Post-Endoscopy Upper Gastrointestinal Cancer in a United States Multicenter Cohort: Site- and Risk-Stratified Trends and Survival

BACKGROUND AND STUDY AIMS: Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an emerging quality metric, but varying definitions complicate benchmarking. We characterized PEUGIC rates and outcomes by anatomical site and coded high-risk condition (HRC) status in a large US cohort. PATIENTS AND METHODS: Retrospective cancer-first cohort study of 14,814 patients with upper gastrointestinal cancer (UGIC) from a multicenter database (2016-2024). Detected UGIC was diagnosed within 6 months of EGD. PEUGIC was defined as UGIC diagnosed 6-36 months after a non-diagnostic EGD. The primary outcome was the PEUGIC rate by cancer type (esophageal [EC], gastric [GC], duodenal [DC]) and HRC status. Secondary outcomes included 3-year overall survival. RESULTS: The overall PEUGIC rate was 9.4% (EC 9.6%, GC 8.6%, DC 10.7%). Rates were higher with HRC (18.2%) versus without HRC (5.0%, P < .001). PEUGIC rate without HRC plateaued (4.1-5.1% in 2022-2024), while PEUGIC rate with HRC for EC (16.8%) and GC (14.4%) decreased over time. In exploratory analysis, PEUGIC was associated with better survival versus Detected UGIC for EC (adjusted hazard ratio [aHR] 0.82, 95% CI 0.67-0.99) and GC (aHR 0.77, 0.62-0.96), and PEUGIC with HRC was associated with lower mortality versus PEUGIC without HRC for EC (aHR 0.51, 0.36-0.74) and GC (aHR 0.50, 0.34-0.73). CONCLUSIONS: One in 10 upper GI cancer patients had a prior non-diagnostic endoscopy within 3 years. PEUGIC rates varied by anatomical site and HRC status, suggesting site- and HRC-stratified benchmarks may better capture endoscopic performance than aggregate metrics.