Wang Yize R, Loftus Edward V, Judge Thomas A, Peikin Steven R
Division of Gastroenterology and Liver Diseases, Cooper Medical School of Rowan University, Camden, N.J., USA.
Digestion. 2016;94(3):176-180. doi: 10.1159/000452794. Epub 2016 Nov 22.
In the United States, little is known about the rates of interval upper gastrointestinal (GI) cancer (possibly missed out) after an esophagogastroduodenoscopy (EGD) is performed. Data from non-US studies reported interval cancer rates of 7-26%. We aimed to study the rate and predictors of interval upper GI cancers in the United States.
Using the random 5% sample of Medicare beneficiaries in the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified patients diagnosed with esophageal or gastric cancer during 2000-2007. EGD performed within 36 months prior to cancer diagnosis was identified using CPT codes. Cancers diagnosed 6-36 months after EGD were defined as interval (vs. detected) cancers. The chi-square test and the multivariate logistic model were used in statistical analysis.
Of 751 patients diagnosed with upper GI cancer, 52 patients (6.9%) were diagnosed with interval cancers 6-36 months after EGD. The rate of interval cancers was 5.5% (31/568) for gastroenterologists and 11.5% (21/183) for non-gastroenterologists (p < 0.01). In multivariate logistic regression, EGDs performed by gastroenterologists (vs. non-gastroenterologists: OR 0.46, 95% CI 0.25-0.83) and those in inpatient setting (vs. outpatient: OR 0.53, 95% CI 0.28-0.997) were associated with a lower likelihood of interval cancers. Sensitivity analyses limited to outpatient EGDs or interval cancers 6-30 months after EGDs led to similar results.
The rate of interval cancers after EGD is the same as the rate of colonoscopy among Medicare patients in the United States. EGDs performed by gastroenterologists and in in-patient settings were associated with a lesser likelihood of interval cancers.
在美国，关于进行食管胃十二指肠镜检查（EGD）后上消化道（GI）间期癌（可能漏诊）的发生率知之甚少。非美国研究的数据报告间期癌发生率为7% - 26%。我们旨在研究美国上消化道间期癌的发生率及预测因素。
利用监测、流行病学和最终结果 - 医疗保险链接数据库中5%的医疗保险受益人的随机样本，我们确定了2000 - 2007年期间被诊断为食管癌或胃癌的患者。使用CPT编码确定在癌症诊断前36个月内进行的EGD。在EGD后6 - 36个月诊断出的癌症被定义为间期（相对于检测到的）癌症。采用卡方检验和多因素逻辑模型进行统计分析。
在751例被诊断为上消化道癌症的患者中，52例（6.9%）在EGD后6 - 36个月被诊断为间期癌。胃肠病学家诊断的间期癌发生率为5.5%（31/568），非胃肠病学家诊断的为11.5%（21/183）（p < 0.01）。在多因素逻辑回归中，由胃肠病学家进行的EGD（相对于非胃肠病学家：比值比0.46，95%可信区间0.25 - 0.83）以及在住院环境中进行的EGD（相对于门诊：比值比0.53，95%可信区间0.28 - 0.997）与间期癌的可能性较低相关。限于门诊EGD或EGD后6 - 30个月的间期癌的敏感性分析得出了类似结果。
在美国医疗保险患者中，EGD后的间期癌发生率与结肠镜检查的发生率相同。由胃肠病学家在住院环境中进行的EGD与间期癌的可能性较小相关。
