Single-bite versus double-bite technique for mapping biopsies during endoscopic surveillance for hereditary diffuse gastric cancer: a single-center, randomized trial

Abstract

BACKGROUND : Endoscopic surveillance is recommended in patients with hereditary diffuse gastric cancer (HDGC) who refuse or want to delay surgery. Because early signet-ring cell carcinoma (SRCC) can be inconspicuous, the current surveillance endoscopy protocol entails 30 random biopsies, which are time-consuming. This study aimed to compare single-bite and double-bite techniques in HDGC surveillance. METHODS : Between October 2017 and December 2018, consecutive patients referred for HDGC surveillance were prospectively randomized to the single- or double-bite arm. The primary outcome was the diagnostic yield for SRCC foci. Secondary outcomes were: procedural time for random biopsies; comfort score; biopsy size; and quality of specimens, the latter assessed by the presence of muscularis mucosa, crush artifact, and proportion usable for diagnostic assessment. RESULTS : 25 patients were randomized to the single-bite arm and 23 to the double-bite arm. SRCC foci were detected in three and four patients in the single- and double-bite arms, respectively (P = 0.70). The procedural time for the double-bite arm (12 minutes, interquartile range [IQR] 4) was significantly shorter than for the single-bite arm (15 minute, IQR 6; P = 0.01), but comfort scores were similar. The size of the biopsies in the double-bite arm was significantly smaller than in single-bite arm (2.5 mm vs. 3.0 mm; P < 0.001) but this did not affect the presence of muscularis mucosa (P = 0.73), artifact level (P = 0.11), and diagnostic utility (P = 0.051). CONCLUSION : For patients undergoing HDGC surveillance, the double-bite technique is significantly faster than the single-bite technique. The diagnostic yield for SRCC and the biopsy quality were similar across both groups.

Trial registration: ClinicalTrials.gov NCT03950908.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Thieme. All rights reserved.

Figures

Figure 1

Scatter plot with superimposed box plot of duration of procedure stratified by group allocation. Circles represent individual patient data, coloured by group. The bold horizontal line represents the median duration of the procedure (p=0.011).

Figure 2

Scatter plot with superimposed box plot of the size of specimens stratified by group allocation. Dots represent individual patient data, coloured by group. Bold horizontal line represents the median size of specimens (p

Figure 3

Case of SRCC detected within the pale area. A) Panoramic view of the antrum with normal-appearing mucosa. B) Detailed view of the pale area on white light endoscopy. C) Detailed view of the pale area on NBI, which allows better delineation of the margins.