Clinical and endoscopic characteristics associated with post-endoscopy upper gastrointestinal cancers: A systematic review and meta-analysis

Leo Alexandre, Theo Tsilegeridis-Legeris, Stephen Lam

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Background and aims: Ten percent of patients with an upper gastrointestinal cancer will have received an esophagogastroduodenoscopy (EGD) within three years prior to 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 UGI cancers, and reported findings at the initial “cancer-negative” endoscopy. We synthesised 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 81184 UGI cancers, of which 7926 were considered PEUGIC. For PEUGIC assessed within 6-36 months of a “cancer-negative” EGD the mean interval was approximately 17 months. Patients with PEUGIC were less likely to present with dysphagia (OR 0.37) and weight loss (OR 0.58) and were more likely to present with gastro-esophageal reflux (OR 2.64) than detected cancers. PEUGIC were more common in women in Western populations (OR 1.30). PEUGIC 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. PEUGIC are overall less advanced at diagnosis. The majority with PEUGIC have abnormalities reported at the preceding “cancer negative” EGD. The epidemiology of PEUGIC may inform preventive strategy.
Original languageEnglish
Early online date25 Dec 2021
Publication statusE-pub ahead of print - 25 Dec 2021

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