Opportunistic upper endoscopy during colonoscopy as a screening strategy for countries with intermediate gastric cancer risk

Background and aim Screening upper endoscopy can detect oesophagogastric (OG) cancers early with improved outcomes. Recent cost-utility studies suggest that opportunistic upper endoscopy at the same setting of colonoscopy might be a useful strategy for screening of OG cancers and it may be more acceptable to the patients due to cost-saving and convenience. We aim to study the diagnostic performance of this screening strategy in a country with intermediate gastric cancer risk. Methods A retrospective cohort study using a prospective endoscopy database from 2015-2017 was performed. Patients included were individuals age > 40 who underwent opportunistic upper endoscopy at the same setting of colonoscopy without any OG symptoms. Neoplastic OG lesions are defined as cancer and high-grade dysplasia. Pre-neoplastic lesions include Barrett's Oesophagus (BE), intestinal metaplasia (IM), and atrophic gastritis (AG). Results The study population involved 1414 patients. Neoplastic OG lesions were detected in five patients (0.35%). Pre-neoplastic lesions were identified in 174 (12.3%) patients. IM was found in 146 (10.3%) patients with 21 (1.4%) having extensive IM. The number needed to scope to detect a neoplastic OG lesion is 282.8 with an estimated cost of USD$ 141,400 per lesion detected. On multivariate regression, age ≥ 60 (RR: 1.84, 95%CI:1.29-2.63) and first-degree relatives with gastric cancer (RR: 1.64, 95%CI:1.06-2.55) were independent risk factors for neoplastic or pre-neoplastic OG lesion. Conclusion For countries with intermediate gastric cancer risk, opportunistic upper endoscopy may be an alternative screening strategy in selected patient population. Prospective trials are warranted to validate its performance.