Intensive Systematic "Train-the-Trainer" Course as an Effective Strategy to Improve Detection of Early Gastric Cancer: A Multicenter Retrospective Study

Background: To improve the diagnosis of early gastric cancer (EGC), a train-the-trainer (TTT) course was developed. This trial aimed to investigate whether TTT courses from trained trainers could improve trainees' EGC detection.

Methods: In this multi-center, retrospective study, the training was carried out 8 times in one year. Clinical records one year before ("2016"), during ("2017"), and after ("2018") the course were collected. The primary endpoint was the improvement of EGC detection rate after TTT courses.

Results: Twenty-four trainees from 17 hospitals were included in this study. A total of 123,416 esophagogastroduodenoscopy and 65,570 colonoscopy procedures were analyzed. The early gastric cancer detection rate (EDR) was 0.101% in 2016, which significantly increased to 0.338% in 2018 (p = 0.015). The early gastric cancer ratio (ECR, ratio of newly detected EGCs to all newly detected gastric cancers) in 2016 was 8.440%, which consistently increased to 11.853% and 19.778% in 2017 and 2018 (p = 0.006), respectively. In contrast, the advanced gastric cancer detection rate (ADR) was similar before, during, or after the course (p = 0.987). The 3-year EDR, ECR, and ADR in esophageal and colorectal cancer were not significantly different.

Conclusions: The systematic training course can improve EGC detection rate and may be an effective educational strategy to reduce gastrointestinal cancers mortality.