TITLE

WOULD INCREASING THE AGE FOR OPEN ACCESS GASTROSCOPY FROM 45 TO 55 MISS EARLY UPPER GI CANCER?

AUTHOR(S)
Muraleedharan, V.; Bygrave, C.; Crimmins, R.; Green, J.T.; Swift, G.L.S.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA111
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objectives: To determine the impact of increasing the age cut off for endoscopy in uncomplicated dyspepsia from 45 to 55 years of age; would we miss early upper Gl cancer in younger patients? Background: BSG guidelines (1996) suggest open access endoscopy for all patients with uncomplicated dyspepsia above the age of 45 and for younger patients with alarm symptoms. The incidence of upper Gl cancer increases dramatically with age-information from the Welsh Cancer Intelligence Surveillance Unit for the year 2000 shows 51 out of 453 oesophageal cancers were under 55 (11%), for gastric cancer the figure is just 5% (31 of 610). To try and reduce the pressure on the open access service, it has recently been suggested that we can safely increase the age to 55 (BSG web site April 2002). Methods: All patients who received a gastroscopy and had a diagnosis of upper Gl cancer were identified from the endoscopy and pathology records of Llandough hospital, over five years (April 1997 to April 2002); presenting symptom and outcome were determined. Results: 11 145 gastroscopies were performed and a total of 228 upper Gl malignancies were detected: 119 oesophageal, 109 gastric. Twenty-five patients (14 oesophageal, 11 gastric) were under 55 years old (11% of total cancers); two of these were less than 45 years. Most presented with alarm symptoms (22 / 25 - 88%), including both < 45 years. Of the remaining three patients, two men aged 54 had abdominal pain only but advanced oesophageal or gastric cancer. The other man, aged 52, had no upper Gl symptoms but was found incidentally to have early gastric cancer while being investigated for possible coeliac disease. Conclusions: Upper Gl malignancy is uncommon under the age of 55. Most of these young patients present with alarm symptoms. Our data also suggest that it is safe to increase the age for the investigation of uncomplicated dyspepsia from 45 to 55 years; it would not miss any curable malignancy in this age group.
ACCESSION #
9748051

 

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