Intravenous sedation during esophagogastroduodenoscopy is associated with a reduced risk of missed gastric cancer

Abstract

Purpose

Esophagogastroduodenoscopy (EGD) is an effective technique for diagnosing gastric cancer (GC). However, it is estimated that 10% of GCs are unnoticed, constituting missed gastric cancer (MGC). To analyse the incidence of MGC in our area, the characteristics of GC and factors related to MGC were evaluated.

Materials and methods

This was a retrospective study of patients diagnosed with GC at a single centre between October 2003 and December 2018. MGC was defined as GC undetected in a EGD performed 3 to 36 months before diagnosis.

Results

A total of 333 patients with GC were identified, 6% of whom had MGC. MGC was more frequently located at anastomotic site of a previous surgery (p = 0.001), and fewer patients with MGC experienced alarm symptoms (p = 0.001). Using fewer biopsies (p = 0.001) and performing the procedure without sedation were associated to MGC. According to multivariate analysis, the factors associated with MGC were the absence of sedation [OR 3.2 (95% CI 1-10.4)] and localization in the anastomosis of previous surgery [OR 11.5 (95% CI 1.8–72.8)]. Moreover, there were no differences in 5-year survival between patients with MGC and patients without MGC.

Conclusions

The MGC percentage was 6%. When an EGD is indicated, regardless of the symptoms, IV sedation is recommended to reduce the risk of MGC. In addition, biopsies of the anastomosis from previous surgery should be considered even in the absence of clear suspicious lesions.