Post-endoscopy upper gastrointestinal cancer: Emerging data and opportunities to improve early detection

The overall prognosis of upper gastrointestinal cancer remains very poor. Early diagnosis is key to avoid morbidity and improve long-term survival. While gastroscopy is the gold standard diagnostic test, premalignant or malignant abnormalities may be overlooked or subject to sub-optimal management, leading to delayed diagnosis and patient harm. Patients with persistent symptoms after a “cancer-negative” gastroscopy may be given false reassurance. Upper gastrointestinal malignancies diagnosed within three years of a “cancer-negative”, index gastroscopy are defined as post-endoscopy upper gastrointestinal cancers (PEUGIC). They are surprisingly common, accounting for 11 % of upper gastrointestinal malignancies internationally. Abnormalities in the endoscopy preceding diagnosis are very common, and include premalignant findings and cancer-related lesions. Root cause analysis suggests deficiencies in endoscopy quality, decision-making and administration. This suggests avoidable PEUGIC cases, and crucially, an opportunity to improve endoscopy quality and outcomes. This narrative review summarises the epidemiology, presentation, contexts and root causes of PEUGIC and makes recommendations for clinical practice and research.