Salmon, C.A.; Park, K.G.M.; Rapson, T.; Phull, P.S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA26
Academic Journal
Introduction: BSG suggest that it may be possible to increase the age threshold for endoscopy from 45 to 55 years in patients with uncomplicated dyspepsia. Patients with 'alarm' symptoms would still undergo an urgent endoscopy. However, there is only limited evidence quantifying the risk of missing upper Gl malignancy in the 45-55 year old patients who would no longer warrant an endoscopy. The aim of this study was to assess the numbers of patients under 55 years of age with upper Gl malignancy but without 'alarm' symptoms. Methods: The Scottish Audit of Gastric and Oesophageal Cancer collected data prospectively for all upper Gl malignancies diagnosed in Scotland between July 1997 and July 1999. The presenting symptoms of all the patients under the age of 55 years were analysed. 'Alarm' symptoms were defined as dysphagia, weight loss, Gl bleeding, anaemia, vomiting, history of gastric surgery, and history of peptic ulcer disease. Results: Of the 3293 patients with upper Gl malignancy, 290 patients were under 55 years of age. Seventy-three (25%) patients had gastric cancer, 55 (19%) had OG junction cancer, and 162 (56%) had oesophageal cancer. Twenty-one (7.2%) patients had no alarm symptoms; 5 patients were under 40 years (1.7%), 9 patients were under 45 years (3.1%), and 15 patients were under 50 years (5%). Thirteen of the 73 (17.8%) patients with gastric cancer had no alarm symptoms compared to 4 of 55 (7.2%) patients with OG junction cancer and 4 of the 162 (2.4%) patients with oesophageal cancer. Conclusion: Increasing the age threshold for endoscopy from 45 years to 55 years in Scotland would double the number of patients with missed upper Gl malignancy. This would predominantly affect patients with gastric cancer.


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