Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: a nationwide registry-based study.

Abstract

Background and aims A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. Methods In this nationwide registry-based study, we analyzed two large Polish datasets: the National Health Fund and the National Cancer Registry, to identify individuals who underwent EGD and were subsequently diagnosed with UGICs. Cancers diagnosed <6 months after EGD were defined as prevalent and those within ≥6 and <36 months as missed. We compared the characteristics of missed and prevalent cancers and analyzed the risk factors for missed UGICs in a multivariable regression model. Results We included 4,105,399 patients (mean age 56.0 [±17.4] years; 57.5% female) who underwent 5,877,674 EGDs between 2012-2018. Within this cohort, 33,241 UGICs were diagnosed, of which 1,993 (6.0%) were missed. Within esophageal neoplasms, adenocarcinomas were more commonly missed than squamous-cell cancers (6.1% vs. 4.2%) with a relative risk of 1.4 (95% confidence interval [CI]:1.2-1.5, P=0.011). In the stomach, missed adenocarcinomas constituted 5.7%. Overall, missed UGICs presented more often at an advanced stage than prevalent cancers (42.2% vs. 36.2%, P<.001). Risk factors for missed UGICs included: initial EGD performed within primary (vs. secondary) care (odds ratio[OR] 1.3, 95%CI:1.2-1.5), female gender (OR 1.3; 95%CI:1.2-1.4), and higher comorbidity (Charlson comorbidity index ≥5 vs. 0; OR 6.0; 95%CI:4.7-7.5). Conclusions Esophageal adenocarcinomas are most commonly missed among UGICs. Overlooked cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.