{
  "abstract": "Introduction Gastric cancer remains a major health burden, with premalignant lesions such as atrophic gastritis (AG) and intestinal metaplasia (IM) offering opportunities for early detection and intervention. This Quality Improvement Project (QIP) evaluated the impact of implementing the Systematic Screening Protocol for the Stomach (SSS) described by Kenshi Yao in 2013, incorporating a standardized 22-image documentation system. Our institution adopted this protocol in response to emerging evidence suggesting higher detection rates of premalignant lesions with increased image documentation. As the existing literature is still limited and lacks robust validation, we implemented this approach both to evaluate its effectiveness in our setting and to contribute meaningful data to the growing but currently insufficient evidence base. The aim of this QIP was to evaluate detection rates of histologically proven gastric premalignant lesions following implementation of the SSS protocol and to assess the feasibility and adherence to the protocol in routine endoscopy workflow.Methods This prospective two-cycle QIP was conducted in a tertiary care endoscopy unit in India using Plan–Do–Study–Act (PDSA) methodology. Prior to implementation, no formal protocol for systematic gastric screening existed in our unit. All endoscopists underwent training in the SSS 22-image documentation protocol, which was then implemented for high-risk patients aged ≥50 years with risk factors for gastric cancer including first degree relative with gastric cancer, previous H. pylori infection, tobacco use, salted fish intake, or alarm symptoms (anemia, loss of weight, anorexia, recent progressive symptoms, melena/hematemesis, dysphagia). Targeted biopsies were obtained from endoscopically suspected areas and premalignant lesions were confirmed histologically. Exclusion criteria included age ≤18 years, known gastric cancer, incomplete or emergency endoscopies, early termination due to intolerance, and inability to provide consent. Baseline data were collected during the first cycle (January–June 2025). Following feedback and reinforcement of training, a second cycle was conducted (July–August 2025). Observation time in the stomach was also calculated as the interval between acquisition of the initial gastric image and the final gastric image during endoscopy.Results A total of 156 high-risk patients were evaluated in the first audit cycle, with a combined histologically proven premalignant lesion detection rate of 37.2% (IM 17.3%, AG 12.2%, both 7.7%). In the second audit cycle, 62 high-risk patients were evaluated with an improved combined histologically proven detection rate of 41.9% (IM 28.3%, AG 8.3%, both 6.7%), representing an absolute improvement of 4.7% following intervention. Compliance with SSS protocol was achieved in all procedures across endoscopists throughout both audit cycles. Mean gastric observation time was 10.0 ± 2.4 min in cycle 1 (n = 156) and 10.4 ± 2.3 min in cycle 2 (n = 62).Conclusions Implementation of the SSS protocol demonstrated improvement in detection of gastric premalignant lesions and standardized diagnostic gastroscopy practice in a high-risk population. The protocol is feasible, sustainable, and can be incorporated into routine endoscopy without major workflow disruption which enables early identification of patients requiring surveillance for gastric cancer prevention. The SSS protocol can be considered for adoption in endoscopy units to standardize quality of gastric examination and facilitate early detection of premalignant conditions.",
  "authors": [
    {
      "affiliations": [
        "Aster MIMS Hospital, Kottakkal, India"
      ],
      "name": "Fahad Fahad"
    },
    {
      "affiliations": [
        "Aster MIMS Hospital, Kottakkal, India"
      ],
      "name": "Fathima Shahana Sumi"
    },
    {
      "affiliations": [
        "Aster MIMS Hospital, Kottakkal, India"
      ],
      "name": "Mahesh Menon"
    }
  ],
  "title": "P291 Improving detection of gastric premalignant lesions using systematic screening protocol for the stomach: a two-cycle quality improvement project",
  "uid": "66d3f586-27cf-5a3c-a9a4-c19bcb666605"
}