RESULTS A total of 2696 subjects were investigated(1876 men and 820 women). The mean chronological age(CA) was 46.0 years and the mean BA was 44.7 years. Metabolic syndrome(MS) was diagnosed in 218 subjects(8.1%). The prevalence of overall colorectal adenoma was 23.1%(622/2,696). When the subjects were divided into four groups based on BA(≤ 39 years; 40-49 years; 50-59 years; ≥ 60 years), the prevalence of colorectal adenoma was increased as BA increased(P < 0.001). Colorectal adenoma located in the proximal colon was more prevalent in the BA-dominant group(BA-CA ≥ 5years) than the CA-dominant group(CA-BA ≥ 5 years)(P = 0.034). When the subjects were categorized into four groups according to MS and age gap between BA and CA, the incidence of colorectal adenoma increased with MS and BA-dominance(P < 0.05).CONCLUSION Measurement of BA may help to assess the risk of colorectal adenoma in screening colonoscopy.