SP 6.07 Post-Endoscopy Upper Gastrointestinal Cancer (PEUGIC) In a Scottish Health Board, 2017–2022: Incidence and Root-Cause Analysis
Benjamin Jones, Iona Robertson, Patrycja Hebda, Luke McElroy, Hamza Othman, Khurram Shahzad KhanAbstract
Aim
The Joint Advisory Group (JAG) defines upper GI cancer diagnosed within 3 years of oesophagogastroduodenoscopy (OGD) as a missed opportunity for earlier diagnosis and treatment. We quantified post-endoscopy upper gastrointestinal cancer (PEUGIC) incidence and analysed contributory factors using the English national PEUGIC root-cause analysis (RCA) taxonomy (Kamran et al).
Methods
We retrospectively reviewed all oesophageal and gastric cancers diagnosed between 2017 and 2022. PEUGIC was defined as a malignancy diagnosed 3–36 months after a prior OGD performed within the health board. Demographic, procedural, and clinical data were extracted from the clinical portal, endoscopy reporting software, and operation notes. Primary outcomes were PEUGIC proportion and RCA category (A–D), assessing lesion recognition, adequacy of mucosal inspection, decision-making, and documentation.
Results
Among 784 upper GI cancers, 59 met PEUGIC criteria (7.5%). Forty-one were oesophageal (69%) and 18 gastric (31%); 38 patients were male (64%) and 21 female (36%). Median age was 72 years (range 37–91). RCA categories were: A—lesion detected, assessment/decision-making adequate (n=1, 2%); B—lesion detected, assessment/decision-making inadequate (n=23, 39%); C—possible missed lesion with adequate endoscopy/decision-making (n=0, 0%); and D—possible missed lesion with inadequate endoscopy and/or decision-making (n=35, 59%). Overall, 58/59 (98%) were B or D.
Conclusion
PEUGIC incidence was comparable to published estimates; however, RCAs indicated predominantly modifiable deficits in endoscopic practice, most commonly substandard photo-documentation, alongside shortcomings in assessment and decision-making. Standardised photo-protocols, structured reporting and targeted feedback, underpinned by ongoing local surveillance, should reduce PEUGIC risk.