Analysis of post-endoscopy upper GI cancers (PEUGIC) in a single centre UGI managed clinical network in the West of Scotland from 2020-2022

Aims 15,800 people in the UK are diagnosed with oesophageal or gastric cancer each year. Upper GI cancers missed at index endoscopy may lose the opportunity for curative treatment. Post-endoscopy upper gastrointestinal cancer (PEUGIC) is defined as a cancer diagnosed within 3 years of an endoscopy which did not detect malignancy. A 2011 study demonstrated the PEUGIC rate at our centre to be 10.4%. This study aims to review post-endoscopy upper GI cancer rates and identify contributing factors.

Methods A retrospective analysis was performed on all cases of upper GI cancer diagnosed within NHS Greater Glasgow and Clyde between 2020-2022. Cases were identified from the West of Scotland Upper GI Managed Clinical Network, which includes all patients discussed at the regional MDT meeting. Electronic patient records were reviewed on Clinical Portal to identify those who had an endoscopy in the preceding 3 years which did not diagnose an upper GI cancer. 121 patients met inclusion criteria (Group A). Patient data including sex, age, past medical history and medication was collected, as well as procedure details including grade of endoscopist, time of procedure and sedation use. Recent publications on this topic suggest 6-36 months post-endoscopy as a more accurate definition of PEUGIC, therefore this subgroup was also analysed (Group B).

Results 12.9% of patients diagnosed with an upper GI cancer between 2020 and 2022 fit the definition of PEUGIC (A). 6.7% of patients had an endoscopy 6-36 months preceding their cancer diagnosis (B). 72.7% (A)/68.3% (B) of patients were male, and mean age at diagnosis was 71.4 years (A)/71.5 years (B). Mean time from index endoscopy to cancer diagnosis was 11.8 months (A)/22 months (B). 54.5% (A)/60.3% (B) of patients had symptoms of gastro-oesophageal reflux disease, 77% (A)/87.3% (B) were taking a proton-pump inhibitor, and 31.4% (A)/46% (B) were known to have Barrett's oesophagus. 61% (A)/61.9% (B) of missed cancers were located within the oesophagus, 26.6% (A)/20.6% (B) in the stomach and 11.6% (A)/14.3% (B) at the gastro-oesophageal junction. Adenocarcinoma was the predominant histological tumour type (46.3% (A), 41.3% (B)), followed by intramucosal adenocarcinoma (24% (A), 23.8% (B)) and squamous cell carcinoma (17.4% (A), 17.5% (B)). There were similar miss rates amongst Consultant gastroenterologists, Consultant surgeons and nurse endoscopists. 58% (A)/66% (B) of PEUGIC patients had their procedure on an afternoon list. Mean midazolam dose was 1.5mg for both groups. Fentanyl was used in only 8.3% (A)/4.8% (B) of cases.

Conclusions Our PEUGIC rate was higher than in 2011 at 12.9%. Factors identified in this study may impact identification of upper GI cancer at time of endoscopy. We plan to analyse all upper GI cancer cases identified from 2020-2022 to identify modifiable factors which are more prevalent in the PEUGIC group. [1] [2] [3]

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Mahmood F, Paton D, Gibson S. et al. Missed cancers at upper GI endoscopy: Endoscopy versus pathology errors. British Journal of Surgery. 2011; 98 S7: 1-55
• 2 Kamran U, King D, Abbasi A. et al. A root cause analysis system to establish the most plausible explanation for post-endoscopy upper gastrointestinal cancer. Endoscopy 2023; 55 02: 109-118
• 3 Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66 12: 2188

Publication History

Article published online:
15 April 2024