Introduction Despite open-access endoscopy, previous series have suggested that between 8–20% of early gastric cancers (GC) are potentially missed at prior endoscopy.^1,2 Although upper gastrointestinal alarm symptoms are more frequently associated with malignancy, this may represent advanced cancer with poorer survival rates, as patients with early GCs may be asymptomatic. The false-negative rate for the diagnosis of GC may also be a measure of quality for endoscopy services. This is based on a reported median duration of 37 months between endoscopic diagnosis of early GC and progression to advanced GC,^2,3 so we assessed all oesophagogastroduodenoscopy (OGD) findings to assess detection of GC in a large tertiary hospital in the West Midlands.

Methods Patients with histologically confirmed GC were identified from histopathology and endoscopy records. Patients who had undergone at least one OGD before the diagnosis were studied. Detection of GC within 3 years of a negative OGD was interpreted as a false negative.

Results Between September 2009 and September 2013, 16823 OGDs were performed. GC was diagnosed in 75 (0.45%) patients (male/female ratio 1.78; median age 74; 85% Caucasian). Sixty-seven (89%) of the 75 patients with GC presented with alarm symptoms. 33% (25) were done as inpatients, with 43% (at least 32 of 50 outpatients) being referred as urgent outpatients. Five of the 75 (7%) patients had previous OGDs within three years preceding diagnosis. Only one of these was planned because of a suspicious gastric ulcerative lesion at the same site, with other causes being gastric polyps (2); normal (1) and gastritis (1). There were 53 (71%) deaths in total, 47 (89%) of these patients had alarm symptoms at diagnosis of GC.

Conclusion The absolute rates of GC are low (0.1%/OGD/year) and false-negative rates of 5% (within 3 years) for diagnosis of GC are reassuring with only a minority of preceding OGDs in this series demonstrating suspicious lesions. Whilst GC presents with alarm symptoms in the vast majority, the prognosis remains very poor, so continued quality measures in endoscopy will be required to ensure that early gastric cancers are not missed.

References

1. Vradelis S, Maynard N, Warren BF et al. Quality control in upper gastrointestinal endoscopy: detection rates of gastric cancer in Oxford 2005–2008. Postgrad Med J. 2011 May;87(1027):335–9

2. Hosokawa O, Tsuda S, Kidani E, et al. Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy. Endoscopy 1998:30:669–74

3. Tsukuma H, Mishima T, Oshima A. Prospective study of “early” gastric cancer. Int J Cancer 1983:31:421–6

Disclosure of Interest None Declared.