Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer

Up to 14 % of upper gastrointestinal cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated.

UGIC subjects were identified from a UK primary care database. Post-EGD upper gastrointestinal cancers (PEUGIC) cases were subjects undergoing EGD 12–36 months prior to UGIC diagnosis. Controls had not undergone EGD during the same period. Logistic regression analysis examined associations with PEUGIC.

4249 gastric cancer (GC) subjects (44.8 %) and 5238 esophageal cancer (EC) subjects (55.2 %) were analyzed. There were 633 (6.7 %) PEUGIC subjects [279 EC and 354 GC]. Multivariate analysis revealed that younger age [OR 1.02, (95 % CI 1.01–1.03), p < 0.0001], female gender [1.39 (1.17–1.64), p < 0.0001], increasing comorbidity [1.35 (1.13–1.61), p < 0.0001], and greater deprivation [1.31 (1.09–1.59), p = 0.005] were associated with PEUGIC. Alarm symptoms on presentation [0.32 (0.26–0.40), p < 0.0001] were less likely to be associated with PEUGIC. GC was more likely to be associated with PEUGIC than EC [1.33 (1.13–1.58), p = 0.001]. PEUGIC EGDs reported findings associated with UGIC (stricture or ulceration) in 8.3 % of cases, and only 60.9 % had a follow-up EGD within 90 days. PEUGIC rate declined from 7.9 to 2.7 % for EC and 9.0–6.5 % for GC during the study period.

PEUGIC occurs in 6.7 % of UGIC. PEUGIC was associated with GC, younger age, female gender, increasing comorbidity and deprivation, and a lack of alarm symptoms.