Background: Endoscopic screening for gastric cancer was introduced in 2016 based on a change of the national policy. Atrophic gastritis is easily diagnosed by endoscopic screening and it might be led to increasing of H. pylori (HP) eradication, which is covered by national health insurance.
Objectives: To clarify the change of in clinical practice after the introduction of endoscopic screening.
Methods: The trends of endoscopic examinations, endoscopic submucosal dissection (ESD) and tests for HP infection using serum, stool, and breath were examined based on the Japanese national health insurance survey from 2008 to 2018.
Results: Before the introduction of endoscopic screening, the total number of endoscopic examinations increased from 2008 to 2013, particularly in outpatient clinics, and then flattened. Outpatient percentages decreased and remained around 10% since 2016. The total number of treatments for gastric cancer increased. ESD increased and accounted for over 50% of treatment since 2015. Although the number of endoscopic examinations has been stable, the number of ESDs has increased. The peak of HP infection testing increased rapidly in 2013, when HP eradication was covered by the national health insurance, but it decreased after that.
Conclusions: There has been no change in clinical practice including HP eradication therapy except an increase of ESD after the introduction of endoscopic screening. The result might suggest that the detection of early cancer has increased with endoscopic screening. However, endoscopic examinations for asymptomatic peoples is still common in clinical setting. To avoid the overuse and inappropriate use of endoscopic examinations for asymptomatic persons in clinical practice, continuous observation is required.
