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PTU-132 An audit of the accuracy of endoscopic reporting and tissue sampling of oesophagogastric cancer
  1. B Markandey,
  2. A Kapour,
  3. EA Griffiths
  1. Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK

Abstract

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.

Reference

  1. 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

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