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PTU-020 Post Endoscopy Missed Gastrointestinal Cancer at a Local DGH - Implications for Practice
  1. S Sultan,
  2. I Salehi,
  3. G Williams,
  4. I Jaly,
  5. H Khadim,
  6. MI Yahya,
  7. A El-Sayed,
  8. M Mirzaali,
  9. J Rademaker
  1. Gastroentorology, Conquest Hospital, East Sussex, UK

Abstract

Introduction Upper gastroenterology tract cancers (UGIT) are the 4 th commonest malignancy worldwide. The best treatment remains early detection allowing for prompt intervention. Oesophagogastroduodenoscopy (OGD) is the gold standard of diagnosing UGIT cancers however it remains imperfect. There is still a substantial rate of missed UGIT cancers at endoscopy. It is estimated that in the UK the national rate of missed UGIT cancers is 7.2%.

It is important that endoscopic techniques undergo regular review ensuring a process of continuous quality improvement. Our aim is to review the missed rate of cancers after a negative OGD examination and to explore the reasons behind this and to propose methods of reducing the rate of missed cancers.

Methods A retrospective case analysis over a five year period (2010–2015) investigating patients who received a diagnosis of UGIT cancer at our local district general hospital. We used our local clinical databases in identifying relevant patients who had been investigated with a negative endoscopy in the prior year but then went on to receive a diagnosis of colorectal cancer.

Results 415 patients (F 143; M 272) were audited with an average age of 76 (range 31–102). 31 patients were excluded as cancer diagnosis was discovered by other means (CT, ERCP and emergency operations). Of the 415 patients audited 54 (14%) were investigated with an OGD in the prior year which was negative. We also investigated the presenting pathway and found that the majority of patients (166; 28%) were presenting through the urgent suspected cancer pathway.

Conclusion Our results show a high rate of missed lesions on initial endoscopy. This has serious implications for practice and suggested published reasons for this are largely thought to be the variability in experience of the endoscopist. To that end it is our recommendation that training for OGD be prolonged. There is also a large variability in reporting of the procedure therefore following a more standardised approach is advocated. Also operators are strongly encouraged to take multiple biopsies of lesions that appear suspicious. Finally we would like to implement a strict, rigorous follow up system whereby patients presenting with alarm symptoms and a negative OGD can be followed up with repeat procedures to ensure no cancers are missed.

References 1 Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnosis with upper gastrointestinal cancers. Endoscopy 2004;36(10):874–9.

2 Gado A, Ebeid B. Gastric cancer missed at endoscopy. Alexandria Journal of Medicine 2013;49(1):25–27.

3 Enns R. Missed cancers in the upper gastrointestinal tract after esophagogastroduodenoscopy. Gastroenterol Hepatol 2010;6:691–693.

Disclosure of Interest None Declared

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