Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2025; 17(4): 104097
Published online Apr 16, 2025. doi: 10.4253/wjge.v17.i4.104097
Endoscopists and endoscopic assistants’ qualifications, but not their biopsy rates, improve gastric precancerous lesions detection rate
Yao Shen, Xiao-Juan Gao, Xiao-Xue Zhang, Jia-Min Zhao, Fei-Fan Hu, Jing-Lue Han, Wen-Ying Tian, Mei Yang, Yun-Fei Wang, Jia-Le Lv, Qiang Zhan, Fang-Mei An
Yao Shen, Xiao-Juan Gao, Xiao-Xue Zhang, Jia-Min Zhao, Fei-Fan Hu, Jing-Lue Han, Wen-Ying Tian, Mei Yang, Yun-Fei Wang, Jia-Le Lv, Qiang Zhan, Fang-Mei An, Department of Gastroenterology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, National Clinical Research Center for Digestive Diseases (Xi’an) Jiangsu Branch, Wuxi 214023, Jiangsu Province, China
Co-first authors: Yao Shen and Xiao-Juan Gao.
Co-corresponding authors: Qiang Zhan and Fang-Mei An.
Author contributions: Shen Y and Gao XJ designed the research methodology and statistical framework; Zhang XX, Zhao JM, Hu FF, Han JL, Yang M, and Wang YF performed data curation and validation; Tian WY and Lv JL conducted the statistical analysis and visualization; Zhan Q and An FM acquired funding, provided resources, and supervised the study, and they contributed equally to this manuscript as co-corresponding authors. Shen Y and Gao XJ drafted the original manuscript with equal contribution as co-first authors of this manuscript. All authors participated in critical revision of the manuscript for important intellectual content and approved the final version.
Supported by Jiangsu Science and Technology Project, No. BK20211039; the Top Talent Support Program for Young and Middle-Aged People of the Wuxi Health Committee, No. BJ2023008; the Major Program of Wuxi Medical Center, Nanjing Medical University, No. WMCM202305; the Cohort and Clinical Research Program of Wuxi Medical Center, Nanjing Medical University, No. WMCC202302; the Scientific Research Program of Wuxi Health Commission, No. Z202208; and Wuxi Municipal Health and Health Commission Precision Medicine Project, No. J202104.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Wuxi People’s Hospital of Nanjing Medical University, No. KY23001.
Informed consent statement: All participants completed the informed consent process prior to participating in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data can be obtained from the corresponding author if necessary.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang-Mei An, MD, PhD, Department of Gastroenterology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, National Clinical Research Center for Digestive Diseases (Xi’an) Jiangsu Branch, No. 299 Qingyang Road, Liangxi District, Wuxi 214023, Jiangsu Province, China. fangmeian@njmu.edu.cn
Received: December 23, 2024
Revised: February 27, 2025
Accepted: March 24, 2025
Published online: April 16, 2025
Processing time: 116 Days and 1.6 Hours
Abstract
BACKGROUND

Detecting gastric precancerous lesions (GPLs) is critical for the early diagnosis and treatment of gastric cancer. Endoscopy combined with tissue examination is an important method for detecting GPLs. However, negative biopsy results often increase patients’ risks, economic burdens, and lead to additional healthcare costs. Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.

AIM

To explore the relationships between the endoscopist biopsy rate (EBR), qualifications of endoscopists and endoscopic assistants, and detection rate of GPLs.

METHODS

EBR, endoscopists, and endoscopic assistants were divided into four groups: Low, moderate, high, and very high levels. Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions. Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR, endoscopist or endoscopic assistant qualifications, and the detection rate of positive lesions.

RESULTS

Compared with those in the low EBR group, the odds ratio (OR) values for detecting positive lesions in the moderate, high, and very high EBR groups were 1.12 [95% confidence interval (CI): 1.06-1.19, P < 0.001], 1.22 (95%CI: 1.14-1.31, P < 0.001), and 1.38 (95%CI: 1.29-1.47, P < 0.001), respectively. EBR was positively correlated with the detection rate of gastric precancerous conditions (atrophic gastritis/intestinal metaplasia) (ρ = 0.465, P = 0.004). In contrast, the qualifications of the endoscopists were positively correlated with GPLs detection (ρ = 0.448, P = 0.005). Compared to endoscopists with low qualification levels, those with moderate, high, and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13% (OR = 1.13, 95%CI: 0.98-1.31), 20% (OR = 1.20, 95%CI: 1.03-1.39), and 32% (OR = 1.32, 95%CI: 1.15-1.52), respectively. Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia (ρ = 0.350, P = 0.034), angularis (ρ = 0.396, P = 0.015) and gastric body (ρ = 0.453, P = 0.005) but not in the antrum (ρ = 0.292, P = 0.079). Moreover, the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications (ρ = 0.427, P = 0.015).

CONCLUSION

Endoscopists and endoscopic assistants with high/very high qualifications, but not EBR, can improve the detection rate of GPLs. These results provide reliable evidence for the development of gastroscopic quality control indicators.

Keywords: Endoscopist biopsy rate; Endoscopist qualifications; Gastric precancerous conditions; Gastric precancerous lesions; Gastric cancer

Core Tip: This study demonstrates that endoscopists and endoscopic assistants with high qualifications, rather than the endoscopist biopsy rate, significantly improve the detection of gastric precancerous lesions (GPLs). Qualified endoscopists showed higher GPLs detection rates, particularly in the gastric cardia, angularis, and body regions. This suggests that a high endoscopist biopsy rate alone is not sufficient for detecting GPLs. Instead, greater emphasis should be placed on improving the qualifications of endoscopists and appropriate collaboration between endoscopists and assistants to perform accurate biopsies. These findings provide valuable insights for developing gastroscopic quality control standards.