Esophagus to Small Intestine

Gastroenterology. 2022;162(4):1123–35

Alexandre L, Tsilegeridis-Legeris T, Lam S

Clinical and endoscopic characteristics associated with post-endoscopy upper gastrointestinal cancers: A systematic review and meta-analysis


Background and aims: Ten percent of patients with an upper gastrointestinal cancer (UGIC) will have received an esophagogastroduodenoscopy (EGD) within 3 years before diagnosis, termed post-endoscopy UGIC (PEUGIC). The authors aimed to determine the characteristics of PEUGIC, and compare these with detected cancers.
Methods: They searched Medline and Embase from inception for studies comparing the characteristics of PEUGIC and detected UGIC, and reported findings at the initial “cancer-negative” endoscopy. Results were synthesized using random effects Conclusions: There is a substantial delay in the diagnosis of post-endoscopy upper gastrointestinal cancers (PEUGICs). They are less likely to present with alarm symptoms than detected cancers. PEUGICs are overall less advanced at diagnosis. Most patients with PEUGIC have abnormalities reported at the preceding “cancer-negative” esophagogastroduodenoscopy. The epidemiology of PEUGIC may inform preventive strategy. meta-analysis.
Results: A total of 2696 citations were screened and 25 studies were included, comprising 81,184 UGIC, of which 7926 were considered PEUGIC. For PEUGIC assessed within 6–36 months of a “cancer-negative” EGD, the mean interval was approximately 17 months. Patients with PEUGIC were less likely to present with dysphagia (odds ratio [OR] = 0.37) and weight loss (OR = 0.58) and were more likely to present with gastroesophageal reflux (OR = 2.64) than detected cancers. PEUGICs were more common in women in Western populations (OR = 1.30). PEUGICs were typically smaller at diagnosis and associated with less advanced disease staging compared with detected cancers (OR = 2.87 for stage 1 vs. 2–4). Most EGDs (> 75%) were abnormal preceding diagnosis of PEUGIC.

Conclusions: There is a substantial delay in the diagnosis of post-endoscopy upper gastrointestinal cancers (PEUGICs). They are less likely to present with alarm symptoms than detected cancers. PEUGICs are overall less advanced at diagnosis. Most patients with PEUGIC have abnormalities reported at the preceding “cancer-negative” esophagogastroduodenoscopy. The epidemiology of PEUGIC may inform preventive strategy.

Dr. L. Alexandre, Norwich Medical School, University of East Anglia, Norwich, UK,
E-Mail: leo.alexandre@uea.ac.uk

DOI: DOI: 10.1053/j.gastro.2021.12.270

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