Endoscopists and endoscopic assistants’ qualifications, but not their biopsy rates, improve gastric precancerous lesions detection rate

Figure 1 Study population flowchart. A total of 200910 patients underwent gastroscopy at our center from January 2018 to April 2023 Among them, 903 patients were younger than 18 years old; 5485 patients had incomplete gastroscopy data; 23561 patients underwent endoscopic submucosal dissection, endoscopic mucosal resection, or surgical treatment; 4750 patients underwent endoscopic ultrasonography; and 2279 patients underwent biopsy histopathology of the esophagus and duodenum. Exclusion criteria and reasons: (1) This study focuses on adult patients, so individuals under 18 years old were excluded; (2) To ensure the completeness and reliability of the data for analysis, patients with incomplete gastroscopy examination data were excluded; (3) This study only focuses on gastric biopsy-related issues, so esophageal or duodenal biopsies were excluded; (4) Gastroscopic treatments such as endoscopic submucosal dissection, endoscopic mucosal resection, or gastric surgery were excluded, as these procedures may alter the normal anatomical structure of the stomach and affect the data analysis; and (5) Endoscopic ultrasonography was excluded to avoid introducing additional variables that could interfere with the study’s findings. A total of 36981 patients were excluded, and 169417 patients were included in the analysis. The biopsy specimen of 45805 patients underwent histopathological examination. EUS: Endoscopic ultrasonography; EBR: Endoscopist biopsy rate; GPCs: Gastric precancerous conditions; GPLs: Gastric precancerous lesions; GC: Gastric cancer; NAG: Nonatrophic gastritis.