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. 2025 May 15;25(1):377.
doi: 10.1186/s12876-025-03936-6.

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

Isabel Salvador  1   2 , Beatriz Arau  1   3 , Xavier Andújar  1   3   2 , Carme Ferrer  4 , Yamile Zabana  1   3 , Laura Ruiz  1   3 , Montserrat Aceituno  1   3 , Fernando Fernández-Bañares  1   3 , Maria Esteve  1   3   2 , Carme Loras  5   6   7   8
Affiliations

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

Isabel Salvador et al. BMC Gastroenterol. .

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.

Keywords: Anastomosis; Esophagogastroduodenoscopy; Missed gastric cancer; Sedation.

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Conflict of interest statement

Declarations. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee Hospital Universitari Mútua Terrassa (P/22–074) on September 22nd, 2022, with the need for written informed consent waived. Consent to participate: Informed consent for information published in this article was not obtained due to the impossibility of obtaining consent from the subjects without disproportionate effort and the use of data in terms that do not allow the direct or indirect identification of participants. The waiver of informed consent was granted in accordance with Article 58 of the Biomedical Research Law 14/2007, and was evaluated and favorably approved by the relevant ethics committee. Consent for publication: Not applicable. Competing interests: C.L. has served as a speaker for Boston Scientific and consulting fees from Fujifilm. M.E. reports grants and personal fees from AbbVie and Jansen as well as travel grants for educational and scientific meetings from AbbVie, Takeda and Ferring, outside the submitted work. Y.Z. has received support for conference attendance, speaker fees, research support and consulting fees from AbbVie, Adacyte, Dr Falk Pharma, FAES Pharma, Ferring, Janssen, Pfizer, Takeda, Galapagos, Boehringer Ingelheim and Tillots.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Tumour location in the two groups (non-MGC and MGC) (p < 0.001)
Fig. 3
Fig. 3
Survival analysis of patients with adenocarcinoma: comparison between non-MGC and MGC patients (n = 216*)
See this image and copyright information in PMC

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