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IMPORTANT ASPECTS OF THE ESOPHAGOGASTRODUODENOSCOPY (OGD) REPORT FOR PREOPERATIVE MANAGEMENT OF GASTRIC CANCER
N Ravindran1, A Mahar2, N Coburn2, J Tinmouth2 1University of Toronto; 2Sunnybrook Hospital, Toronto, Ontario
AIMS: To identify important features of the OGD report for preoperative management of gastric cancer.
METHODS: Part 1: A systematic literature review, involving a search of Medline, Embase & the Cochrane Review of Controlled Trials using the terms "gastric", "stomach" & "cancer", "carcinoma", "neoplasm" or "tumour" was implemented. Abstracts were reviewed by 2 independent evaluators, & retained if they addressed the following question: "What are the important features of an OGD for the preoperative management of gastric cancer?" Part 2: A convenience sample was identified comprising all gastroenterologists and general surgeons from 2 academic & 2 community hospitals; 5 from each specialty were interviewed. Respondents were required to be in independent & active practice, to perform endoscopy routinely & to have experience in the preoperative evaluation of gastric cancer patients. Semi-structured interviews focused on important aspects of an OGD report pertaining to gastric cancer, & included questions requiring response on a Likert scale graded 1-4 (1=not necessary, 2=not necessary but nice to have, 3=recommended & 4=absence mandates repeat OGD). Interviews were individually conducted, taped, transcribed & analyzed.
RESULTS: Part 1: Literature review & search yielded 4910 abstracts. None of the abstracts addressed quality of OGD in preoperative planning for gastric cancer. Part 2: The study sample (n=10) consisted of 70% academicians with median 7 (Range 1-24) years in practice, who diagnosed or managed median of 50 (5-150) cases of gastric cancer during practice to date, & who perform median of 275 (80-1000) OGDs/year. All respondents agreed that distance of gastric neoplasms from GEJ, size of mass & location of mass should be included in the OGD report (Likert (L) 3-4). Additionally, 90% felt that describing the appearance of mass, video and photos were important (L 3-4). Tattooing of a neoplasm was important if it was small (3/10) or to be treated laparoscopically (4/10) while 50% felt that biopsies for H. pylori or of surrounding tissue was important (L 3-4). Gastroenterologists (GIs) would repeat OGD only to confirm equivocal histopathology while all general surgeons (GSxs) indicated they would repeat OGD themselves to confirm location of the tumour & to assist with patient counseling & surgical planning, regardless of quality & content of OGD report.
CONCLUSIONS: There is a paucity of research on the quality of OGD reporting in the preoperative management of gastric cancer. Regardless of quality of OGD reporting, general surgeons are likely to repeat OGD. Improved communication & cooperation between GIs & GSxs is needed to optimize gastric cancer care & to avoid duplication of endoscopic procedures.