Postendoscopy Upper GI Cancers Common, Diagnosis Often Delayed
NEW YORK (Reuters Health) – Patients who develop upper gastrointestinal cancers within three years of esophagogastroduodenoscopy (EGD) are less likely to present with “alarm” symptoms than patients whose upper GI cancers are detected at endoscopy, according to new research that sheds light on the epidemiology of post-endoscopy upper gastrointestinal cancers (PEUGIC).
“Given PEUGIC are common (relative to detected cancers) and that delays in diagnosis are very likely clinically significant, strategies aimed at reducing the rate of PEUGIC and minimizing delays in diagnosis need prioritization and are urgently required,” write Dr. Leo Alexandre of the University of East Anglia, in Norwich, UK, and colleagues in Gastroenterology.
Knowledge of the epidemiology of PEUGIC is an important prerequisite for devising a strategy to reduce their incidence, they say.
To that end, they performed the first “comprehensive and contemporaneous” global assessment of the characteristics of PEUGIC compared with detected cancers. Their systematic review and meta-analysis included 25 studies, with 81,184 upper GI cancers, of which 7,926 were considered PEUGIC.
PEUGIC was common, with a pooled prevalence of 10.7% and delays in diagnosis were substantial. For PEUGIC assessed within six to 36 months of a “cancer-negative” EGD, the mean interval was roughly 17 months, the researchers report.
PEUGIC was more common in the Western world (odds ratio, 1.30) and in women.
Patients with PEUGIC were less apt to present with dysphagia (OR, 0.37) and weight loss (OR, 0.58) and were more likely to present with gastroesophageal reflux (OR, 2.64) than patients with detected cancers at EGD.
Missed upper GI cancers were typically smaller at diagnosis and less advanced compared with detected cancers (OR, 2.87 for stage 1 vs. 2 to 4). More than three-quarters of EGDs were abnormal preceding diagnosis of PEUGIC.
While PEUGIC can occur at any site in the upper tract, there is a slight preponderance of tumors in the upper esophagus (post-endoscopy esophageal cancer or PEEC) and gastric body (post-endoscopy gastric cancer or PEGC), the team found.
“PEGC commonly occur in the context of intestinal metaplasia and most commonly arises in the gastric body. Meticulous inspection of the upper GI tract with detailed mucosal visualization and recognition of subtle malignant abnormalities will likely minimize PEUGIC rates,” they say.
“Evidence-based strategies are required to target the prevention of PEUGIC and reduce delays in diagnosis, with the aim of ultimately improving prognosis,” the team concludes.
SOURCE: https://bit.ly/31AmgKO Gastroenterology, online December 24, 2021.
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