To Evaluate the Best Metric for Inspection Time During a Diagnostic and/or Surveillance Upper Gastrointestinal Endoscopy (Age ≥ 18 Years, Informed Consent), Between Total Inspection Time Versus Withdrawal Time, for the Identification of Malignant Lesions

June 1, 2025 updated by: Maria Inês Viegas, Portuguese Oncology Institute, Coimbra

Analysis of Withdrawal Time in Upper Gastrointestinal Endoscopy as Procedure Time: a Randomised, Parallel, Double-blinded, Multicenter, International Clinical Trial

Gastric cancer is the fifth cause of cancer-related mortality worldwide. Gastric carcinogenesis involves the progression from premalignant conditions such as atrophic gastritis and intestinal metaplasia to premalignant lesions like dysplasia, and ultimately carcinoma. Most diagnoses of gastric cancer are made at advanced stages, with a five-year relative survival rate of 36%. Therefore, early detection of premalignant conditions and lesions is crucial, as it allows for timely surveillance and treatment, which can improve patient survival.

Upper gastrointestinal endoscopy (UGE) is the first-line examination for diagnosing upper gastrointestinal tract pathology, particularly oncological conditions. The European Society of Gastrointestinal Endoscopy (ESGE) and the United European Gastroenterology (UEG) have established that UGE quality is a priority, identifying specific quality parameters, such as the duration of the procedure, which is the most extensively studied parameter.

According to ESGE recommendations, all UGE reports should include the procedure time (goal: ≥90% of reports), which should be seven minutes or longer for surveillance of intestinal metaplasia. This time threshold follows a study that established a causal relationship between longer procedures (≥ seven minutes) and a higher detection rate of premalignant gastric conditions and lesions. Subsequent observational studies have generally shown that setting a minimum procedure time increases the detection rate of lesions.

The definition of procedure time varies between studies, being described as the time from intubation to extubation, but also as the time for withdrawing the endoscope from the second portion of the duodenum (D2) to extubation, also known as withdrawal time.

The hypothesis under study is that a better definition of the most appropriate time for a diagnostic UGE could standardize reports, improve malignant lesion detection rates, and reduce the rate of undiagnosed cancers, without any additional risk to patients.

Existing studies have been retrospective or comparative between different temporal cohorts, with no prospective or randomised comparative studies, nor any studies comparing the two existing metrics. Therefore, the aim of this study is to evaluate the best metric for inspection time during a diagnostic and/or surveillance UGE, between total inspection time versus withdrawal time, for the identification of malignant lesions.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Execution of UGE using high-resolution endoscopes, with the option of virtual chromoendoscopy, according with the physician's preference. Possible optimization of visualization with washing and/or the use of simethicone or similar, as pre-medication or during the examination, according with the physician's preference. Patients will be randomised to one of the following measurements-total time versus withdrawal time-in a parallel 1:1 scheme. The allocation of the randomisation group will be computer-generated. The endoscopist must record the time at which the following three anatomical structures are reached (either by noting during the procedure or based on the information in the photographic documentation), before any biopsies or therapeutic interventions, in the format xxh:xxmin:xxsec:

  1. First esophageal image;
  2. First image of the second portion of the duodenum;
  3. Last esophageal image.

The endoscopist will perform the UGE for as long as clinically necessary, which may be shortened if there is any need to interrupt the procedure for any clinical reason (such as intolerance or other), without any minimum or maximum time limits.

Although this is a non-interventional study that does not involve any modification to daily clinical practice, regarding the analyzed UGE, the study will be submitted for evaluation by the Ethics Committee of the Portuguese Institute of Oncology of Coimbra and will be performed in accordance with the principles of the Helsinki Declaration. All analyzed data will be kept confidential, and the investigators will ensure the anonymity of the patients included during data analysis and publication.

This study aims to define the best metric for quantifying the most appropriate time for performing a diagnostic or surveillance UGE. To our knowledge, all existing studies on the topic of procedure time in UGE are observational. This study will be the first randomised clinical trial in this area, with the purpose of providing a systematic evaluation that will contribute to the optimization of quality measures.

Study Type

Interventional

Enrollment (Estimated)

1290

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Age ≥ 18 years
  • Diagnostic or surveillance upper gastrointestinal endoscopy for premalignant conditions
  • Informed consent for the execution of the upper gastrointestinal endoscopy and participation in the study

Exclusion Criteria:

  • Previous esophagus, stomach, or duodenum surgery
  • Known or suspected neoplasia
  • Therapeutic procedure (polypectomy, argon plasma coagulation, hemostasis, others)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Analysis of the withdrawal time of the Upper Gastrointestinal Endoscopy
Other: Analysis of the withdrawal time of the Upper Gastrointestinal Endoscopy
Time of last esophageal image - time of first image of the second portion of the duodenum.
Other: Upper gastrointestinal endoscopy: Common Practices

Execution of UGE using high-resolution endoscopes, with the option of virtual chromoendoscopy, according with the physician's preference. Possible optimization of visualization with washing and/or the use of simethicone or similar, as pre-medication or during the examination, according with the physician's preference. Patients will be randomised to one of the following measurements-total time versus withdrawal time-in a parallel 1:1 scheme.

The allocation of the randomisation group will be computer-generated. The endoscopist must record the time at which the following three anatomical structures are reached (either by noting during the procedure or based on the information in the photographic documentation), before any biopsies or therapeutic interventions, in the format xxh:xxmin:xxsec:

  1. First esophageal image;
  2. First image of the second portion of the duodenum;
  3. Last esophageal image.
Active Comparator: Analysis of the total time of the Upper Gastrointestinal Endoscopy
Other: Upper gastrointestinal endoscopy: Common Practices

Execution of UGE using high-resolution endoscopes, with the option of virtual chromoendoscopy, according with the physician's preference. Possible optimization of visualization with washing and/or the use of simethicone or similar, as pre-medication or during the examination, according with the physician's preference. Patients will be randomised to one of the following measurements-total time versus withdrawal time-in a parallel 1:1 scheme.

The allocation of the randomisation group will be computer-generated. The endoscopist must record the time at which the following three anatomical structures are reached (either by noting during the procedure or based on the information in the photographic documentation), before any biopsies or therapeutic interventions, in the format xxh:xxmin:xxsec:

  1. First esophageal image;
  2. First image of the second portion of the duodenum;
  3. Last esophageal image.
Other: Analysis of the total time of the Upper Gastrointestinal Endoscopy
Time of last esophageal image - time of first esophageal image

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Primary outcome: Detection rate of premalignant conditions and malignant lesions, defined as the total number of lesions in the esophagus, stomach, or duodenum detected per randomisation group, confirmed by histological evaluation (if necessary)
Time Frame: One month
One month

Secondary Outcome Measures

Outcome Measure
Time Frame
• Complications: related to sedation, cardiopulmonary adverse events, bleeding, perforation, others.
Time Frame: 1 month
1 month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Portuguese Oncology Institute, Coimbra

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 7, 2025

Primary Completion (Estimated)

January 1, 2026

Study Completion (Estimated)

January 1, 2026

Study Registration Dates

First Submitted

October 30, 2024

First Submitted That Met QC Criteria

November 17, 2024

First Posted (Actual)

November 20, 2024

Study Record Updates

Last Update Posted (Actual)

June 4, 2025

Last Update Submitted That Met QC Criteria

June 1, 2025

Last Verified

June 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PortugueseOIC 006

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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