RT Journal Article SR Electronic T1 Variation in the rate of detection of minute and small early gastric cancers at diagnostic endoscopy may reflect the performance of individual endoscopists JF BMJ Open Gastroenterology JO BMJ Open Gastro FD BMJ Publishing Group Ltd SP e001143 DO 10.1136/bmjgast-2023-001143 VO 10 IS 1 A1 Murakami, Daisuke A1 Yamato, Masayuki A1 Amano, Yuji A1 Nishino, Takayoshi A1 Arai, Makoto YR 2023 UL http://bmjopengastro.bmj.com//content/10/1/e001143.abstract AB Objective The documented variation in gastric cancer (GC) detection among endoscopists has often been dismissed as a coincidental artefact of the low incidence of gastric neoplasms; it is not considered associated with differences in physicians’ performance of the esophagogastroduodenoscopy procedure. This study is to confirm whether significant variations among endoscopists in early GC detection suggest the individual performance of the upper endoscopy.Design A retrospective observational study at a single centre in Japan assessed the results of 218 early GCs detected during 25 688 routine esophagogastroduodenoscopies by 12 endoscopists. The main outcome was the rate of early GC detection for each endoscopist under the same circumstances. Other measures included the major diameters and locations of the lesions, Helicobacter pylori infection status, and baseline patient characteristics that could affect the prevalence of GC.Results The early GC detection rates exhibited wide variation among endoscopists (0.09%–2.87%) despite performing routine esophagogastroduodenoscopies in a population with a similar background. Endoscopists were assigned to a low-detection group (n=6; detection rate: 0.47% (range: 0.09%–0.55%)) and a high-detection group (n=5; detection rate: 0.83% (range: 0.63%–1.12%)), with the single highest detector analysed separately due to his distinct detection rate (2.87%). Endoscopists in the high-detection group had better detection rates for minute (major diameter ≤5 mm) and small (major diameter 6–10 mm) GCs than the low-detection group (0.19%/0.23% vs 0.085%/0.098%). These differences were significant (p<0.01), although there were no significant differences in detection of larger tumours (major diameter ≥11 mm; 0.40% vs 0.28%; p=0.13). The tumour location and H. pylori status were similar in the low-detection group, high-detection group and for the highest detector.Conclusion Significant variation in the detection of hard-to-find, smaller GCs may reflect individual performance of the examination.Data are available upon reasonable request. Raw data were generated at New Tokyo Hospital. Derived data supporting the findings of this study are available from the corresponding author (DM) on request.