Diagnostic yield and biopsy practice variability between gastroenterologists and general surgeons performing upper gastrointestinal endoscopy

Kucukdemirci Ö., Cagaptay S., Bas B.

WORLD JOURNAL OF GASTROINTESTINAL SURGERY, cilt.18, sa.9, 2026 (SCI-Expanded)

Özet

BACKGROUND To compare biopsy practices, histopathological diagnostic yield, and detection of premalignant gastric lesions between gastroenterologists and general surgeons performing upper gastrointestinal endoscopy in a geographically remote, specialist-limited setting, and to evaluate whether endoscopist specialty remained associated with intestinal metaplasia detection after adjustment for biopsy sampling intensity and temporal factors. AIM To compare biopsy practices, histopathological diagnostic yield, and detection of premalignant gastric lesions between gastroenterologists and general surgeons performing upper gastrointestinal endoscopy, and to evaluate whether endoscopist specialty remained associated with intestinal metaplasia detection after adjustment for biopsy sampling intensity and temporal factors. METHODS This retrospective observational study included 8825 upper gastrointestinal endoscopy procedures performed from 2015 to 2025 at a secondary-care hospital. Endoscopic findings, biopsy practices, and histopathological outcomes were compared between gastroenterologists and general surgeons. Histopathological analyses were restricted to procedures with at least one pathologically evaluable biopsy specimen. Multivariable logistic regression and temporal sensitivity analyses were performed to identify factors associated with intestinal metaplasia detection. RESULTS Of 8825 procedures, 7232 (82.0%) were performed by gastroenterologists and 1593 (18.0%) by general surgeons. Biopsy acquisition was more frequent among gastroenterologists (90.2% vs 79.7%, P < 0.001), who also performed multisite sampling more often. Among biopsied procedures, intestinal metaplasia was detected in 10.3% and 8.8% of procedures, respectively (P = 0.124), whereas Helicobacter pylori infection (62.4% vs 56.6%, P < 0.001) and dysplasia (1.2% vs 0.2%, P = 0.004) were more frequently identified in the gastroenterologist group. In multivariable analysis, increasing age [odds ratio (OR): 1.04, 95% confidence interval (CI): 1.03-1.04, P < 0.001] and Helicobacter pylori infection (OR: 1.48, 95%CI: 1.26-1.74, P < 0.001) were independently associated with intestinal metaplasia. After adjustment for biopsy sampling intensity and study period, endoscopist specialty was not independently associated with intestinal metaplasia detection (OR: 1.08, 95%CI: 0.87-1.33, P = 0.511), whereas biopsy sampling intensity remained significant (OR: 1.13, 95%CI: 1.08-1.18, P < 0.001). CONCLUSION Gastroenterologists and general surgeons demonstrated differences in biopsy acquisition practices and histopathological diagnostic yield. However, the attenuation of specialty-related differences after adjustment for biopsy sampling intensity and temporal factors suggests that biopsy strategy and sampling behavior may play a greater role than specialty background alone in the detection of premalignant gastric lesions.