The Post-Endoscopy Upper Gastrointestinal Cancer (PEUGIC) project

The PEUGIC project is an NIHR (National institute for Health and Care Research) funded national quality improvement project which aims to shed light on why PEUGIC occurs and identify effective strategies to reduce PEUGIC occurrence.

The project comes as a response to the persistently high and rising PEUGIC rates in England, with the latest figure reaching 8.9% in 2018. Astonishingly, over 1,200 upper GI cancers are diagnosed annually following endoscopies that failed to detect them in the previous three years, and a recent English study suggests that approximately 70% of these cancers could potentially have been avoided.

PEUGIC rates are a crucial quality indicator for endoscopy services. The BSG (British Society of Gastroenterology), AUGIS (Association of Upper Gastrointestinal Surgeons) and JAG (Joint Advisory Group) strongly recommend that endoscopy units regularly review PEUGIC cases. However, identifying PEUGIC has proven challenging for services as clinicians often fail to inquire about recent endoscopies when a patient presents with a new cancer. Moreover, if a patient presents to another service, the hospital where the initial endoscopy was performed is unlikely to be informed about a subsequent cancer diagnosis.

To aid endoscopy services in identifying and reviewing PEUGICs, a national reporting system has been developed. Patients who underwent an endoscopy 3-36 months prior to an upper GI cancer diagnosis are identified through central databases and the endoscopy unit is notified via a secure online portal. The portal features a root cause analysis tool that assists in determining the most likely explanations and contributory factors for the occurrence of PEUGICs.

Starting in October 2023, as the portal becomes available, each participating organisation will thoroughly review their respective local PEUGICs. They will provide essential details concerning the endoscopy procedure, the cancer diagnosis, and any factors that might have played a role in the delayed diagnosis. After a period of 6 months, the data from each unit will be anonymized, pooled, and subjected to analysis. This collaborative endeavour will yield unparalleled insights into the factors that contribute to PEUGICs, guiding the PEUGIC project team in suggesting effective measures for endoscopy units to reduce the incidence of PEUGIC and improve standards of upper GI endoscopy.