Improving the detection rate of early gastric cancer requires more than open access gastroscopy: a five year study

Abstract

Background/aims: To explore the reasons why patients with gastric cancer continue to present with advanced disease despite open access gastroscopy.

Patients: All patients diagnosed with gastric cancer between 1 August 1989 and 31 July 1994.

Methods: A retrospective study of the presentation of gastric cancer in South Tees; patients were diagnosed at open access gastroscopy or referred through conventional channels. Primary care records of 81 patients dying between 1991 and 1995 were analysed for previous symptoms, investigations, and antisecretory drug therapy. Findings were compared with 200 age and sex matched controls.

Results: The overall incidence of earlier stage gastric cancer remains low at 13%. Diagnostic delay occurs in both primary and secondary care due to a high incidence of previous dyspepsia and investigation. One in six patients had been previously investigated in the three years prior to diagnosis, the majority of whom were on antisecretory drugs.

Conclusions: Early gastric cancer remains rare in South Tees health district. Advantages of open access gastroscopy appear to be compromised by delayed referral to hospital and failure of endoscopists to recognise the early disease; either they are unaware of its appearance or prior treatment with an H2 receptor antagonist masks the disease by allowing mucosal healing.

Figure 1

: An overview of the past medical history of 81 patients dying of gastric cancer in the years 1991-95 (results obtained from primary care records). NAD, no abnormality detected.

Figure 2

: Durtion of symptoms in 59 patients with a previous history of dyspepsia.