Introduction Upper gastrointestinal (UGI) cancers are an important cause of morbidity and mortality across the western world and are often detected late. Whilst for colonoscopy the post procedure cancer rate is set at <5% as a performance indicator, there is currently no similar guideline for UGI cancer. This study set out to determine the miss rate for UGI cancers at Royal United Hospital (RUH), Bath.
Method A retrospective audit of UGI cancers diagnosed endoscopically over a two year period between 2013 and 2015. Patient data was obtained from the UGI malignancy multidisciplinary records. Patients who had an endoscopy in the preceding 3 years at RUH were identified. Endoscopy reports, histopathology and clinic letters were analysed and true misses identified.
Results Of 164 cases reviewed, 125 had adenocarcinoma and 26 had squamous cell carcinoma (SCC). Of the remainder, 2 had lymphoma, 2 a GIST, 1 a neuroendocrine tumour (NET) and 7 had poorly differentiated carcinoma. One had high grade dysplasia but was treated as a cancer. The majority of the cancers (61%) were oesophageal in origin, with 24% stomach, 13% gastro-oesophageal junction and 2% duodenal.
Of the 30 patients who developed cancer despite having had an OGD in the last 3 years, 12 patients were described as having a missed cancer. This equated to a miss rate of 7.3%. Of these, 8 were adenocarcinoma, 2 were SCC and one was a NET.
Conclusion The rate of missed UGI cancers at RUH was 7.3%, in keeping with the 11.3%1 suggested by a recent meta-analysis. However, the calculated miss rate of 1 in 398 endoscopies published in this study seems a significant over estimate for our population. Over 4000 individual patients have UGI endoscopies per year and an average of 6 per year were found to miss cancer suggesting 1 in 667 OGDs miss early cancer. Key performance indicators were suggested by the European Society of Gastrointestinal Endoscopy2 and are likely to be adopted by the BSG. To determine if changes in training and performance standards are improving quality in OGD it is vital that miss rates are recorded and reported.
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Disclosure of Interest None Declared
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