About

Background

Endoscopy is the main test for diagnosing upper gastrointestinal cancer. This procedure also has the potential to prevent the disease by removing precancerous or early cancerous lesions, and so it is an important tool to help improve cancer outcomes.

Unfortunately, the test is not 100% accurate and cancers can appear within months or years after a endoscopy that is negative for cancer. These cases are termed post-endoscopy upper gastrointestinal cancers (PEUGICs). Around 15,800 patients are diagnosed with upper gastrointestinal cancer each year in the English National Health Service (NHS). 1200 (8%) of these are PEUGICs therefore reducing the incidence of PEUGIC is vital.

Endoscopy services in the NHS are under pressure. Currently, around 1.2 million endoscopies are undertaken each year, but demand is growing substantially and there is concern that the workforce needed to meet this demand is insufficient.

Although major efforts have been made to ensure the NHS delivers high quality endoscopy services through, for example, the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation scheme, not all providers have been mandated to participate. As a result, there is likely to be variation in the quality of endoscopy services across the country and unless this variation is investigated, it cannot be addressed.

Objectives

The PEUGIC root cause analysis project aims to identify patients with PEUGICs who had an endoscopy three months to three years prior to diagnosis of upper gastrointestinal cancer and to ask the endoscopy unit where the procedure was performed to provide feedback on what happened during the endoscopy. The methodology for contacting endoscopy units will follow the same procedure as used in the Post Colonoscopy Colorectal Cancer (PCCRC) audit – i.e. a list of patients will be displayed in a secure online platform and a questionnaire requested for each case. The process will enable an endoscopy service to address local factors that lead to PEUGICs.

In addition, by gathering this additional information, feeding it back into the National Cancer Registration and Analysis Service (NCRAS) and analysing it we aim to identify risk factors for PEUGIC as well as good practice and produce guidelines and an SOP (standard operating procedure) for endoscopies. Thus, learning from relatively rare events can be shared with NHS providers and ultimately to all endoscopy providers across the world.