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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(07): E916-E923
DOI: 10.1055/a-2348-9264
Original article

Mortality from upper gastrointestinal tumors in colorectal cancer screening patients

Jasmin Zessner-Spitzenberg
1   Division of Gastroenterology and Hepatology, Medical University of Vienna, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Elisabeth Waldmann
1   Division of Gastroenterology and Hepatology, Medical University of Vienna, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Lisa-Maria Rockenbauer
1   Division of Gastroenterology and Hepatology, Medical University of Vienna, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Daniela Penz
3   Internal Medicine I, St. John of God Hospital Vienna, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Anna Hinterberger
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Barbara Majcher
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Arno Asaturi
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
,
Michael Trauner
1   Division of Gastroenterology and Hepatology, Medical University of Vienna, Department of Internal Medicine III, Vienna, Austria
,
Monika Ferlitsch
1   Division of Gastroenterology and Hepatology, Medical University of Vienna, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology (OEGGH), Vienna, Austria
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Abstract

Background and study aims Currently, gastric cancer screening is only cost-effective in countries with high incidence. Integrated screening, in which gastroscopy is performed in conjunction with colonoscopy, could help reduce the gastric cancer screening procedure burden in countries with low or intermediate incidence. However, there is a lack of population-based studies to identify high-risk groups.

Methods In this retrospective analysis of a colorectal cancer (CRC) screening program database, we used Cox proportional hazards model to identify an association of high- and low-risk finding (polyps ≥ 10 mm or with high-grade dysplasia) with time to death from upper gastrointestinal cancer (esophageal and gastric). We estimated the 10-year mortality of upper gastrointestinal tumors in different 10-year age groups, stratified by sex and polyp finding at colonoscopy.

Results We included 349,856 CRC screening colonoscopies in our study. The median follow-up time was 5.22 years (95% confidence interval [CI] 5.21–5.24 years). Of the participants, 4.5% had polyps ≥ 10 mm or with high-grade dysplasia (HGD). At the end of the study period, 384 deaths from upper gastrointestinal cancer had occurred. Aside from age and sex, we found the presence of high-risk polyps to be significantly associated with upper gastrointestinal cancer death (hazard ratio 1.54, 95% CI 1.06–2.25, P = 0.025).

Conclusions CRC screening participants with polyps < 10 mm and no HGD have a lower risk for mortality from upper gastrointestinal cancers compared with participants with polyps > 10 mm and HGD. Future studies will demonstrate whether integrated screening with additional gastroscopy is effective in CRC screening participants with large or highly dysplastic polyps.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - CRC screening - Epidemiology - Endoscopic ultrasonography - Gastric cancer - Esophageal cancer

Supplementary Material



Publication History

Received: 14 February 2024

Accepted after revision: 07 May 2024

Article published online:
25 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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