Open-access gastroscopy is associated with improved outcomes in gastric cancer

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Abstract
Objective To examine whether patients with gastric cancer diagnosed via open-access gastroscopy (OAG) differ in their outcomes compared with patients referred conventionally to outpatient clinics or as acute emergencies. Design and setting Prospective observational study in the gastroenterology and surgical units of a large district general hospital. Participants One hundred consecutive patients with gastric adenocarcinoma. Main outcome measures Data were collected prospectively and subdivided into two groups according to whether the patients were referred via the open-access route or the conventional route. Results Diagnostic delay from onset of symptoms was shorter for patients referred via OAG compared with those referred conventionally. Stages of disease were significantly earlier in patients referred via OAG compared with patients referred conventionally. Potentially curative resection was significantly more likely following OAG than after conventional referral. Cumulative five-year survival for patients referred via OAG was 30% compared with 12% after conventional outpatient referral and 13% after acute referral. Multivariate analysis revealed three factors to be associated with survival: stage of disease, distant metastases and referral via the open-access route. Conclusions Gastric cancers presenting at OAG were diagnosed at an earlier stage than cancers diagnosed after conventional referral. This led to a higher proportion of potentially curative resections and better five-year survival.