Longer Examination Time Improves Detection of Gastric Cancer During Diagnostic Upper Gastrointestinal Endoscopy

Objective: To study whether speed of examination during esophageogastroduodenoscopy (EGD) affected detection rates of high-risk gastric pathology.Design: We utilized a cohort of 2,014 consecutive patients who underwent their first diagnostic EGD. We dichotomized endoscopists as fast or slow using their mean examination time for performing normal EGD without biopsy. Detection rates of intestinal metaplasia, gastric atrophy, dysplasia and carcinoma between the two groups were compared.Results: 837 patients were included. Mean duration of 224 normal examinations was 6.6 minutes with 8 endoscopists classified as fast (mean duration 5.5±2.1 minutes) and 8 as slow (mean duration 8.6±4.2 minutes). 86 patients were diagnosed with 92 high-risk gastric lesions. Endoscopists classified as slow were more than twice as likely to detect a high-risk lesion (OR 2.50, 95% CI 1.52- 4.12) and thrice as likely to detect a neoplastic lesion (carcinoma or dysplasia) (OR 3.42, 95% CI 1.25-10.38) compared to fast endoscopists. A linear relationship was observed between an endoscopist's mean examination time during a normal endoscopic examination and his detection rate of high-risk gastric lesions. Conclusion: Our findings suggest that speed of examination affects detection rates of gastric lesions during EGD. We would advocate endoscopists spending more time on examination to improve diagnostic accuracy.