title: Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer.
abstract: Up to 14 % of upper gastrointestinal cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated.
  
  
  
  UGIC subjects were identified from a UK primary care database. Post-EGD upper gastrointestinal cancers (PEUGIC) cases were subjects undergoing EGD 12-36 months prior to UGIC diagnosis. Controls had not undergone EGD during the same period. Logistic regression analysis examined associations with PEUGIC.
  
  
  
  4249 gastric cancer (GC) subjects (44.8 %) and 5238 esophageal cancer (EC) subjects (55.2 %) were analyzed. There were 633 (6.7 %) PEUGIC subjects [279 EC and 354 GC]. Multivariate analysis revealed that younger age [OR 1.02, (95 % CI 1.01-1.03), p < 0.0001], female gender [1.39 (1.17-1.64), p < 0.0001], increasing comorbidity [1.35 (1.13-1.61), p < 0.0001], and greater deprivation [1.31 (1.09-1.59), p = 0.005] were associated with PEUGIC. Alarm symptoms on presentation [0.32 (0.26-0.40), p < 0.0001] were less likely to be associated with PEUGIC. GC was more likely to be associated with PEUGIC than EC [1.33 (1.13-1.58), p = 0.001]. PEUGIC EGDs reported findings associated with UGIC (stricture or ulceration) in 8.3 % of cases, and only 60.9 % had a follow-up EGD within 90 days. PEUGIC rate declined from 7.9 to 2.7 % for EC and 9.0-6.5 % for GC during the study period.
  
  
  
  PEUGIC occurs in 6.7 % of UGIC. PEUGIC was associated with GC, younger age, female gender, increasing comorbidity and deprivation, and a lack of alarm symptoms.
authors.affiliation: Sandwell General Hospital, Lyndon, West Bromwich, UK.
authors.forename: Danny
authors.initials: D
authors.lastname: Cheung
authors.affiliation: New Cross Hospital, Wolverhampton Road, Wolverhampton, UK.
authors.forename: Shyam
authors.initials: S
authors.lastname: Menon
authors.affiliation: St Mary's Hospital, Praed Street, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hoare
authors.affiliation: Darlington Memorial Hospital, Hollyhurst Road, Darlington, UK.
authors.forename: Anjan
authors.initials: A
authors.lastname: Dhar
authors.affiliation: Sandwell General Hospital, Lyndon, West Bromwich, UK. nigel.trudgill@nhs.net.
authors.forename: Nigel
authors.initials: N
authors.lastname: Trudgill
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004381:Duodenal Ulcer / Q000453:epidemiology; D004382:Duodenitis / Q000453:epidemiology; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D004940:Esophageal Stenosis / Q000453:epidemiology; D004941:Esophagitis / Q000453:epidemiology; D005260:Female; D005756:Gastritis / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D013276:Stomach Ulcer / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Early detection of cancer; Endoscopy; Esophageal cancer; Gastric cancer