RESUMO
BACKGROUND: A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. METHODS: In this nationwide registry-based study, we analyzed two large Polish datasets (National Health Fund and National Cancer Registry) to identify individuals who underwent EGD and were subsequently diagnosed with UGIC. Cancers diagnosedâ<â6 months after EGD were defined as "prevalent" and those within ≥â6-â<â36 months as "missed." We compared the characteristics of missed and prevalent cancers, and analyzed the risk factors for missed UGICs in a multivariable regression model. RESULTS: We included 4â105â399 patients (mean age 56.0 years [SD 17.4]; 57.5â% female) who underwent 5â877â674 EGDs in 2012-2018. Within this cohort, 33â241 UGICs were diagnosed, of which 1993 (6.0â%) were missed. Within esophageal neoplasms, adenocarcinomas were more frequently missed than squamous cell cancers (6.1â% vs. 4.2â%), with a relative risk of 1.4 (95â% confidence interval [CI] 1.1-1.8, Pâ=â0.01). Most gastric cancers were adenocarcinomas, of which 5.7â% were classified as missed. Overall, a higher proportion of missed UGICs than prevalent cancers presented at an advanced stage (42.2â% vs. 36.2â%, Pâ<â0.001). Risk factors for missed UGICs included initial EGD performed within primary (vs. secondary) care (odds ratio [OR] 1.3, 95â%CI 1.2-1.5), female sex (OR 1.3, 95â%CI 1.2-1.4), and higher comorbidity (Charlson comorbidity index ≥â5 vs. 0; OR 6.0, 95â%CI 4.7-7.5). CONCLUSIONS: Among UGICs, esophageal adenocarcinomas were missed most frequently. Missed cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.