Impact of open-access endoscopy on detection of early oesophageal and gastric cancer 1994 - 2003: population-based study

BACKGROUND AND STUDY AIMS: There is conflicting evidence regarding the ability of open-access endoscopy to detect oesophageal and gastric cancers at an earlier stage. The aim of the study was to assess the impact, with regard to earlier diagnosis of oesophageal and gastric cancer, of the first 10 years of a regional open-access endoscopy service in the Dumfries and Galloway region of Scotland. PATIENTS AND METHODS: Data were retrieved from prospectively compiled endoscopy and cancer registry databases. Route of referral (open-access vs. outpatient vs. inpatient), presenting symptoms (alarm vs. benign) and UICC disease stage in consecutive 5-year periods (1994 - 1998 and 1999 - 2003) were compared. RESULTS: 386 oesophagogastric cancers were identified (179 during 1994 - 1998 and 207 in 1999 - 2003). The number of patients undergoing endoscopy increased from 500 per annum prior to the open-access service to 7359 during 1994 - 1998 and 9701 in 1999 - 2003. Patient age, route of referral and presenting symptoms were unchanged. There was no improvement in disease stage at diagnosis (stage I, 7 % vs. 7 %; stage II, 16 % vs. 17 %; stage III, 31 % vs. 28 %). CONCLUSIONS: Despite a 32 % increase in endoscopy workload, the provision, over 10 years, of a regional open-access endoscopy service was not associated with earlier detection of oesophageal or gastric cancer.