grade between the two groups. 92.5% of patients treated with gastrectomypresented with symptoms, as compared to only 30.9% of those treated with ESDhad symptoms (p � 0.001). There was a significantly higher proportion ofpatients with atrophic gastritis (31.9% vs 10%; p � 0.009) and intestinalmetaplasia (73.4% vs 55.0%; p � 0.04) upon histology in the ESD group. Patientstreated with radical gastrectomy sustained a longer operative time (262.3 �/-61.2 minutes) when compared to ESD (102.8 �/- 52.0 minutes)(p � 0.001). Theywere also having a longer mean hospital stay (11.7 �/- 5 days) when comparedto ESD (3.1 �/- 1 days)(p � 0.001). There was no perioperative mortality, butthe overall complication rate was significantly higher in the gastrectomy group.The 3 year survival rate was 94.6% for the ESD group and 89.7% for gastrectomygroup, and log rank test showed p of 0.44 (Figure 1). Conclusions: ESD achievedsimilar oncological outcomes as compared to radical gastrectomy for treatment ofearly gastric cancer. Patients treated with ESD had significantly betterperioperative outcomes when compared to gastrectomy in terms of operativetime, complication rate and hospital stay.

Sa1651The Clinicopathological Characteristics of the “Endoscopic”Atrophic Gastritis and the Gastric Cancer in the Actual Practice.Analysis of 32450 Cases in the Four High-Volume EndoscopicCentersKoji Matsuda1, Yasushi Oda2, Kiyohito Tanaka3, Mitsuhiro Kida4,Solemio FFP Group1

1Department of Endoscopy, The Jikei University Aoto Hospital, Tokyo,Japan; 2Oda GI Clinic, Kumamoto, Japan; 3Department ofGastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan;4Department of Gastroenterology, Kitasato University Hospital East,Kanagawa, JapanBackground: We have reported the relationship between the “endoscopic”atrophic grade and the gastric cancer (GC) with the histological characteristics.(2010DDW 314f) The “endoscopic” atrophic change as a clinicopathologicalfactor depending on the histological characteristics was little investigated, as wellas the final interventions (endoscopic submucosal dissection, surgery, etc).Design: Prospective case control study. Setting: Four high-volume endoscopycenters. Object and Method: From 2008.1 to 2010.10, a total of 32450 consecutivecases in the four high-volume endoscopy centers in Japan were enrolled in thisstudy. All procedures were performed or supervised by the experiencedendoscopists at each center. Exclusion criteria were as follows: 1) cases whosetype of the atrophic change was unclassified 2) cases in which the patient hadthe first procedure at each institute, or the interval from the last procedure wasunknown, or less than 6 months 3) cases with the history of the previoustreatment for the GCs 4) cases in which GCs were already confirmed by thereferring physicians. Finally, a total of 16956 patients were assessed prospectivelywith the severity of the “endoscopic” atrophic change (A: C-0,I, B: C-II, III, O-I,C: O-II, III), the interval of the procedures (I: 0.5 to 1.5 years, II: 1.5 to 2.5 years,III: more than 2.5 years), gender, age, and the pathohistrogical characteristics: IM(intestinal or mixed) and D (diffuse) type, using univariate and multivariateanalysis. Final interventions were also assessed. Results: A total of 60 cases (IMtype: D type � 42:18) with the GC were newly found at four institutes. No

patient with the GC was less than 40 years old. The age of the patients with theGCs was significantly higher than those without the GC (70.1�-9.03: 60.1�-11.8,p�0.001). Male more likely had the GC than Female. (41/9309:19/7589,p�0.040). The results of multivariate logistic regression analysis were shown inTable 1. Regarding the final interventions, 73.8% of cases (38/42) with IM type ofthe GC was treated with ESD, whereas no patient underwent ESD in case of theD type of the GC. Conclusions: The ‘endoscopic’ atrophic change, the interval ofthe procedures, and age were definitely critical factors for the GC. In the IMtype, gender was also important, whereas only the “endoscopic” atrophic changewas statistically significant in case of the D type. Annual or biannual endoscopicfollow-up for the patient with severe “endoscopic” atrophic gastritis will behelpful to find the GC as an early stage, especially in case of the IM type of theGC, which has a potential to be a nice candidate for ESD.

Multivariate analysis of ’endoscopic’ atrophic grade, interval, and gender.

’endoscopic’ atrophicgrade

Interval of theprocedures

Gender(male)

All cases 3.98; 2.57-6.16 1.87; 1.40-2.49 1.71; 0.99-2.96IM types 3.97; 2.34-6.72 2.06; 1.47-2.90 2.95; 1.41-6.19D types 4.00; 1.83-8.74 1.46; 0.84-2.53 0.61; 0.24-1.57

(Odds ratio; 95%CI)

Sa1652The Direct Comparison of the Incidence of the Gastric CancerWith the Previous Experience of Esophagogastroduodenoscopy(EGD) in the Actual Practice. Analysis of 32450 Cases in theFour High-Volume Endoscopic CentersKoji Matsuda1, Kiyohito Tanaka2, Mitsuhiro Kida4, Yasushi Oda3,Solemio FFP Group1

1Department of Endoscopy, The Jikei University Aoto Hospital, Tokyo,Japan; 2Kyoto Second Red Cross Hospital, Kyoto, Japan; 3Oda GIClinic, Kumamoto, Japan; 4Kitasato University East Hospital,Kanagawa, JapanBackground: Gastric cancer (GC) is still frequently seen in the actual practice inAsian countries. The real incidence of the gastric cancer was not so muchevaluated depending on the previous EGD history. The aim of the study is toevaluate the incidence of GC depending on the previous EGD history and thepresence of gastrointestinal (GI) related symptom (epigastralgia, nausea, etc.).Study design: Prospective case control study. Setting: Four high-volumeendoscopy centers. Object and Method: From 2008.1 to 2010.10, a total of 32450consecutive cases in the four high-volume endoscopy centers in Japan wereenrolled in this study. Solemio ENDO® Ver.3.2 (Olympus Medical Systems Inc.,Tokyo, Japan) was used to collect the data at each institution. All procedureswere performed or supervised by the experienced endoscopists at each center.Exclusion criteria were as follows: 1) cases in which the patient had the firstprocedure at each institute with the previous experiences at other institutes, orthe interval from the last procedure was unknown, or less than 6 months 2)cases with the history of the previous treatment for the GCs. 3) cases in whichGC was already confirmed by the referring physicians. 4) cases in which thepatients were less than 40 years old. 5) cases in which the reasons for theprocedure was except GI related symptoms or asymptomatic. Finally, a total of18357 patients were assessed. The incidence of GC was assessed prospectivelywith the interval of the procedures (0: the first EGD in one’s life I: 0.5 to 1.5years, II: 1.5 to 2.5 years, III: more than 2.5 years), the presence of GI relatedsymptoms (Group A: absence, Group B: presence), gender and age, usingunivariate and multivariate analysis. Results: A total of 87 cases (0.47%) with theGC were newly found at four institutes. The age of the patients with the GC wassignificantly higher than that without the GC. (70.9�-8.5: 60.8�-11.1, p�0.001)Gender didn’t show the statistical significance. (p�0.054) Total incidence of theGC in Group B was significantly higher than that in Group A. (p�0.000) Theincidence of the GC in each group was shown in the Table 1. In Group 0, theresults of multivariate logistic regression analysis were as follows (Odds ratio;95%CI): Gender (male) (1.66; 0.81-3.41), age (every ten years from forty yearsold) (2.12; 1.536-2.923), the presence of GI related symptoms (2.58; 1.21-5.52).Conclusions: The first EGD for the patient over 40 years old would be importantin terms of the detection of the GC, especially with the GI related symptoms andage. The incidence of the GC for the first EGD in one’s life was not statisticallymore significant than that with more than three year’s interval, regardless the GIrelated symptom. Annual or biannual EGD follow-up would be optimal for thepatients with the average risk.

0 I II III total

All 31/2366 (1.31%)� 28/11856 (0.24%)�� 9/2097 (0.43%) 19/2038 (0.93%)� 87/18357 (0.47%)

Group A 11/1582 (0.70%)� 26/11160 (0.23%)�� 6/1769 (0.34%) 12/1439 (0.83%)� 55/15950 (0.34%)

Group B 20/784 (2.55%)�� 2/696 (0.29%)�� 3/328 (0.91%) 7/599 (1.17%) 32/2407 (1.33%)

(Chi square test: compared with the total incidence in each group � p�0.05, �� p�0.01)

Figure 1. 36 months survival between ESD group and Gastrectomygroup

Abstracts

www.giejournal.org Volume 73, No. 4S : 2011 GASTROINTESTINAL ENDOSCOPY AB235