Introduction The treatment of oesophageal and gastric cancer can depend on the location of the tumour, especially around the gastro-oesophageal junction (GOJ). Accurate measurements at endoscopy are critical, especially in patients who are surgical candidates or in those who need radiotherapy. It is also important that a diagnosis is achieved at first endoscopy and adequate biopsies taken to ensure repeat endoscopy is minimised.
Method OGD reports of patients with oesophagogastric cancers diagnosed between 2013–2014 at a tertiary referral centre were retrospectively reviewed. Main audit standards for oesophageal cancers included:1upper and lower tumour margin to be reported as a distance from the incisor teeth (100%) and GOJ should be measured from the incisor teeth (100%). For gastric cancers; the location and size should be stated (100%). For both tumours, a minimum of 6 biopsies should be taken (100%) and less than 10% of patients should require repeat endoscopy for diagnostic purposes.
Results 153 endoscopy results were analysed. Patient demographics consisted of: 68% oesophageal or GOJ cancers and 32% gastric cancers. For oesophageal/GOJ cancers; 84% had upper tumour margins stated, 56% had lower tumour margins stated and GOJ junction was measured in 27%. Endoscopy reports for gastric cancers revealed that 96% stated the location and 35% stated size of the tumour. 73% of oesophageal /GOJ cancers had a minimum of 6 biopsies taken and 11% had a repeat OGD due to inadequate biopsies/diagnosis. For gastric cancers, 73% had minimum of 6 biopsies and 4% of endoscopies were repeated due to inadequate biopsies/diagnosis. Brush cytology was used in 10% of patients with oesophageal cancers and was not used for gastric cancers. Reasons for sub-optimal biopsies included; unknown (59%), patient unable to tolerate procedure (12%), too tight to pass scope due to neoplasm or stricture (10%), patient on clopidogrel (10%), inadequate stomach emptying (5%), bleeding (2%) and malignancy not clinically suspected (2%).
Conclusion It is critical that oesophagogastric cancers are accurately measured and biopsied as this impacts on treatment decisions and disease management. For both oesophageal/GOJ and gastric cancers, around a quarter of the patients did not have the minimum number of diagnostic biopsies. Overall, 8.5% of endoscopies had to be repeated due to inadequate biopsies. We plan to disseminate our findings to our endoscopists and update departmental protocols and re-audit this important topic.
Disclosure of interest None Declared.
LCA Oesophageal and Gastric Cancer Clinical Guidelines. 2014[cited 2014 Feb 19]; Available from URL; http://www.londoncanceralliance.nhs.uk/media/71819/LCA%20OG%20Cancer%20Clinical%20Guidelines%20April%202014.pdf