How commonly is upper gastrointestinal cancer missed at endoscopy? A meta-analysis

Abstract

Background and study aims: Upper gastrointestinal (UGI) cancer in the Western world usually presents at an advanced stage, when opportunities for curative therapy are limited. The failure to detect subtle, early-stage UGI cancer at endoscopy may contribute to a poor prognosis. We undertook a meta-analysis of studies of endoscopic miss rates for UGI cancer to quantify how often opportunities to diagnose cancer at an earlier stage are missed. Patients and methods: A MEDLINE search was conducted to identify relevant studies, and a meta-analysis was conducted. “Missed” UGI cancer was defined as cancer that had not been diagnosed by UGI endoscopy performed within 3 years before the diagnosis. Random effects meta-analysis was used to determine the event rate of missed UGI cancer. Results: Ten studies were identified that included 3,787 patients with UGI cancer. Four hundred eighty-seven UGI cancers were missed at endoscopy within 3 years before diagnosis. Marked heterogeneity was observed between studies (I 2, 94.4 %; P < 0.001). On random effects meta-analysis, the pooled miss rates were 6.4 % (95 % confidence interval [CI], 4.3 % – 9.5 %) within 1 year and 11.3 % (95 % CI, 7.5 % – 16.6 %) within 3 years before diagnosis. There appeared to be no difference between the miss rates of oesophageal (44 %) and gastric (51 %) cancer (P = 0.42). Conclusion It appears that 11.3 % of UGI cancers are missed at endoscopy up to 3 years before diagnosis. To ameliorate the poor prognosis of patients with UGI cancer in the Western world, efforts should be made to improve the quality of UGI endoscopy and create opportunities for earlier diagnosis.

Optimizing early upper gastrointestinal cancer detection at endoscopy

“…[3][4][5][6][7][8][9][10] A meta-analysis from 2014 confirms these findings. 11 This result is comparable to post-colonoscopy colorectal cancer rates of 2.5-7.7% in Western populations. 12 Notably, upper gastrointestinal cancer miss rates in some studies from the Far East are higher than those reported for the West, [13][14][15][16] but these series include early gastric neoplasia, whereas the Western publications report predominantly advanced cancers (Table 1).…”

Reassessing the value of gastroscopy for the investigation of dyspepsia

“…Although similar studies are yet to be conducted, it seems likely that the same will apply to OGD 23–26. Poor tolerance of OGD may be associated with a reduced lesion detection rate,27 and some studies suggest that sedation, particularly for anxious patients, may improve tolerance 28 29. Patients should have had their H. pylori status checked prior to referral5 and appropriate notification on the referral form should render rapid urease testing unnecessary for most.…”

Characteristics of gastric cancer detected within 1 year after successful eradication of <i>Helicobacter pylori</i>

“…(23) Most gastric cancers found within 1 year after eradication may have been missed on previous endoscopic screenings. (24) It is well known that H. pylori infection causes endoscopic gastritis, which presents as erythema, erosion, hemorrhage, and large gastric folds. (16) H. pylori eradication improves gastritis as determined endoscopically and histologically.…”