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THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER IN SURVEILLANCE ENDOSCOPY: PILOT RESULTS FROM THE NATIONAL ROOT CAUSE ANALYSIS PROJECT

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Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) can be missed opportunities to diagnose earlier or even prevent cancer. PEUGIC in patients undergoing endoscopic surveillance for pre-malignant conditions (e.g. Barrett’s oesophagus) are an important quality metric. A process for identifying PEUGIC and performing root cause analysis was piloted and the results are described.

Aims & Methods

The aims of the project were to develop a system to identify all PEUGIC in the English NHS and to allow endoscopy providers to conduct standardised root causes analysis of their PEUGIC via an online platform. This study allows local learning from PEUGIC and quantifies the reasons why PEUGIC occur at a national level.

PEUGIC occurring 3-36 months after a non-diagnostic (index) endoscopy between 2017 and 2023 were identified from final or provisional registrations in the National Cancer Registration and Hospital Episode Statistics Datasets held by the National Cancer Registration and Analysis Service. Data for root cause analysis were uploaded onto a secure root cause analysis portal following local hospital review. Only PEUGIC following surveillance endoscopy were included in this analysis.

Results

305 PEUGIC were examined by local reviewers in 13 hospitals in England. 40 were excluded, due to errors in provisional cancer data. Data were available for 220 PEUGIC (83%). 54 PEUGIC (26%) were undergoing surveillance for either Barrett’s oesophagus (87%) or chronic atrophic gastritis (13%).

Table 1 shows the PEUGIC root cause analysis based on World Endoscopy Organisation categorisation (Kamran Endoscopy 2023). Inadequate assessment or decision making was found in 11% of PEUGIC.

Findings in addition to the pre-malignant lesion: oesophageal PEUGIC focal lesion 17%; gastric PEUGIC focal lesion 29%. For oesophageal PEUGIC, 40% were diagnosed 3 months after the recommended surveillance date and 10% were interval cancers. In gastric PEUGIC, 29% were diagnosed 3 months after the recommended surveillance date and 29% were interval cancers.
Gastric PEUGIC tended to present more advanced stage 2 cancer or greater (43% vs 22.5% oesophageal). 2% of oesophageal and 14.3% of gastric PEUGIC were considered potentially avoidable by reviewers. Treatment appeared adversely affected with more invasive or palliative not curative treatment in 17% of oesophageal and 43% of gastric PEUGIC. Reviewers considered that 4% of PEUGIC led directly to a premature death.

Table 1 Root causes of surveillance endoscopy PEUGIC

PEUGIC categorisation	Number of cases
Lesion detected, adequate assessment and decision making but PEUGIC occurred	34 (63%)
Lesion detected, inadequate assessment and decision making	6 (11%)
Possible missed lesion, endoscopy and decision making adequate	14 (25%)
Possible missed lesion, endoscopy or decision making inadequate	0

Conclusion

Inadequate assessment or decision making was noted in 11% of surveillance PEUGIC. Focal lesions were noted at non-diagnostic endoscopy in 19%. 43% of gastric surveillance patients presented with stage 2 cancer or greater and adverse treatment outcomes occurred in 22% of surveillance PEUGIC.

References

Kamran U, King D, Abbasi A, Coupland B, Umar N, Chapman WC, Hebbar S, Trudgill NJ. A root cause analysis system to establish the most plausible explanation for post-endoscopy upper gastrointestinal cancer. Endoscopy. 2023 Feb;55(2):109-118. doi: 10.1055/a-1917-0192. Epub 2022 Aug 31. PMID: 36044914.

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER IN SURVEILLANCE ENDOSCOPY: PILOT RESULTS FROM THE NATIONAL ROOT CAUSE ANALYSIS PROJECT

Amar Srinivasa 1, Rebeca Fiadeiro 2, Shilpi Goel 2, Tameera Rahman 2, Tim Gentry 2, Nicholas E Burr 3, Matthew Banks 4, Richard Tighe 5, Mimi McCord 6, Mark Fullard 7, Chris Healey 8, Andrew Moore 9, Anjan Dhar 10, Dipankar Mukherjee 11, Gaius Longcroft-Wheaton 12, Benjamin Colleypriest 13, Roland Valori 14, Nigel Trudgill 1

1 Sandwell and West Birmingham NHS Trust, West Bromwich, United Kingdom

2 Health Data Insight CIC, Cambridge, United Kingdom

3 Leeds Institute for Biomedical and Clinical Sciences, Leeds, United Kingdom

4 University College London Hospital NHS Trust (UCLH), London, United Kingdom

5 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom

6 Heartburn Cancer UK, Basingstoke, United Kingdom

7 WEST HERTFORDSHIRE HOSPITALS NHS TRUST, Watford, United Kingdom

8 Airedale Nhs foundation trust, Keighley, United Kingdom

9 Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom

10 Darlington Memorial & Bishop Auckland Hospitals, Darlington, United Kingdom

11 BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST, Romford, United Kingdom

12 Portsmouth Hospitals NHS trust, Hampshire, United Kingdom

13 Royal United Hospital, Bath, United Kingdom

14 Gloucestershire NHS Foundation Trust - Medicine, Gloucestershire NHS Foundation Trust; Cheltenham/GB, Cheltenham, United Kingdom

Event

UEG Week Vienna 2024

Topics

Digestive Oncology Endoscopy Small Intestine & Nutrition Stomach & H. Pylori Oesophagus

Submission format

Abstract

Session

Upper GI endoscopy: From diagnosis to treatment

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Podcast Episode

UEG Podcast

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Oesophageal cancer with Massimiliano di Pietro (Part 1)

Massimiliano di Pietro, Pradeep Mundre

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

UEG Podcast Episode

UEG Podcast

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Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

Topics

Small Intestine & Nutrition

Published

2026

UEG Mistakes In Articles

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Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo, Javier Molina-Infante

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

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UEG Podcast

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BOSS update: Oesophageal cancer with Massimiliano Di Pietro (bonus episode)

Massimiliano di Pietro, Pradeep Mundre

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

UEG Podcast Episode

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UEG Online Courses x UEG Podcast: Impact of polyp detection in colonoscopy

Raf Bisschops, Manuele Furnari, Pieter Sinonquel, Veronique Van der Voort

Topics

Endoscopy

Published

2026

UEG Presentation

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MANAGEMENT OF SEVERE EROSIVE GASTROESOPHAGEAL REFLUX DISEASE (EGERD) WITH HIGH-DOSE PROTON PUMP INHIBITORS: INTERIM RESULTS FROM A REAL-WORLD OBSERVATIONAL STUDY (POWER 3.0)

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Introduction

Treatment response in patients with severe erosive gastroesophageal reflux disease (eGERD) is often inadequate using regular doses of proton pump inhibitors (PPIs), thus necessitating escalation of dosing. High-dose PPIs improve compliance in such patients, leading to better outcomes. However, comparative data on effectiveness of high-dose PPIs is limited.

Aims & Methods

This interim analysis assessed symptomatic improvement of regurgitation in an ongoing, prospective, real-world, observational study to compare the effectiveness of rabeprazole 40mg to pantoprazole 80mg and omeprazole 40mg/esomeprazole 80mg. Adult patients with endoscopically confirmed severe eGERD were enrolled. Patients shifted from low-dose PPIs or started on high-dose PPIs were included; those with complications of GERD were excluded.

Results

A total of 260 patients (rabeprazole, 130; omeprazole/esomeprazole, 65; pantoprazole, 65) from 37 sites in India were analyzed. Although symptomatic improvement of diurnal and nocturnal regurgitation based on patient-reported severity scores was observed among the three arms after 4±1 weeks of treatment, the complete-resolution rate of diurnal regurgitation was significantly higher with rabeprazole (17.97%) compared to omeprazole/esomeprazole (5.08%; p=0.018) and higher than pantoprazole (8.20%; p=0.077). Similarly, complete resolution of nocturnal regurgitation was significantly higher with rabeprazole (14.06%) compared to omeprazole/esomeprazole (1.59%; p=0.007) and higher than pantoprazole (7.94%; p=0.221). Among patients with associated work-related stress (n=132), one-fifth in the rabeprazole arm experienced complete resolution of diurnal regurgitation compared to none in the omeprazole/esomeprazole (p=0.013) or pantoprazole (p=0.030) arms. Patients with lack of regular physical exercise (83.08%) exhibited higher rate of complete resolution of nocturnal regurgitation with rabeprazole (13.73%) compared to the other PPIs. Overall, elderly patients >60 years of age (mean±SD, 68.82±6.54 years) treated with rabeprazole showed significantly higher complete-resolution rates of diurnal regurgitation compared to pantoprazole (36.67% vs. 0%; p=0.003). For complete resolution of nocturnal regurgitation, rabeprazole proved to be significantly better when compared to omeprazole/esomeprazole (31.25% vs. 0%; p=0.015) in elderly patients (Table 1).

Conclusion

The interim results showed that rabeprazole led to significantly higher complete-resolution rates of diurnal and nocturnal regurgitation at 4±1 weeks of treatment than omeprazole/esomeprazole in adults with severe eGERD. In elderly patients, rabeprazole showed significant resolution over pantoprazole.

Disclosure

Study funded by: Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India

MANAGEMENT OF SEVERE EROSIVE GASTROESOPHAGEAL REFLUX DISEASE (EGERD) WITH HIGH-DOSE PROTON PUMP INHIBITORS: INTERIM RESULTS FROM A REAL-WORLD OBSERVATIONAL STUDY (POWER 3.0)

Mahesh Goenka 1, Kranthi Pebbili 2, Balakrishna Namala 2

1 Apollo Gleneagles Hospitals, Kolkata, India

2 Dr Reddys Laboratories Ltd, Hyderabad, India

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Neurogastroenterology & Motility Oesophagus Stomach & H. Pylori

Submission format

Late-Breaking Abstract

Session

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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