Systematic review with meta-analysis: age-related malignancy detection rates at upper gastrointestinal endoscopy

Background: Age is an important and objective risk factor for upper gastrointestinal (GI) malignancy. The accuracy of various age limits to detect upper GI malignancy is unclear. Determination of this accuracy may aid in the decision to refer symptomatic patients for upper GI endoscopy. The aim of this analysis was to synthesize data on upper GI malignancy detection rates for various age limits worldwide through meta-analysis. Methods: We searched MEDLINE, EMBASE, and Web of Science in November 2018. Selection criteria included studies addressing malignant findings at upper GI endoscopy in a symptomatic population reporting age at time of diagnosis. Meta-analyses were conducted to derive continent-specific cancer detection rates. Results: A total of 33 studies including 346,641 patients across 21 countries fulfilled the inclusion criteria. To detect >80% of malignant cases all symptomatic patients over 40 years of age should be investigated in Africa, over 50 years of age in South America and Asia, and over 55 years of age in North America and Europe. Conclusion: This systematic review and meta-analysis provides data on intercontinental variation in age at time of upper GI malignancy diagnosis in symptomatic patients referred for upper GI endoscopy. Guideline recommendations for age-based selection should be tailored to local age-related detection rates.

Upper gastrointestinal surgery

Diseases of the upper gastrointestinal tract (GI) have changed a great deal both in their aetiology and presentations as well as their manage­ment in the last three decades. Modern students and junior doctors need to understand the range of upper GI conditions which now present, especially the increasing issues of upper GI malignancy and the impact of morbid obesity on medical and surgical practice. Old text books full of operations for benign peptic ulcer disease have been replaced with texts on the constantly advancing treatment of oesophagogastric cancer and operations for obesity management. Symptoms and signs in upper GI disease are often subtle and non-specific so a sound knowledge of clinical findings and the choices for appropriate investigations are extremely important and are covered in this chapter. Lastly, some of the most urgent and life-threatening surgical emergen­cies can occur due to upper GI disease and the management of these conditions is a vital area of knowledge for all junior doctors.