Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria

Background: The objective of the study is to identify differences in epidemiology and clinical presentation between oesophageal and gastric cancer and to evaluate the sensitivity of the Australian urgent endoscopy referral guidelines. Methods: Design; Observational cohort study from February 2013 to October 2018. Setting: A single tertiary specialist oesophago-gastric cancer centre: Flinders Medical Centre, South Australia. Participants: Patients with oesophageal and gastric cancer that had surgery with curative intent 61.9% oesophageal cancer, 38.1% gastric cancer. Main outcome measures: Differences between oesophageal and gastric cancer in terms of demographical variables, first presenting symptoms and sensitivity of the Australian urgent endoscopy referral guidelines. Results: Oesophageal cancer presented at a median age of 64.4 years old, with a male: female ratio of 6:1, and dysphagia as the first presenting symptom in 61%. Gastric cancer presented at a median age of 69.5, with a 2:1 male: female ratio and predominantly non-specific symptoms—blood loss (36%), weight loss, nausea, and anorexia (21%) and epigastric pain (13%). The Australia urgent endoscopy referral guidelines had 76% sensitivity for oesophageal cancer detection compared with a 33% sensitivity for gastric cancer in this cohort. Delays from symptom onset to referral occurred for most patients with timeframes over four times the recommended 2-week timeframe. Conclusion: There should be a separate urgent referral guideline for oesophageal and gastric cancer. These should include dysphagia for oesophageal cancer and blood loss (anaemia, haematemesis, melaena) for gastric cancer. Delays from symptom onset to referral indicate the need for further education of the public and general practitioners on symptoms warranting urgent referral.