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Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea
Jun Ki Min, Jae Myung Cha, Yu Kyung Cho, Jie-Hyun Kim, Soon Man Yoon, Jong Pil Im, Yunho Jung, Jeong Seop Moon, Jin-Oh Kim, Yoon Tae Jeen
Clin Endosc 2018;51(3):239-252.   Published online May 31, 2018
DOI: https://doi.org/10.5946/ce.2018.075
AbstractAbstract PDFPubReaderePub
Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Citations

Citations to this article as recorded by  
  • Current status of quality control in screening esophagogastroduodenoscopy and the emerging role of artificial intelligence
    Lihui Zhang, Liwen Yao, Zihua Lu, Honggang Yu
    Digestive Endoscopy.2024; 36(1): 5.     CrossRef
  • Interval Advanced Gastric Cancer After Negative Endoscopy
    Tae Jun Kim, Jeung Hui Pyo, Young Hye Byun, Sung Chul Choi, Jin Pyo Hong, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
    Clinical Gastroenterology and Hepatology.2023; 21(5): 1205.     CrossRef
  • Simulator-based training method in gastrointestinal endoscopy training and currently available simulators
    Yuri Kim, Jeong Hoon Lee, Gin Hyug Lee, Ga Hee Kim, Gunn Huh, Seung Wook Hong, Hwoon-Yong Jung
    Clinical Endoscopy.2023; 56(1): 1.     CrossRef
  • Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
    Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
    Intestinal Research.2023; 21(1): 20.     CrossRef
  • Quality indicators in the endoscopic detection of gastric cancer
    Vikneswaran Namasivayam, Noriya Uedo
    DEN Open.2023;[Epub]     CrossRef
  • The Influence of Face Shields on the Quality of Colonoscopy in the Era of the COVID-19 Pandemic
    Jin Wook Lee, Hyo Jeong Lee, Dae Sung Kim, Jiyoung Yoon, Seung Wook Hong, Ha Won Hwang, Jong-Soo Lee, Gwang-Un Kim, Sinwon Lee, Jaewon Choe, Jin Hwa Park, Dong-Hoon Yang, Jeong-Sik Byeon
    Gut and Liver.2022; 16(3): 404.     CrossRef
  • Quality indicators in esophagogastroduodenoscopy
    Sang Yoon Kim, Jae Myung Park
    Clinical Endoscopy.2022; 55(3): 319.     CrossRef
  • Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys
    Lei Xin, Ye Gao, Zhiyuan Cheng, Tianjiao Wang, Han Lin, Yanan Pang, Chang Sun, Zengjun Fu, Zhaoshen Li, Xudong Ma, Luowei Wang
    Chinese Medical Journal.2022; 135(16): 2003.     CrossRef
  • Reduced detection rate of artificial intelligence in images obtained from untrained endoscope models and improvement using domain adaptation algorithm
    Junseok Park, Youngbae Hwang, Hyun Gun Kim, Joon Seong Lee, Jin-Oh Kim, Tae Hee Lee, Seong Ran Jeon, Su Jin Hong, Bong Min Ko, Seokmin Kim
    Frontiers in Medicine.2022;[Epub]     CrossRef
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    Vasuki Rajaguru, Jieun Jang, Jeoung A. Kwon, Jae Hyun Kim, Jaeyong Shin, Mison Chun
    Frontiers in Public Health.2022;[Epub]     CrossRef
  • Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition
    Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
    The Korean Journal of Gastroenterology.2022; 80(3): 115.     CrossRef
  • Antispasmodic Agent Administration Improves Gastric Neoplasm Detection Rates during Esophagogastroduodenoscopy
    Sang Yoon Kim, Jae Myung Park
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(3): 246.     CrossRef
  • Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition
    Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
    Clinical Endoscopy.2022; 55(6): 703.     CrossRef
  • Current Endoscopy Training in Korea and Future Aspects
    Young-Eun Joo
    The Korean Journal of Gastroenterology.2022; 80(5): 207.     CrossRef
  • Colonoscopy quality in community hospitals and nonhospital facilities in Korea
    Jae Gon Lee, Dong Soo Han, Young-Eun Joo, Dae-Seong Myung, Dong Il Park, Seul Ki Kim, Yunho Jung, Won Hyun Lee, Eun Soo Kim, Joon Seok Yoon, Chang Soo Eun
    The Korean Journal of Internal Medicine.2021; 36(Suppl 1): S35.     CrossRef
  • Association of Regular Endoscopic Screening with Interval Gastric Cancer Incidence in the National Cancer Screening Program
    Choong-Kyun Noh, Eunyoung Lee, Gil Ho Lee, Sun Gyo Lim, Bumhee Park, Sung Jae Shin, Jae Youn Cheong, Kee Myung Lee
    Journal of Clinical Medicine.2021; 11(1): 230.     CrossRef
  • Impacts of age and sedation on cardiocerebrovascular adverse events after diagnostic GI endoscopy: a nationwide population-based study
    Sang Yoon Kim, Chang Mo Moon, Min Ho Kim, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim, Sung-Ae Jung
    Gastrointestinal Endoscopy.2020; 92(3): 591.     CrossRef
  • Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial
    Youn I Choi, Jong-Joon Lee, Jun-Won Chung, Kyoung Oh Kim, Yoon Jae Kim, Jung Ho Kim, Dong Kyun Park, Kwang An Kwon
    Journal of Clinical Medicine.2020; 9(10): 3286.     CrossRef
  • Endoscopy training in Korea
    Joon Sung Kim, Byung-Wook Kim
    The Korean Journal of Internal Medicine.2019; 34(2): 237.     CrossRef
  • Updates on the Facilities, Procedures, and Performance of the Accredited Endoscopy Unit
    Tae Hee Lee, Jin Young Yoon, Chang Nyol Paik, Hyuk Soon Choi, Jae-Young Jang
    Clinical Endoscopy.2019; 52(5): 431.     CrossRef
  • Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program
    Jun Ki Min, Jae Myung Cha, Min Seob Kwak, Jin Young Yoon, Yunho Jung, Jeong Eun Shin, Hyo-Joon Yang
    Yonsei Medical Journal.2019; 60(11): 1054.     CrossRef
  • 6,401 View
  • 172 Download
  • 21 Web of Science
  • 21 Crossref
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How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program
Yu Kyung Cho
Clin Endosc 2016;49(4):312-317.   Published online July 29, 2016
DOI: https://doi.org/10.5946/ce.2016.084
AbstractAbstract PDFPubReaderePub
In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

Citations

Citations to this article as recorded by  
  • Simethicone and N-acetyl cysteine combination as premedication before esophagogastroduodenoscopy: Double-blind randomized controlled trial
    Veeraraghavan Krishnamurthy, Abel Joseph, Shreyas Venkataraman, George Kurian
    Endoscopy International Open.2022; 10(05): E585.     CrossRef
  • Trends in the Performance of the Korean National Cancer Screening Program for Gastric Cancer from 2007 to 2016
    Ji Eun Ryu, Eunji Choi, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu Won Jung, Kui Son Choi
    Cancer Research and Treatment.2022; 54(3): 842.     CrossRef
  • Current Endoscopy Training in Korea and Future Aspects
    Young-Eun Joo
    The Korean Journal of Gastroenterology.2022; 80(5): 207.     CrossRef
  • Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea
    Hyun Young Kim
    Gastroenterology Report.2022;[Epub]     CrossRef
  • Response
    Sang Yoon Kim, Jae Myung Park
    Gastrointestinal Endoscopy.2021; 94(4): 876.     CrossRef
  • A Nationwide Survey on the Facilities and Personnel for Endoscopic Sedation: Results from 50 Qualified Endoscopy Units of Teaching Hospitals Accredited by the Korean Society of Gastrointestinal Endoscopy (KSGE)
    Seon-Young Park, Jun Kyu Lee, Jung-Wook Kim, Tae Hee Lee, Chang-Hwan Park, Jae-Yong Jang, Byung-Wook Kim, Byung Ik Jang
    Clinical Endoscopy.2021; 54(6): 843.     CrossRef
  • Screening for gastric cancer: East and West, features of diagnostic criteria
    A. A. Avanesyan, O. V. Chukina, Yu. V. Kokovina, T. M. Chirkina, I. G. Bakulin
    Experimental and Clinical Gastroenterology.2020; (9): 73.     CrossRef
  • Endoscopy training in Korea
    Joon Sung Kim, Byung-Wook Kim
    The Korean Journal of Internal Medicine.2019; 34(2): 237.     CrossRef
  • Establishing a model to measure and predict the quality of gastrointestinal endoscopy
    Luo-Wei Wang, Han Lin, Lei Xin, Wei Qian, Tian-Jiao Wang, Jian-Zhong Zhang, Qian-Qian Meng, Bo Tian, Xu-Dong Ma, Zhao-Shen Li
    World Journal of Gastroenterology.2019; 25(8): 1024.     CrossRef
  • Factors related to paradoxical reactions during propofol-induced sedated endoscopy
    Seung Hwa Lee, Gyu Min Lee, Dong Ryul Lee, Jung Un Lee
    Scandinavian Journal of Gastroenterology.2019; 54(3): 371.     CrossRef
  • Laparoscopic Surgery for Gastric Cancer: The European Point of View
    Mickael Chevallay, Minoa Jung, Felix Berlth, Chon Seung-Hun, Philippe Morel, Stefan Mönig
    Journal of Oncology.2019; 2019: 1.     CrossRef
  • Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program
    Jun Ki Min, Jae Myung Cha, Min Seob Kwak, Jin Young Yoon, Yunho Jung, Jeong Eun Shin, Hyo-Joon Yang
    Yonsei Medical Journal.2019; 60(11): 1054.     CrossRef
  • Needs assessment survey for simulation‐based training for gastrointestinal endoscopy nurses
    Sol Yu, Young Sook Roh
    Nursing & Health Sciences.2018; 20(2): 247.     CrossRef
  • Screening for gastric cancer with magnetically controlled capsule gastroscopy in asymptomatic individuals
    An-Jing Zhao, Yang-Yang Qian, Hui Sun, Xi Hou, Jun Pan, Xiao Liu, Wei Zhou, Yi-Zhi Chen, Xi Jiang, Zhao-Shen Li, Zhuan Liao
    Gastrointestinal Endoscopy.2018; 88(3): 466.     CrossRef
  • Gastrointestinal endoscopy satisfaction questionnaire is a valid tool to measure patient satisfaction in Asian country
    Jin Young Yoon, Jae Myung Cha, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin, Kwang Ro Joo, Joung Il Lee
    Medicine.2018; 97(29): e11477.     CrossRef
  • An Adjusted Level of Adenoma Detection Rate is Necessary for Adults Below 50 Years Old
    Jin Young Yoon, Jae Myung Cha, Jeong Eun Shin, Kyeong Ok Kim, Hyo-Joon Yang, Hyun Gun Kim, Young-Seok Cho, Sun-Jin Boo, Jun Lee, Yunho Jung, Hyun Jung Lee, Hoon Sup Koo, Young-Eun Joo
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    Bang Wool Eom, Kyu-Won Jung, Young-Joo Won, Hannah Yang, Young-Woo Kim
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    Joon Sung Kim, Byung-Wook Kim
    Clinical Endoscopy.2017; 50(4): 318.     CrossRef
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    Jieun Kim, Su Mi Kim, Man Ho Ha, Jeong Eun Seo, Min-Gew Choi, Jun Ho Lee, Tae Sung Sohn, Sung Kim, Sin-Ho Jung, Jae Moon Bae
    Medicine.2016; 95(49): e5490.     CrossRef
  • 8,712 View
  • 204 Download
  • 19 Web of Science
  • 19 Crossref
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Original Article
Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea
Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon, Ethics and Quality Control Committee of Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2016;49(6):542-547.   Published online March 2, 2016
DOI: https://doi.org/10.5946/ce.2015.113
AbstractAbstract PDFPubReaderePub
Background
/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions.
Methods
We surveyed the staff of institutional endoscopic units via e-mail.
Results
Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program.
Conclusions
Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

Citations

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  • Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center
    Shu‐Hui Chen, Theophile Liu, Huei‐Wen Lai, Hui‐Lan Chang, Hsu‐Heng Yen
    Advances in Digestive Medicine.2022; 9(2): 103.     CrossRef
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    Yu Kyung Cho
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    Dong-Hoon Yang
    Gut and Liver.2016; 10(5): 657.     CrossRef
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    In Kyung Yoo, Yoon Tae Jeen
    Clinical Endoscopy.2016; 49(6): 495.     CrossRef
  • 9,669 View
  • 125 Download
  • 5 Web of Science
  • 7 Crossref
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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancer
Prevention Strategies for Gastric Cancer: A Global Perspective
Jin Young Park, Lawrence von Karsa, Rolando Herrero
Clin Endosc 2014;47(6):478-489.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.478
AbstractAbstract PDFPubReaderePub

Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

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Focused Review Series: Endoscopic and Molecular Imaging of Premalignant GI Lesions, Part II
Barrett Esophagus: When to Endoscope
Joshua Butt, Gabor Kandel
Clin Endosc 2014;47(1):40-46.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.40
AbstractAbstract PDFPubReaderePub

Increasing interest in identifying an effective strategy for decreasing the burden of esophageal adenocarcinoma (EAC) has been fuelled by the rising EAC rates worldwide, the morbidity associated with esophagectomy, and the development of endoscopic methods for curing early-stage EAC. In the face of this enthusiasm, however, we should be cautious about continuing our current evidence-free approach to screening and one with unclear benefits and unclear costs to the community. The literature is increasingly recognizing that the value of traditional endoscopy for screening and surveillance of Barrett esophagus may be more limited than initially believed. A better understanding of the risk factors for Barrett esophagus and progression to dysplasia and a more individualized risk calculation will be useful in defining populations to consider for Barrett screening. The development of novel, nonendoscopic screening techniques and of less expensive endoscopic techniques holds promise for a cost-effective screening and surveillance method to curtail the increasing rates of EAC.

Citations

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원저 : 식도 위장관 ; 건강검진 수진자 9,137 명에 대한 위내시경적 집단 검진 소견 ( Original Articles : Esophagus , Stomach & Intestine ; Esophgogastroduodenoscopic Findings in 9,137 Healthy Subjects Examined for the Secondary Prevention )
Korean J Gastrointest Endosc 1998;18(2):161-168.   Published online November 30, 1997
AbstractAbstract PDF
Background
A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. Methods: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. Results: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. Conclusion: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms. (Korean J Gastrointest Endosc 18: 161-168, 1998)
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자동차제조회사 근로자 1865명에 대한 위내시경적 집단검진 소견 ( Mass Screening for Stomach Cancer by Gastrofiberscopy in 1865 Employees of a Car Manufacturing Company )
Korean J Gastrointest Endosc 1993;13(2):347-352.   Published online November 30, 1992
AbstractAbstract PDF
Background
Stomach cancer is the most commonly diagnosed malignant tumor in Korea. Early detection by mass screening very important to increase survival rate of stomach cancer, because the prognosis of early gastric cancer is excellent, and specific symptoms and physical findings are rare with early gastric cancer. Methed: 1865 car manufacturing company employees were examinined by gastrofiberscopy at a dispensary of the company from May 6, l992 to July 13, 1992. Results: 1. Number of cases with normal finding was 1262(67.7%), gastritis 422(22.6%), gastric ulcer 47(2.5%), gasrtric cancer 4(0.2%), duodenitis 39(2.1%), duodenal ulcer 63(3.4%), combined ulcer(gastric & duodenal) 2(0.1%,), post operative state 6(0.3%), and others 4(0.3%) in total 1865 examinees. 2. Of 422 cases with gastritis, cases with superficial gastritis were 171 (9.2%), atrophic gastritis 138(7.4%), erosive gastritis 94(5.0%) and hemorrhagic gastritis 19(1.0%). 3. Of 4 cases with stomach cancer, 1 case was advanced stomach cancer and 3 cases were early gastric cancer(two cases of IIc and one case of IIc+III) by macroscopic classification. Conclusion: Mass screening provides an excellent opportunity to detect gastric cancer in populations without symytoms or with nonspecific symptoms. It should be recommended to undergo screening exam for high risk group of stomach cancer.
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