Background & aims

Ten percent of patients with an upper gastrointestinal cancer will have received an esophagogastroduodenoscopy (EGD) within 3 years before diagnosis, termed post-endoscopy upper gastrointestinal cancers (PEUGIC). We aimed to determine the characteristics of PEUGIC, and compare these with detected cancers.

Methods

We searched MEDLINE and Embase from inception for studies comparing the characteristics of PEUGIC and detected upper gastrointestinal cancers, and reported findings at the initial “cancer-negative” endoscopy. We synthesized results using random effects meta-analysis. This review is registered on PROSPERO, CRD42019125780.

Results

A total of 2696 citations were screened and 25 studies were included, comprising 81,184 UGI cancers, of which 7926 were considered PEUGIC. For PEUGIC assessed within 6 to 36 months of a “cancer-negative” EGD, the mean interval was approximately 17 months. Patients with PEUGIC were less likely to present with dysphagia (odds ratio [OR] 0.37) and weight loss (OR 0.58) and were more likely to present with gastroesophageal reflux (OR 2.64) than detected cancers. PEUGICs were more common in women in Western populations (OR 1.30). PEUGICs were typically smaller at diagnosis and associated with less advanced disease staging compared with detected cancers (OR 2.87 for stage 1 vs 2–4). Most EGDs (>75%) were abnormal preceding diagnosis of PEUGIC.

Conclusions

There is a substantial delay in the diagnosis of PEUGIC. They are less likely to present with alarm symptoms than detected cancers. PEUGICs are overall less advanced at diagnosis. Most patients with PEUGIC have abnormalities reported at the preceding “cancer-negative” EGD. The epidemiology of PEUGIC may inform preventive strategy.

中文翻译：

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与内镜检查后上消化道癌相关的临床和内窥镜特征：系统评价和荟萃分析

背景与目标

10% 的上消化道癌患者在确诊前 3 年内接受过食管胃十二指肠镜检查 (EGD)，称为内镜检查后上消化道癌 (PEUGIC)。我们旨在确定 PEUGIC 的特征，并将其与检测到的癌症进行比较。

方法

我们从一开始就搜索了 MEDLINE 和 Embase，以寻找比较 PEUGIC 的特征和检测到的上消化道癌症的研究，并报告了最初“癌症阴性”内镜检查的结果。我们使用随机效应荟萃分析综合了结果。该评论已在 PROSPERO 注册，CRD42019125780。

结果

共筛选了 2696 篇引文，纳入了 25 项研究，包括 81,184 篇 UGI 癌症，其中 7926 篇被认为是 PEUGIC。对于在“癌症阴性”EGD 的 6 至 36 个月内评估的 PEUGIC，平均间隔约为 17 个月。PEUGIC 患者出现吞咽困难（优势比 [OR] 0.37）和体重减轻（OR 0.58）的可能性较小，并且与检测到的癌症相比，出现胃食管反流（OR 2.64）的可能性更大。PEUGIC 在西方人群的女性中更为常见（OR 1.30）。与检测到的癌症相比，PEUGIC 在诊断时通常较小，并且与较不先进的疾病分期相关（OR 2.87 对 1 期与 2-4 期）。大多数 EGDs (>75%) 在 PEUGIC 诊断之前是异常的。

结论

PEUGIC的诊断有很大的延迟。与检测到的癌症相比，他们不太可能出现警报症状。PEUGIC 在诊断方面总体上不太先进。大多数 PEUGIC 患者在之前的“癌症阴性”EGD 中报告有异常。PEUGIC 的流行病学可能为预防策略提供信息。