MISSED UPPER GI CANCERS AFTER PREVIOUS GASTROSCOPY - WHAT RATE IS ACCEPTABLE?

Aims Early detection of upper GI cancers is necessary to optimise outcomes as late diagnosis carries a poor prognosis. Post colonoscopy colorectal cancer (PCCRC) rate is a quality assurance measure that defines an acceptable miss rate but an equivalent standard does not exist for the upper GI tract. We aim to describe missed opportunities for earlier diagnosis of upper GI cancers at our Trust and investigate contributing factors.

Methods Retrospective study at a tertiary London-based hospital Trust. Endoscopy software used to identify all new oesophageal, gastric and duodenal cancers diagnosed during gastroscopy during an 18 month period (January 2017 to August 2018). Interrogation for a prior gastroscopy within 3 years of the date of each cancer diagnosis was performed.

Results 90 cases of upper GI cancer diagnosed during gastroscopy (53 oesophageal (58.9%), 26 gastric (28.9%), 11 duodenal (12.2%)). There were 10 cases of post gastroscopy cancer (PGC) within 3 years giving our Trust a miss rate of 11.1%.

Median age of patients with PGC was 78 (range 47 - 94), female 7/10 (70%) and interval between gastroscopies was less than or equal to 12 months for 6/10 (60%). Type of cancers: 7 oesophageal (70%), 2 gastric (20%) and 1 duodenal (10%). Photo-documentation was absent in 6/10 (60%), conscious sedation was not used in 5/10 (50%) and 8/10 (80%) were performed by consultants.

Conclusions Our Trust has a post gastroscopy cancer miss rate of 11.1% which is comparable to that published in a recent meta-analysis. More than half the PGCs occur within 12 months of the prior gastroscopy and photo-documentation is missing in 60%. Female gender is associated with cancer diagnosed after previous gastroscopy. We recommend the introduction of UK guidelines on acceptable upper GI cancer miss rates (as per colorectal cancer key performance indicators) to drive better standards in upper GI endoscopy.