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CC BY-NC-ND 4.0 · Endoscopy 2025; 57(01): 17-28
DOI: 10.1055/a-2378-1464
Original article

The variation in post-endoscopy upper gastrointestinal cancer rates among endoscopy providers in England and associated factors: a population-based study

Umair Kamran 
1   Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
,
Felicity Evison
2   Data Science, Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
,
Eva Judith Ann Morris
3   Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
,
Matthew J Brookes
4   Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
5   Faculty of Science and Engineering, Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, United Kingdom of Great Britain and Northern Ireland
,
Matthew David Rutter 
6   Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
7   Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom of Great Britain and Northern Ireland
,
Mimi McCord
8   -, Heartburn Cancer UK, London, United Kingdom of Great Britain and Northern Ireland
,
Nicola J Adderley
9   Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
,
Nigel Trudgill
1   Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
10   Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
› Author AffiliationsThe views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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Post-endoscopy upper gastrointestinal cancer: how to move from the dark sideEndoscopy 2025; 57(01): 29-30
DOI: 10.1055/a-2398-9277

Abstract

Background Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an important key performance indicator for endoscopy quality. We examined variation in PEUGIC rates among endoscopy providers in England and explored associated factors.

Methods The was a population-based, retrospective, case–control study, examining data from National Cancer Registration and Analysis Service and Hospital Episode Statistics databases for esophageal and gastric cancers diagnosed between 2009 and 2018 in England. PEUGIC were cancers diagnosed 6 to 36 months after an endoscopy that did not diagnose cancer. Associated factors were identified using multivariable logistic regression analyses.

Results The national PEUGIC rate was 8.5%, varying from 5% to 13% among endoscopy providers. Factors associated with PEUGIC included: female sex (odds ratio [OR] 1.29 [95%CI 1.23–1.36]); younger age (age >80 years, OR 0.52 [0.48–0.56], compared with ≤60 years); increasing comorbidity (Charlson score >4, OR 5.06 [4.45–5.76]); history of esophageal ulcer (OR 3.30 [3.11–3.50]), Barrett’s esophagus (OR 3.21 [3.02–3.42]), esophageal stricture (OR 1.28 [1.20–1.37]), or gastric ulcer (OR 1.55 [1.44–1.66]); squamous cell carcinoma (OR 1.50 [1.39–1.61]); and UK national endoscopy accreditation status – providers requiring improvement (OR 1.10 [1.01–1.20]), providers never assessed (OR 1.24 [1.04–1.47]).

Conclusion PEUGIC rates varied threefold among endoscopy providers, suggesting unwarranted differences in endoscopy quality. PEUGIC was associated with endoscopy findings known to be associated with upper gastrointestinal cancer and a lack of national endoscopy provider accreditation. PEUGIC variations suggest an opportunity to raise performance standards to detect upper gastrointestinal cancers earlier and improve outcomes.

Supplementary Material



Publication History

Received: 11 July 2023

Accepted after revision: 19 June 2024

Article published online:
29 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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