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Endoscopy
DOI: 10.1055/a-2807-8630
Original article

Survival In Post-Endoscopy Esophageal Cancer: A Nordic Population-Based Cohort Study

Authors

  • Dag Holmberg 

    1   Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)

  • Amalia Liljequist Aspelund

    1   Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)

  • Sachin Wani

    2   Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, United States (Ringgold ID: RIN129263)

  • Eivind Ness-Jensen

    3   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)
    4   Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway (Ringgold ID: RIN8018)
    5   Medical Department, Levanger Hospital, Levanger, Norway (Ringgold ID: RIN60502)

  • My Von Euler-Chelpin

    6   Institute of Public Health, Københavns Universitet, Copenhagen, Denmark (Ringgold ID: RIN4321)

  • Joonas Kauppila

    1   Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)
    7   Department of Surgery, Oulu University Hospital, Oulu, Finland (Ringgold ID: RIN60664)

  • Giola Santoni

    1   Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)

  • Jesper Lagergren

    3   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Ringgold ID: RIN27106)
    8   School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4616)

Supported by: Swedish Society of Medicine
Supported by: Swedish Cancer Society
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Background and Study Aims: Post-endoscopy esophageal cancer (PEEC), i.e., esophageal cancer diagnosed shortly after an endoscopy in which no cancer was found, constitutes about 5-10% of all esophageal cancers. The long-term survival in PEEC has previously not been reported. Patients and Methods: This population-based cohort study included all patients with a newly diagnosed esophageal cancer in Denmark, Finland, or Sweden between 2004-2022. Patients with PEEC, i.e., a history of upper endoscopy between 6-36 months before esophageal cancer diagnosis, were compared with all other esophageal cancer, i.e., those without upper endoscopy 6-36 months before diagnosis. The outcomes were 5-year disease-specific mortality and 5-year all-cause mortality. Multivariable Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI), adjusted for country, age, sex, calendar year, comorbidity and tumor histology. Results: Among all 27,309 study patients with esophageal cancer, 1588 (5.8%) were classified as PEEC. The cumulative 5-year mortality among patients with PEEC was 74.6% (n=1185), and 79.6% of the deaths (n=943) were disease-specific. PEEC was associated with decreased risks of both 5-year disease-specific mortality (HR 0.72, 95% CI 0.68-0.77) and 5-year all-cause mortality (HR 0.74, 95% CI 0.71-0.80). Stratified analysis found that the decreased 5-year disease-specific mortality in PEEC was limited to patients with adenocarcinoma (HR 0.57, 95% CI 0.52-0.62), whereas no such decrease was found among patients with squamous cell carcinoma (HR 1.04, 95% CI 0.95-1.15). Conclusions: The 5-year survival in patients with PEEC seems to be better than in those with other esophageal cancer, but the survival is still poor. Keywords: PEUGIC; PEEC; missed lesions; esophageal neoplasm.



Publication History

Received: 01 October 2025

Accepted after revision: 05 February 2026

Accepted Manuscript online:
06 February 2026

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