Patients with postendoscopy upper gastrointestinal cancers (PEUGIC) are less likely to have classic alarm symptoms than those with initially detected cancers, as well as a substantial delay in diagnosis, according to a study in Gastroenterology.

Researchers conducted a systematic review and meta-analysis to determine the demographic, clinical, endoscopic/procedural, and tumor-related characteristics of PEUGIC and compared them with initially detected cancers.

The study authors searched for relevant published articles and abstracts in MEDLINE and EMBASE from inception through November 22, 2021, with 25 studies ultimately included in the analysis.


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A total of 81,184 upper gastrointestinal (UGI) cancers were reported, 7926 of which were considered PEUGIC (pooled prevalence, 10.7%; 95% CI, 8.0-13.7 overall). Among 3 studies that considered a definition of PEUGIC as 6 to 36 months after a cancer-negative endoscopy, the mean interval until diagnosis was 16.7 (SD, 8.5) and 17.5 (SD, 8.8) months, according to 2 of the studies.

Evidence showed that men may have lower odds of PEUGIC compared with women (odds ratio [OR], 0.87; 95% CI, 0.75-1.01; P =.07) overall. Subgroup analysis confirmed this observation in Western populations (OR, 0.77; 95% CI, 0.75-0.86).

Patients with PEUGIC had lower odds of presenting with alarm symptoms vs those with detected UGI cancers (OR, 0.46; 95% CI, 0.28-0.78), especially for dysphagia and weight loss. PEUGIC were more commonly associated with reflux (OR, 2.64; 95% CI, 2.25-3.10) and proton pump inhibitor use (OR, 4.13; 95% CI, 2.47-6.88), which were observed in postendoscopy esophageal cancer (PEEC) and postendoscopy gastric cancer (PEGC) individually in 2 studies.

Subgroup analysis found significant interactions for alarm symptoms overall, dysphagia, and anemia when stratifying according to tumor site. PEEC and PEGC individually were less frequently associated with any alarm symptoms. The strongest inverse associations were found with esophageal cancers (OR, 0.25; 95% CI, 0.19-0.33 vs OR, 0.42; 95% CI, 0.32-0.54 with gastric cancers; Pinteraction =.009).

Patients with PEUGIC were more likely to present with stage 1 disease compared with stages 2 to 4 (OR, 2.87; 95% CI, 1.64-5.03).

For PEGC, normal appearances during esophagogastroduodenoscopy (EGD) were reported in 24.9% of the preceding “cancer-negative” procedures. Intestinal metaplasia, gastritis, erosions, gastric ulcer, and “suspicious gastric lesions” were the most commonly reported abnormalities (22% to 32%) 6 to 36 months before diagnosis. Regarding PEEC, normal appearances during EGD were reported in 17% of the preceding “cancer-negative” procedures, and esophagitis (26.4%) was the most common abnormality.

The researchers noted that substantial heterogeneity occurred among the estimates from the included studies. Additionally, the observed associations were based on few studies with relatively small numbers of PEUGIC and are unadjusted, which may potentially preclude causal interpretation.

“Evidence-based strategies are required to target the prevention of PEUGIC and reduce delays in diagnosis, with the aim of ultimately improving prognosis,” the study authors commented.

Reference

Alexandre L, Tsilegeridis-Legeris T, Lam S. Clinical and endoscopic characteristics associated with post-endoscopy upper gastrointestinal cancers: a systematic review and meta-analysis. Gastroenterol. Published online December 24, 2021. doi: 10.1053/j.gastro.2021.12.270