Transnasal and standard transoral endoscopies in the screening of gastric mucosal neoplasias

doi:10.4253/wjge.v3.i8.162

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Aug 16, 2011 (publication date) through Jul 21, 2024

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Endosc. Aug 16, 2011; 3(8): 162-170
Published online Aug 16, 2011. doi: 10.4253/wjge.v3.i8.162

Table 1 Clinical profiles of the subjects screened by transnasal or transoral endoscopy and clinicopathological characteristics of detected gastric mucosal neoplasia (mean ± SD) n (%)

		Subject screened
	Total subjects	By transnasal EGD	By transoral EGD
No. of screened subjects	3324	1382	1942
Age (yr)	53.4 ± 15.4	53.4 ± 15.4	53.5 ± 15.4
Males	1442 (43.4)	684 (49.4)^a	758 (39.0)
Smokers	678 (20.4)	267 (19.3)	411 (21.1)
Helicobacter pylori-infected subjects	1202 (40.2)	510 (39.8)	692 (40.5)
CAG-positive subjects	1360 (40.9)	560 (40.5)	800 (41.2)
No. of subjects with gastric neoplasia/DR	55/0.0165	23/0.0166	32/0.0165
Location of neoplasia (U/M/L)	20/15/20	8/7/8	12/8/12
Adenoma cases/DR	12/0.0036	3/0.0022	9/0.0046
Location of adenoma (U/M/L)	2/4/6	0/2/1	2/2/5
Size of adenoma (mm)	10.5 ± 7.0	9.7 ± 4.0	10.8 ± 7.9
Cancer cases/DR	43/0.0129	20/0.0145	23/0.0118
Location of cancer (U/M/L)	18/11/14	8/5/7	10/6/7
Size of cancer (mm)	27.3 ± 16.7	32.6 ± 19.5^a	22.3 ± 12.8
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	12/1/15/13	6/1/5/8	6/0/12/5
With intestinal-type cancer	33 (76.7)	18 (90.0)^a	15 (65.2)
Depth of invasion (m/sm/pm-)	20/10/13	5/7/8	15/3/5
With early cancer	30 (69.7)	12 (60.0)	18 (78.3)

^aP < 0.05 vs transoral esophagogastroduodenoscopy (EGD). CAG: Chronic atrophic gastritis; DR: Detection rate; U: Upper third of the stomach; M: Middle third of the stomach; L: Lower third of the stomach.

Table 2 Screening performance of the two esophagogastroduodenoscopies in subjects with or without Helicobacter pylori infection (mean ± SD) n (%)

	Total subjects (H. pylori analyzed)	H. pylori
	Total subjects (H. pylori analyzed)	Positive	Negative
Screened by transnasal EGD
Screened subjects	1280	510	770
Age (yr)	53.4 ± 15.4	56.8 ± 13.6^c	50.2 ± 14.3
Males	623 (48.7)^a	268 (52.5)^a	355 (46.1)^a
Smokers	247 (19.3)	118 (23.1)^c	129 (16.7)^a
Subjects with gastric neoplasia/DR	21/0.0164	16/0.0314^c	5/0.00649
Location of neoplasia (U/M/L)	7/6/8	4/6/6	3/0/2
Adenoma cases/DR	3/0.0023	3/0.00589	0/0
Size of adenoma (mm)	9.7 ± 4.0	9.7 ± 4.0	0
Cancer cases/DR	18/0.0141	13/0.0255^c	5/0.00649
Size of cancer (mm)	31.2 ± 19.5	25.5 ± 13.3	46.0 ± 28.2
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	6/1/4/7	5/0/4/4	1/1/0/3
With intestinal-type cancer	16 (88.9)	12 (92.3)	4 (80)
Depth of invasion (m/sm/pm-)	5/6/7	4/5/4	1/1/3
With early cancer	12 (66.7)	10 (76.9)	2 (40)
Screened by transoral EGD
Screened subjects	1707	692	1015
Age (yr)	53.5 ± 15.4	56.3 ± 14.7^c	51.8 ± 14.8
Males	655 (38.4)	298 (43.1)	357 (35.2)
Smokers	354 (20.7)	141 (20.3)	213 (21.0)
Subjects with gastric neoplasia/DR	33/0.0193	26/0.0376^c	6/0.00591
Location of neoplasia (U/M/L)	12/8/12	10/8/9	2/0/3
Adenoma cases/DR	9/0.0052	5/0.00722	4/0.00394
Size of adenoma (mm)	10.8 ± 7.9	13 ± 11.5	10 ± 4.08
Cancer cases/DR	23/0.0135	21/0.0303^c	2/0.00197
Size of cancer (mm)	22.3 ± 12.8	23.2 ± 13.4	20 ± 0
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	6/0/12/5	6/0/10/5	0/0/2/0
With intestinal-type cancer	15 (65.2)	14 (66.7)	1 (50)
Depth of invasion (m/sm/pm-)	15/3/5	13/3/5	2/0/0
With early cancer	18 (78.3)	14 (76.2)	2 (100)

^aP < 0.05 vs transoral,

^cP < 0.05 vs Helicobacter pylori (H. pylori)-negative. DR: Detection rate; U: Upper third of the stomach; M: Middle third of the stomach; L: Lower third of the stomach; EGD: Esophagogastroduodenoscopy.

Table 3 Screening performance of the two esophagogastroduodenoscopies in subjects with or without chronic atrophic gastritis (mean ± SD) n (%)

	Total subjects	CAG
		Positive	Negative
Screened by transnasal EGD
Screened subjects	1382	560	822
Age (yr)	53.4 ± 15.4	60.3 ± 11.8^c	47.0 ± 14.5
Males	684 (49.4)^a	316 (56.4)^a	368 (44.8)^a
Smokers	267 (19.3)	121 (21.6)	146 (17.8)
Subjects with gastric neoplasia/DR	23/0.0166	22/0.0286^c	1/0.00122^a
Location of neoplasia (U/M/L)	8/7/8	8/6/8	0/1/0
Adenoma cases/DR	3/0.0022	3/0.00536	0/0
Size of adenoma (mm)	9.7 ± 4.0	9.7 ± 4.0	0
Cancer cases/DR	20/0.0145	19/0.0315^c	1/0.00122
Size of cancer (mm)	32.6 ± 19.5^a	34.1 ± 18.8^a	5 ± 0
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	6/1/5/8	6/1/4/8	0/0/1/0
With intestinal-type cancer	18 (90.0)	18 (94.7)	0 (0)
Depth of invasion (m/sm/pm-)	5/7/8	4/7/8	1/0/0
With early cancer	12 (60.0)	11 (57.9)^a	1 (100)
Screened by transoral EGD
Screened subjects	1942	800	1142
Age (yr)	53.5 ± 15.6	62.3 ± 11.4^c	47.3 ± 14.2
Males	758 (39.0)	363 (45.3)	395 (34.6)
Smokers	411 (21.2)	165 (20.6)	246 (21.6)
Subjects with gastric neoplasia/DR	32/0.0164	24/0.0300^c	8/0.0070
Location of neoplasia (U/M/L)	12/8/12	8/7/9	4/1/3
Adenoma cases/DR	9/0.0046	7/0.00875^c	2/0.00175
Size of adenoma (mm)	10.8 ± 7.9	11.7 ± 8.8	7.5 ± 3.5
Cancer cases/DR	23/0.0118	17/0.0213^c	6/0.00525
Size of cancer (mm)	22.3 ± 12.8	19.4 ± 11.7	31.4 ± 12.1
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	6/0/12/5	6/0/9/2	0/0/3/3
With intestinal-type cancer	15 (65.2)	12 (70.6)^c	2 (33.3)
Depth of invasion (m/sm/pm-)	15/3/5	13/2/2	2/1/3
With early cancer	8 (78.3)	15 (88.2)	3 (50.0)

^aP < 0.05 vs transoral;

^cP < 0.05 vs CAG-negative. CAG: Chronic atrophic gastritis; DR: Detection rate; U: Upper third of the stomach; M: Middle third of the stomach; L: Lower third of the stomach; EGD: Esophagogastroduodenoscopy.

Table 4 Screening performance of the two esophagogastroduodenoscopies according to the stages of Helicobacter pylori-related chronic gastritis (mean ± SD) n (%)

	Group A	Group B	Group C	Group D	Total subjects (H. pylori analyzed)
Screened by transnasal EGD
Screened subjects	572	189	321	198	1280
Age (yr)	45.3 ± 13.8	49.2 ± 14.6^c	59.8 ± 12.1^c	63.4 ± 12.8^c	53.4 ± 15.4
Males	257 (44.9)^a	74 (39.3)	194 (60.2)^a	98 (49.4)	623 (48.7)^a
Smokers	89 (15.6)^a	43 (22.8)^a	75 (23.3)	40 (20.2)	247 (19.2)
Subjects with gastric neoplasia/DR	0/0	1/0.0053^a^c	15/0.0466^c	5/0.0253	21/0.0164
Location of neoplasia (U/M/L)	0	0/1/0	4/5/6	3/0/2	7/6/8
Adenoma cases/DR	0/0	0/0	3/0.0093	0/0	3/0.0023
Size of adenoma (mm)	0	0	9.7 ± 4.0	0	9.7 ± 4.0
Cancer cases/DR	0/0	1/0.00532	12/0.0373	5/0.0253	18/0.0141
Size of cancer (mm)	0	5 ± 0	27.3 ± 12.3	46.0 ± 28.2	31.2 ± 19.5
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	0	0/0/1/0	5/0/3/4	1/1/0/3	6/1/4/7
With intestinal-type cancer	0 (0)	0/1 (0)	12/12 (100)	4/5 (80)	16/18 (88.9)
Depth of invasion (m/sm/pm-)	0	1/0/0	3/5/4	1/1/3	5/6/7
With early cancer	-	1 (100)	8 (66.7)	2 (40)	12 (66.7)
Screened by transoral EGD
Screened subjects	751	257	435	264	1707
Age (yr)	46.0 ± 12.6	46.6 ± 15.4	60.9 ± 11.8^c	64.0 ± 11.4^c	53.5 ± 15.4
Males	247 (32.9)	95 (37.0)	203 (46.7)	110 (41.7)	655 (38.4)
Smokers	167 (22.2)	39 (15.2)	102 (23.4)	46 (17.4)	354 (20.7)
Subjects with gastric neoplasia/DR	0/0	8/0.0311^c	18/0.0414^c	6/0.0227	32/0.0187
Location of neoplasia (U/M/L)	0	4/1/3	6/7/5	2/0/4	12/8/12
Adenoma cases/DR	0/0	2/0.00778	3/0.00689	4/0.0152	9/0.0052
Size of adenoma (mm)	0	7.5 ± 3.53	8.0 ± 13.9	10 ± 4.08	10.8 ± 7.9
Cancer cases/DR	0/0	6/0.0233	15/0.0345	2/0.00758	23/0.0134
Size of cancer (mm)	0	31.4 ± 12.1	19.4 ± 12.5	20 ± 0	22.3 ± 12.8
Morphological cancer type (I-IIa/IIb/IIc-III/Ad)	0	0/0/3/3	6/0/7/2	0/0/2/0	6/0/12/5
With intestinal-type cancer	0 (0)	2/6 (33.3)	12/15 (80)	1/2 (50)	16/24 (66.7)
Depth of invasion (m/sm/pm-)	0	2/1/3	11/2/2	2/0/0	15/3/5
With early cancer	-	3 (50)	13 (86.7)	2 (100)	18 (78.3)

^aP < 0.05 vs transoral;

^cP < 0.05 vs previous stage. H. pylori: Helicobacter pylori; DR: Detection rate; U: Upper third of the stomach; M: Middle third of the stomach; L: Lower third of the stomach; EGD: Esophagogastroduodenoscopy. Group A: H. pylori (-), chronic atrophic gastritis (CAG) (-); Group B: H. pylori (+), CAG (-); Group C: H. pylori (+), CAG (+); Group D: H. pylori (-), CAG (+).

Citation: Nakata H, Enomoto S, Maekita T, Inoue I, Ueda K, Deguchi H, Shingaki N, Moribata K, Maeda Y, Mori Y, Iguchi M, Tamai H, Yamamichi N, Fujishiro M, Kato J, Ichinose M. Transnasal and standard transoral endoscopies in the screening of gastric mucosal neoplasias. World J Gastrointest Endosc 2011; 3(8): 162-170
URL: https://www.wjgnet.com/1948-5190/full/v3/i8/162.htm
DOI: https://dx.doi.org/10.4253/wjge.v3.i8.162