The impact of photographic image quantity on early upper gastrointestinal cancer detection during esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) serves as a standard screening modality for upper gastrointestinal (GI) tumors, though standardized quality metrics remain undefined. Crucially, there was little direct evidence previously demonstrating the impact of the number of images taken during EGD on the detection rates of early upper gastrointestinal cancer (UGIC). This multicenter retrospective study aimed to assess the influence of the number of photographic images on early UGIC detection rates and identify associated risk factors. We retrospectively analyzed the data of 245,161 subjects who underwent EGD either as part of a health screening program or as symptomatic patients at Zhejiang Provincial Hospital of Traditional Chinese Medicine and Zhejiang Provincial People's Hospital between May 2018 and October 2024. Cases were stratified by image count: < 20 (low), 20-40 (medium), and > 40 (high). Early UGIC was histologically confirmed. Primary outcomes were the comparison of detection rates across groups; secondary outcomes involved identifying detection-associated factors via logistic regression. Early UGIC detection rates were significantly higher in the high-image group versus the low and medium groups (p < 0.05). Subanalysis revealed optimal detection with > 80 images. Endoscopist-specific detection rates correlated strongly with image count (p < 0.001). Multivariate analysis identified increased image acquisition (OR 1.32, 95% CI 1.18-1.47), advanced age (OR 2.14, 95% CI 1.89-2.42), and male sex (OR 1.48, 95% CI 1.32-1.65) as independent predictors of early UGIC detection. The number of photographic images taken during EGD was significantly correlated with the detection of early UGIC. This parameter can be considered as an effective indicator for assessing the quality of EGD.