About 10% of upper GI cancers (esophageal and gastric) are post-endoscopy upper gastrointestinal cancers (PEUGIC) i.e. they were diagnosed within three years of a “cancer-negative” esophagogastroduodenoscopy. A systematic review and meta-analysis of 25 trials was conducted to define the characteristics of PEUGICs and compare them with detected cancers. Out of a total of 81184 upper gastrointestinal (GI) cancers identified, 7926 were regarded as PEUGIC. The mean time interval between a negative endoscopy and diagnosis of PEUGIC was around 17 months (range: 6-36 months). The prevalence of PEUGIC was higher in women (odds ratio 1.30). Gastroesophageal reflux was a common clinical presentation in patients with PEUGIC (OR 2.64) compared to those with detected cancers. Symptoms of dysphagia (OR 0.37) and weight loss (OR 0.58) occurred less frequently in this group of patients. PEUGICs were smaller and were also unlikely to be diagnosed at an advanced disease stage than detected cancers (OR 2.87 for stage 1 vs. 2-4). 

According to this meta-analysis, acid reflux is common in PEUGIC, which are often diagnosed late because alarm symptoms are less frequent compared to detected cancers. The findings of the meta-analysis can come to the aid of physicians in clinical decision making.

Alexandre L, et al. Gastroenterology. 2021 Dec 24;S0016-5085(21)04166-4.