Medical Technology

Common Postendoscopy UpperGI Cancers Diagnostics Often Delay

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 that PEUGIC are more common than other cancers, and delays in diagnosis can be clinically significant, strategies to reduce the incidence of PEUGIC need prioritization and urgently require attention,” writes Dr. Leo Alexandre of University of East Anglia in Norwich, UK and colleagues in Gastroenterology.

They state that it is important to understand the epidemiology of PEUGIC before you can devise strategies to reduce their incidence.

To achieve this, they performed the first “comprehensive and contemporaneous” global assessment of the characteristics of PEUGIC when compared to cancers that have been detected. They reviewed 25 studies and performed an analysis of meta-data. Of the 81,184 upper GI tumors, 7,926 were included in their systematic review.

PEUGIC was common with a pooled prevalence of 10.7% and delays in diagnosis were significant. The median time for PEUGIC was about 17 months for patients who were diagnosed with “cancer-negative” EGDs.

PEUGIC was more common among Westerners (odds ratio 1.30) than in women.

Patients with PEUGIC were less likely to suffer from dysphagia (OR: 0.37) or weight loss (OR: 0.58) and more likely to present gastroesophageal reflux disease (OR. 2.64) than patients with EGD-diagnosed cancers.

Missed upper GI cancers were typically less advanced than cancers that were detected (OR, 2.87 stage 1 vs. Stage 2 to 4). More than three quarters of EGDs were abnormal prior to being diagnosed with PEUGIC.

While PEUGIC can occur at any site in the upper tract however, there is a presence of tumors in the upper esophagus (post-endoscopy esophageal cancer , or PEEC) and gastric body (post-endoscopy gastric cancer, or PEGC) the team discovered.

“PEGC typically occur in the context of intestinal metaplasia and is most often seen in the gastric organ. They recommend that you look at the upper GI tract with care and mucosal visualization. This can help lower the risk of PEUGIC.

The team concludes that evidence-based methods are required to stop PEUGIC and reduce delay in diagnosis with the goal of improving prognosis.

SOURCE: Gastroenterology, online December 24, 2021.

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