Introduction

TOGAS (TOwards GAstric Cancer Screening Implementation in the EU) is a large EU-funded study providing preliminary data to inform implementation of gastric cancer screening. “Pilot 2” focuses on participants aged 50-74 years-old undergoing FIT-positive/surveillance colonoscopy. Patients are offered additional gastroscopy at time of scheduled colonoscopy to determine prevalence of Helicobacter pylori infection, precancerous lesions and gastric cancer.

Aim

To determine whether preliminary evidence supports an improvement in gastroscopy key performance indicators (KPIs) following the introduction of the TOGAS pilot study in Ireland, similar to the established KPI enhancements seen in colonoscopy after the initiation of the Irish BowelScreen programme.

Reports from 100 gastroscopies performed before the start of the TOGAS study were reviewed. Data were collected on photographic documentation, use of anti-bubble solution, biopsies taken, and whether precancerous lesions such as intestinal metaplasia (IM) or atrophy were noted. These findings were then analysed and compared with reports from 91 gastroscopies conducted during the TOGAS study. P values were determined using Fisher’s exact test.

In the pre-TOGAS cohort, the average number of photographs taken was 12, compared with the minimum of 15 obtained in the TOGAS cohort. Complete photographic documentation of the antrum, body, and incisura was achieved in all TOGAS gastroscopies, but in only 22 (22%) of pre-TOGAS procedures (P<0.0001). Photographic evidence of examination under NBI was completed in every TOGAS gastroscopy, in comparison to less than half of the pre-TOGAS cohort. Use of anti-bubble solution was not documented in any pre-TOGAS gastroscopy. Full Sydney protocol biopsies were performed in all TOGAS procedures, compared with just two in the pre-TOGAS group (P<0.0001). Comments on the presence or absence of intestinal metaplasia or gastric atrophy were included in 28.26% of TOGAS reports, but only 4% of pre-TOGAS reports (P<0.0001).

Adherence to the MAPS 2 (management of epithelial precancerous conditions and lesions in the stomach) and Sydney protocol was much more prevalent in the TOGAS cohort in comparison to the pre-TOGAS group. This may suggest that participation in the TOGAS study results in improved quality of upper GI endoscopy.