The Applications Of Intensive Systematic Training Course In The Detection Of Early Gastric Cancer

BackgroundChina is a country with a high incidence of gastric cancer.The new and dead cases of gastric cancer rank at the top of all cancers in China,with a heavy burden of cancer diseases,posing a serious threat to the health of Chinese residents.Previous studies have found that early diagnosis and treatment of gastric cancer can effectively reduce the risk of death and improve the survival and prognosis of patients with gastric cancer.With the progress of various endoscopic imaging systems and the development of computer-aided diagnostic systems,the detection rate of early gastric cancer has significantly improved.However,although early gastric cancer screening program has been carried out in many high risk areas of gastric cancer in our country,the diagnosis and treatment rate of early gastric cancer is still far lower than that of Japan and South Korea,which may be due to the lack of a large amount of formal training and assessment of endoscopists in China.Based on this,the gastroenterology team of Nanfang Hospital,Southern Medical University has developed an intensive systematic "train-the-trainer"(TTT)course to help Chinese endoscopists improve the detection ability of early gastric cancer,reduce the death risk of gastric cancer in the Chinese population.AimsThe intensive systematic "TTT" course has been conducted for many years in the Department of Gastroenterology,Nanfang Hospital,Southern Medical University,and has trained many young endoscopists from different endoscopic centers.However,the effect of this course on improving the detection of early gastric cancer by endoscopists has not been confirmed in a large sample population.Therefore,this study aims to investigate whether the intensive systematic training courses provided by the trainers can effectively improve the early gastric cancer detection ability of endoscopists from different endoscopic centers in China,thereby providing certain guidance for the early gastric cancer screening strategy in China.Materials and methodsThis study included all endoscopists who completed the intensive systematic"TTT" course in the Department of Gastroenterology,Nanfang Hospital,Southern Medical University from July 2016 to June 2017.The general information of all trained endoscopists was restrospectively recorded,and clinical data related to all patients undergoing digestive endoscopy by the trained endoscopists one year before the course training("2016"),during the course training period("2017"),and one year after the course training("2018").The main outcome of the study was early gastric cancer detection rate(EDR).Results24 trained endoscopists from 14 tertiary hospitals and 3 secondary hospitals were included in this study.By analyzing 123416 cases of esophagogastroduodenoscopy and 65570 cases of colonoscopy,it was found that the EDR was 0.101%in 2016,while it had significantly increased to 0.338%in 2018(p=0.015).The early gastric cancer ratio(ECR)(the ratio between newly detected early gastric cancer and all newly detected gastric cancer)was 8.440%in 2016,while it significantly increased to 11.853%and 19.778%in 2017 and 2018,respectively(p=0.006).In contrast,the advanced gastric cancer detection rate(ADR)was similar before,during and after the training course(p=0.987).There was no significant difference in EDR,ECR and ADR between esophageal cancer and colorectal cancer within 3 years.ConclusionsThe intensive systematic training courses can improve the detection rate of early gastric cancer and is an effective educational strategy to reduce the risk of death from gastrointestinal cancer.