Affiliations 

  • 1 Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  • 2 Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
  • 3 Department of Gastroenterology, Lyell McEwin and Modbury Hospital, University of Adelaide, Adelaide, South Australia, Australia
  • 4 Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
  • 5 Department of Endoscopy, University Chikushi Hospital, Fukuoka, Japan
  • 6 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
  • 7 Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
  • 9 Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
  • 10 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand
  • 11 Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
  • 12 Department of Innovative Interventional Endoscopy Research, Jikei University School of Medicine, Tokyo, Japan
  • 13 Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
Gut, 2019 02;68(2):186-197.
PMID: 30420400 DOI: 10.1136/gutjnl-2018-317111

Abstract

BACKGROUND: This is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers.

METHOD: The Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement.

RESULTS: Risk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy.

CONCLUSION: This consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.