Risk of Upper Gastrointestinal Cancers in Patients With Gastroesophageal Reflux Disease After a Negative Screening Endoscopy

Abstract

Background & Aims Practice guidelines recommend a 1-time screening endoscopy for patients with gastroesophageal reflux disease (GERD) who are at high risk for Barrett’s esophagus or malignancy. However, little is known about the risk of cancer in patients with negative findings from screening endoscopies. Methods We conducted a retrospective cohort study using data from 121 Veterans Health Administration facilities nationwide to determine the incidence rate of esophageal adenocarcinoma (EA) separately, as well as any upper gastrointestinal cancers, in patients with an initial negative screening endoscopy (EGD). We included veteran patients with GERD diagnosed between 2004 and 2009 who had a negative screening EGD within 1 year of diagnosis. We estimated the incidence rate of EA, and any upper gastrointestinal cancer, in patients with GERD who had a negative screening EGD. We examined differences in demographic, clinical, and facility factors among patients with and without cancer. Results We identified 68,610 patients with GERD and a negative screening EGD (mean age, 55.5 years; 90% men; 67.5% white). During a mean follow up of 3.2 years, 10 patients developed EA and 29 developed any upper gastrointestinal malignancies, including EA. The incidence of subsequent EA in this group was 4.6/100,000 patient-years of follow up, whereas the incidence of any upper gastrointestinal cancers was 13.2/100,000 patient-years of follow up. Patients with a subsequent cancer were significantly older and had higher comorbidity scores than patients without cancer. Other clinical and facility factors did not differ significantly between these 2 groups. Conclusion The risk of cancer is low, over a mean 3-year period, for patients with GERD who had a negative screening endoscopy. These findings justify recommendations for a 1-time screening endoscopy for patients with GERD.

Systematic review with meta-analysis: age-related malignancy detection rates at upper gastrointestinal endoscopy

“…Prevalence per country is presented in Figure 3 . Within individual continents, there was moderate heterogeneity between studies (I 2 <65%), which was significant ( p = 0.04) in Asian studies at age limits of 45 years and 50 years, and in Europe at a 60-year age limit ( Supplemental Figure 1 ). Univariate meta-regression analysis using covariates ‘presence of alarm symptoms’, ‘malignancy location’, and ‘sample size n ⩾ 1000’ did not reveal a potential source for heterogeneity (not significant) ( Supplemental Table 3 ).…”

“…Confidence intervals (CIs) were calculated according to the Wilson score method. Heterogeneity was quantified using the I 2 measure if more than three studies were included. In cases where heterogeneity was encountered, univariate meta-regression analysis was used to explore the influence of alarm symptoms, location of malignancy, and sample size as a source for heterogeneity.…”

“…Upper GI endoscopy is the universal gold standard for detecting upper GI malignancy. 2 , 3 However, the lack of malignancy-specific symptoms results in diagnostic overuse as more than 100 procedures are needed to detect a single patient with a GI tumor. 4 On the other hand, malignancies may be missed at upper GI endoscopy.…”

Incidence and Mortality in Upper Gastrointestinal Cancer After Negative Endoscopy for Gastroesophageal Reflux Disease

“…21 Reviews of patients diagnosed with upper gastrointestinal cancer a short time after a negative upper endoscopy found that the index upper endoscopy in most of these patients demonstrated suspicious or unclear findings that were neglected by the endoscopist or the reviewing pathologist. 22,23 Approximately 30% of esophageal adenocarcinomas arising from Barrett's esophagus are now considered to be post-endoscopy tumors. 24 Regarding colonoscopy, several quality indicators have been developed and implemented after the introduction of general colorectal cancer screening programs, such as adenoma detection rate of the performing endoscopist.…”

Esophageal cancer: Recent advances in screening, targeted therapy, and management

“…[ 5 6 ] Additionally, recent studies have demonstrated that while screening endoscopy can be performed on patients with GERD, the risk of developing adenocarcinoma in a patient with negative screening endoscopy is very low, such that routine follow up endoscopies is not necessary. [ 7 8 ] Nonetheless, there is a reported 7.8% inaccuracy rate of endoscopy missing esophageal cancer during endoscopy. [ 9 ] Thus, no routine endoscopic surveillance strategy has been established for esophageal cancer.…”