Rate and Predictors of Interval Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in the United States

Abstract

Background and Aims: In the United States, little is known about the rates of interval upper gastrointestinal (GI) cancer (possibly missed out) after an esophagogastroduodenoscopy (EGD) is performed. Data from non-US studies reported interval cancer rates of 7-26%. We aimed to study the rate and predictors of interval upper GI cancers in the United States. Methods: Using the random 5% sample of Medicare beneficiaries in the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified patients diagnosed with esophageal or gastric cancer during 2000-2007. EGD performed within 36 months prior to cancer diagnosis was identified using CPT codes. Cancers diagnosed 6-36 months after EGD were defined as interval (vs. detected) cancers. The chi-square test and the multivariate logistic model were used in statistical analysis. Results: Of 751 patients diagnosed with upper GI cancer, 52 patients (6.9%) were diagnosed with interval cancers 6-36 months after EGD. The rate of interval cancers was 5.5% (31/568) for gastroenterologists and 11.5% (21/183) for non-gastroenterologists (p < 0.01). In multivariate logistic regression, EGDs performed by gastroenterologists (vs. non-gastroenterologists: OR 0.46, 95% CI 0.25-0.83) and those in inpatient setting (vs. outpatient: OR 0.53, 95% CI 0.28-0.997) were associated with a lower likelihood of interval cancers. Sensitivity analyses limited to outpatient EGDs or interval cancers 6-30 months after EGDs led to similar results. Conclusions: The rate of interval cancers after EGD is the same as the rate of colonoscopy among Medicare patients in the United States. EGDs performed by gastroenterologists and in in-patient settings were associated with a lesser likelihood of interval cancers.

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

“…Our data failed to demonstrate any association between professional background, training grade and volume of gastroscopies performed with missed cancer occurrences. Previous studies comparing gastroenterologists and non-gastroenterologists are inconclusive and endoscopist experience, when measured by number of years’ experience, did not affect sensitivity of gastroscopy to detect early gastric cancer 29 30. It seems more likely that expertise, based on continuing training and experience, is the main determinant of high quality gastroscopies, rather than professional background or procedural volume per se.…”

“…Much of the literature on missed cancer in gastroscopy are cohort studies devoted to establishing incidence of missed cancer and patient factors associated with missed OG cancer occurrences 4 5 10 12. Despite up to 70% reporting visible lesion at gastroscopies that miss cancer, only few studies examine the effect of the endoscopist29 30 and no studies examine the effect of service provision pressures, or use of sedation on missed cancer procedures. Time spent on examination increases the sensitivity of gastroscopy,31 and we hypothesised therefore that service provision pressures may also have an impact on sensitivity.…”

Rate of missed oesophageal cancer at routine endoscopy and survival outcomes: A multicentric cohort study

“…Besides, MECs were more often encountered as flat or depressed (which could have contributed to missing a lesion), follow-up or biopsy policy were often inappropriate and no differences were found in grade of differentiation. [9][10][11][12][13] Altogether leads us to hypothesize that most MECs were actually 'true MECs' secondary to an unrecognized lesion rather than new fast-growing ECs.…”

“…Studies addressing missed upper gastrointestinal tumours have also found that 4.6% to 25.8% of patients had a negative endoscopy within 3 years before diagnosis 7 . Nevertheless, the number of studies is limited, and most of them have focused on gastric cancer or adenocarcinoma arising from previously diagnosed Barrett's oesophagus (BE) 7–12 . Missed oesophageal cancer (MEC) is a poorly characterized entity in the non‐BE population with only a few retrospective studies in this area, mainly from the UK and with data coming from administrative databases 11 , 13 .…”

Using artificial intelligence to improve adequacy of inspection in gastrointestinal endoscopy

“…Recently a first attempt to use AI as method to measure and stimulate endoscopists to perform inspection of the entire stomach was published. We know from numerous studies that just as in the colon, lesions are being missed in the stomach [11,47,48]. In Asia gastric cancer remains a major cause of death, and screening programs to find gastric cancer early are common [49].…”