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

Abstract

Background: Age is an important and objective risk factor for upper gastrointestinal (GI) malignancy. The accuracy of various age limits to detect upper GI malignancy is unclear. Determination of this accuracy may aid in the decision to refer symptomatic patients for upper GI endoscopy. The aim of this analysis was to synthesize data on upper GI malignancy detection rates for various age limits worldwide through meta-analysis. Methods: We searched MEDLINE, EMBASE, and Web of Science in November 2018. Selection criteria included studies addressing malignant findings at upper GI endoscopy in a symptomatic population reporting age at time of diagnosis. Meta-analyses were conducted to derive continent-specific cancer detection rates. Results: A total of 33 studies including 346,641 patients across 21 countries fulfilled the inclusion criteria. To detect >80% of malignant cases all symptomatic patients over 40 years of age should be investigated in Africa, over 50 years of age in South America and Asia, and over 55 years of age in North America and Europe. Conclusion: This systematic review and meta-analysis provides data on intercontinental variation in age at time of upper GI malignancy diagnosis in symptomatic patients referred for upper GI endoscopy. Guideline recommendations for age-based selection should be tailored to local age-related detection rates.

Age Cutoff and Yield of Prompt Esophagogastroduodenoscopy to Detect Malignancy in Vietnamese with Upper Gastrointestinal Symptoms: An Endoscopic Database Review of 472,744 Patients from 2014 to 2019

“…A recent systematic review showed that the YoE values for the detection of gastric and esophageal cancer were reported separately in several original studies [ 9 ]. However, as the overlap of upper gastrointestinal symptoms is very frequent in real-life practice [ 17 ], the YoE for all types of UGIM should be considered together.…”

“…However, as the overlap of upper gastrointestinal symptoms is very frequent in real-life practice [ 17 ], the YoE for all types of UGIM should be considered together. In the abovementioned systematic review, apart from studies in Africa which generally showed that esophageal cancer was the most predominant UGIM and gastric cancer accounted for less than half of all UGIMs, almost all large-scale studies in the West and in Asia consistently showed that gastric cancer accounted for more than two-thirds and up to 80% of all UGIM cases [ 9 ]. Duodenal cancer was very rare and only reported in a few large-scale studies.…”

“…By contrast, patients with UGIM are much younger in Asia. A recent meta-analysis reported that the age cutoff should be 50 years of age in South America and Asia and 55 years of age in North America and Europe to detect at least 80% of UGIM in patients with upper gastrointestinal symptoms [ 9 ]. In another meta-analysis, the frequencies of gastric cancer under the ages of 45 years and 35 years in Asia were 17.8% and 3.0%, respectively [ 8 ].…”

“…The age cutoff for the selection of patients who should undergo EGD, however, varies significantly across the guidelines depending on the prevalence of UGIM in each population. Two meta-analysis studies have shown that the age at onset of UGIM in Asian populations is much lower than that in the West [ 8 , 9 ]. However, the Asian data in these two meta-analyses were mainly based on studies conducted on Chinese populations [ 8 , 9 ].…”

“…Two meta-analysis studies have shown that the age at onset of UGIM in Asian populations is much lower than that in the West [ 8 , 9 ]. However, the Asian data in these two meta-analyses were mainly based on studies conducted on Chinese populations [ 8 , 9 ]. As the risk level of UGIM is significantly different across Asian populations [ 10 , 11 ], further data from other Asian populations are necessary to clarify this issue.…”