Longer examination time improves detection of gastric cancer during diagnostic upper gastrointestinal endoscopy.

BACKGROUND & AIMS: It is not clear how the duration of upper endoscopy affects the detection of cancer or premalignant lesions that increase the risk for gastric cancer. We investigated whether the length of time spent performing esophagogastroduodenoscopy (EGD) affects the detection of important pathologic features of the stomach. METHODS: We collected data from 837 symptomatic patients, during a 3-month period in 2010, who underwent a first diagnostic EGD at a tertiary university hospital in Singapore. Endoscopists were classified as fast or slow based on the mean amount of time it took them to perform a normal EGD examination. We used logistic regression to compare between groups the numbers of intestinal metaplasias, gastric atrophies, dysplasias, and cancers detected, using histologic analysis of biopsy samples collected during endoscopy as the standard. RESULTS: Of 224 normal endoscopies, the mean duration was 6.6 minutes (range, 2-32 min). When we used 7 minutes as the cut-off time, 8 endoscopists were considered to have short mean examination times (mean duration, 5.5 ± 2.1 min; referred to as fast endoscopists), and 8 endoscopists were considered to have long mean examination times (mean duration, 8.6 ± 4.2 min; referred to as slow endoscopists). Eleven cancers and 81 lesions considered to pose risks for cancer were detected in 86 patients; 1.3% were determined to be cancer, 1.0% were determined to be dysplasia, and 8.7% were determined to be intestinal metaplasia and/or gastric atrophy. Slow endoscopists were twice as likely to detect high-risk lesions as fast endoscopists (odds ratio, 2.50; 95% confidence interval, 1.52-4.12), regardless of whether they were endoscopy staff or trainees. The slow endoscopists also detected 3-fold more neoplastic lesions (cancer or dysplasia; odds ratio, 3.42; 95% confidence interval, 1.25-10.38). CONCLUSIONS: Endoscopists with mean EGD examination times longer than 7 minutes identified a greater number of high-risk gastric lesions than faster endoscopists. Examination time may be a useful indicator of quality assessment for upper endoscopy. Studies are required to test these findings in different populations.

Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore.

OBJECTIVES: Neighborhood socioeconomic status (SES) can be associated with depression. We aimed to assess prevalence of depression amongst community-dwelling elderly in a multiethnic, urban, low-SES, Asian neighborhood, comparing against a higher SES neighborhood. METHOD: The study population involved all residents aged ≥60 years in two Singaporean housing estates comprising owner-occupied public housing (higher SES) and public rental housing (low SES) in 2012. Having lifetime prevalence of depression was defined as having a score ≥5 on the Geriatric Depression Scale-15 or a history of depression. Demographic/clinical details were collected via questionnaire. Those with depression were referred to local polyclinics. Multilevel multivariate logistic regression determined predictors of depression and depression screening. RESULTS: Participation was 61.5% (559/909). In the low-SES community, 26.2% (104/397) had depression, compared with 14.8% (24/162) in the higher SES community. After adjusting for other sociodemographic variables, staying in a low-SES community (public rental housing) was independently a ssociated with depression [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) = 1.02-2.84]. Within the low-SES community, not being married (aOR = 2.27, CI = 1.35-3.70), falls (aOR = 2.72, CI = 1.59-4.67), visual impairment (aOR = 2.37, CI = 1.28-4.39), and poorer social network (aOR = 3.70, CI = 1.96-7.14) were associated with depression. CONCLUSION: Residing in a low-SES community was independently associated with depression after controlling for individual SES.