Upper GI Endoscopy for Gastric Cancer Screening: Who Needs It and How Often?

 


One of the most lethal public health problems globally, especially among high-risk nations, is gastric cancer. Screening would bring improved results through the identification of precancerous lesions and early gastric cancers at the optimal time for treatment. 


Among all the many screening tests, upper GI endoscopy is the gold standard for the diagnosis of oesophageal, stomach, and small intestine disease. The test allows direct visualisation of the upper GI tract and biopsy of the suspect lesions and thus is the ideal tool to screen for gastric cancer.

What Is Upper GI Endoscopy?

Upper GI endoscopy, or esophagogastroduodenoscopy (EGD), is a harmless outpatient test. An elastic, thin tube with a light on the end and a camera placed in the mouth, such that the doctor can directly see the lining of the oesophagus, stomach, and duodenum. 


Ulcers, swelling, or tumour-type tissue masses are seen, and tissue samples (biopsies) can be obtained during the test for microscopic study. This is a more sensitive examination for gastric cancer and precancerous lesions than other screening tests like radiography.

Who are good candidates for Upper GI Endoscopy Screening for Gastric Cancer?

Though screening for all patients is not recommended, certain patients will improve markedly by upper GI endoscopy screening based on history or risk. 


The best candidates for use are:

  • Adults aged more than 50 years with chronic gastric atrophy or pernicious anaemia

  • Individuals with a family history of first-degree relatives with stomach cancer

  • Individuals with a history of partial gastrectomy

  • Individuals with a documented genetic gastrointestinal cancer syndrome or hereditary susceptibility

  • Residents in high-risk populations for gastric cancer, i.e., residents in East Asia and Eastern Europe

  • Individuals with a known history of long-standing Helicobacter pylori infection or gastric intestinal metaplasia, both of which are well-established as gastric cancer risk factors.

How often should screening be performed?

Screening of upper GI endoscopy for gastric cancer is divided based on personal risk factors and previous endoscopy history. Patients who have precancerous lesions like intestinal metaplasia or dysplasia, for instance, would enjoy follow-up of 1 to 3 years as per gastroenterology guidelines. Patients with a family history but no underlying gastric disease, on the other hand, would be recommended for screening every 3 to 5 years.


Population screening in Japan and South Korea, where gastric cancer is extremely prevalent, suggests screening every 40 or 50 years, 1-2 years. These tests have been able to decrease gastric cancer mortality, as they identify the gastric cancers at the curable early stage.

Benefits of Upper GI Endoscopy for Screening

Upper GI endoscopy is superior to other screening tests:

  • Direct visualisation of the mucosa allows early detection of subtle abnormalities

  • Rapid real-time biopsy for histologic diagnosis

  • Increased sensitivity and specificity for gastric cancers and precancerous lesions

  • Facilitating earlier therapeutic interventions, e.g., endoscopic mucosal resection for early cancer

  • Follow-up of high-risk lesions to avoid unnecessary surgery

Potential Risks and Limitations

While generally safe, upper GI endoscopy carries some risk, including:

  • Discomfort or gagging during the test

  • Infrequent side effects include bleeding, GI perforation, or sedation reaction.

  • False-negative findings from incipient cancer are not seen

  • False-positive outcomes with additional follow-up testing

Significant risk-benefit analysis trades off screening interval and eligibility, as determined by a clinician on the basis of history and clinical presentation.

Preparation for the Procedure

Patients typically have the instruction to fast for 6 to 8 hours before the procedure so that it can be done with facile visualisation. Sedation is typically given for tolerance of the procedure. The procedure time is 15 to 30 minutes, and most patients can be discharged the same day after brief monitoring.

Role in Prevention of Gastric Cancer

Early diagnosis by means of upper GI endoscopy makes it possible for premalignant dysplasia and gastric intestinal metaplasia to be addressed early, resulting in an unparalleled reduction in the incidence of invasive cancer risk. It is a complement to primary prevention in the form of lifestyle change and eradication of Helicobacter pylori. If you see any symptoms visit gastroenterology hospital today

Conclusion


Upper GI endoscopy is an excellent teaching tool for early detection of gastric cancer in high-risk patients. Screening on a regular basis following clinical symptoms and risk factors is the best hope for early diagnosis and cure. Referral by upper GI endoscopy of a patient to a gastroenterologist is justified in cases of suspected risk for gastric cancer or unexplained weight loss, intractable epigastric pain, or anaemia.


Take control of your health. Schedule your upper GI endoscopy today at Ruby Hospital, best gastroenterology hospital in Kolkata, for gastric cancer screening and peace of mind. 

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