Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) are often missed opportunities to diagnose earlier or even prevent cancer. PEUGIC in patients undergoing surveillance for pre-malignant conditions are a potentially important surveillance quality indicator. A national process for identifying all PEUGIC in the English National Health Service and performing root cause analysis was developed.

Aims & Methods

Potential PEUGIC between 2017 and 2023 occurring 3-36 months after an index endoscopy which did not result in a cancer diagnosis were identified from National Cancer Registration Dataset and Hospital Episode Statistics held by the National Cancer Registration and Analysis Service. Data from local root cause analysis were uploaded onto a secure portal for national analysis. Only PEUGIC following surveillance endoscopy were included in this analysis. Logistic regression analysis was used to identify associations.

Results

3151 potential PEUGIC were examined by local reviewers in 144 English hospitals. 635 (20%) were excluded and data were available for 2516 PEUGIC. 618 PEUGIC (24.6%) were undergoing surveillance for: Barrett’s oesophagus (83%); chronic atrophic gastritis (7%) or other conditions (10%). PEUGIC sites were oesophagus 85%, stomach 13% and duodenum 1%. 5% of PEUGIC were not related to the pre-malignant condition under surveillance.
Table 1 summarises the PEUGIC root cause analysis results based on the World Endoscopy Organisation categorisation. Inadequate endoscopy or decision making occurred in 30% of PEUGIC (categories B/D) and was associated with patient harm OR 2.61 (95% CI 1.74 -3.92).
Seattle biopsy protocol compliance was only 58% in Barrett’s surveillance PEUGIC. Additional focal or cancer associated lesions were present at index endoscopy in the PEUGIC segment in 23%.
Oesophageal and gastric PEUGIC often presented with stage 2 cancers or greater (48% and 43% respectively). 45.2% of oesophageal and 47.0% of gastric PEUGIC were considered at least possibly avoidable. Treatment was adversely affected with palliative treatment in 22% of oesophageal and 30% of gastric PEUGIC. 6% led to premature death.
Endoscopy practices associated with stage ≥2 cancer were: sedation without opioids OR 1.75 (95% CI 1.03-2.97); lack of image enhancement OR 1.78 (95% CI 1.18-2.70) and lack of dedicated surveillance sessions OR 2.08 (95% CI 1.46-2.98).

Table 1 Root causes of all surveillance PEUGIC

Conclusion

Inadequate assessment or decision making was noted in 30% of surveillance PEUGIC, which adversely affected treatment in 20% of oesophageal and 30% of gastric PEUGIC. 48% of oesophageal and 43% of gastric PEUGIC patients presented with stage 2 cancer or greater suggesting potential failures of surveillance. Optimal sedation practice, image enhancement and dedicated surveillance sessions were associated with stage 1 PEUGIC and better outcomes.

Introduction

Corpus atrophic gastritis (CAG) requires endoscopic-histological surveillance due to the risk of developing gastric neoplastic lesions (GNL). This study aimed to identify variables associated with GNL development at long-term follow-up using a feature ranking method based on a novel One-Class Support Vector Machine (SVM) model.

Aims & Methods

A dataset containing clinical, endoscopic, and histological variables from consecutive CAG patients (2001-2023) adhering to a surveillance program was considered. GNL presence at the longest available follow-up was recorded. Gastric biopsies and histological evaluations were conducted according to the updated Sydney system. CAG patients with any missing data or a GNL diagnosis at the baseline gastroscopy were excluded from the final analysis. A Fisher score-based feature ranking method and One-Class SVM were used to select the optimal subset of baseline variables associated with GNL development, aiming to achieve average sensitivity (Se) and specificity (Sp) above 80%.

Results

Overall, 355 CAG patients were initially considered. Of these, 36 were excluded due to the presence of GNL at baseline gastroscopy, and 216 for missing data. Thus, a total of 103 patients were considered and grouped into: CAG patients with [22 patients (F 68.1%), median age 68 (35-83) years] and without GNL at follow-up [81 patients (F 72.8%), median age 59(26-84) years]. After a median follow-up of 60 (12-192) months, 13 epithelial GNL (gastric adenocarcinoma or high/low-grade dysplasia) and nine type-1 gastric-neuroendocrine-tumors (T1gNET) were recorded. Parietal-cell-antibodies and pepsinogen-I < 30 μg/l were associated with both epithelial GNL and T1gNET. Antral inflammation and age > 60 were linked to epithelial GNL, while anti-thyroperoxidase-antibodies, smoking, and dyspeptic symptoms at CAG diagnosis were linked to T1gNET. Low-dose aspirin and H. pylori eradication therapy showed inverse associations with epithelial GNL and T1gNET, respectively.

Conclusion

This is the first study in which an AI model simultaneously considers clinical, endoscopic, and histological characteristics from a dataset of CAG patients, showing good sensitivity and specificity in identifying those variables associated with developing GNL. Nonetheless, we acknowledge the need for improved variable standardization and data balancing between groups to enhance model performance further.

Introduction

Burnout Syndrome is a subject that has been studied for several decades. Despite the fact that is a well-known topic and that more and more people are suffering from it, the bibliography shows that there are no great changes in it and as a consequence, there are still great deficiencies in the prevention of this syndrome today.
In 1981, Maslach and Jackson defined Burnout as a syndrome that occurs when there is inadequate coping with chronic stress, i.e., as a consequence of continuous work stress, negative attitudes and feelings appear both in the professional role itself and towards colleagues, and this makes the person suffering from it emotionally exhausted.
Burnout syndrome is now considered a public health problem because of the number and severity of the consequences for the physical and psychological integrity of workers. According to the International Council of Nurses, professionals who suffer higher levels of work and personal stress are 30% more likely to suffer accidents in their workplace. This means that on the one hand the person suffering from work-related stress and/or burnout syndrome has a series of complications of varying degrees of severity and on the other hand the organisation has to bear the costs involved (e.g. sick leave).

Results & Findings

Observational, descriptive and cross-sectional study, carried out in March 2025 on the nursing staff of our Digestive Endoscopy Unit. A survey was distributed with a section for the analysis of socio-demographic data and another presenting the Maslach Burnout Inventory (MBI) questionnaire.
Descriptive statistical analysis was performed using frequency and association tables.
All questionnaires received were analysed and no exclusion criteria were established. Total sample was 30 professionals, 18 nurses (60%) and 12 TCAES (40%).

Summary & Discussion

Proffesionals with presence and/or tendency to suffer burnout is characterised by being a professional of nursing on a temporary contract, female, aged 31-45 years and who have been working in our Endoscopy Unit from 5 to 10 years.
It is worth emphasising that there is a significant percentage of professionals who suffer from a high level of emotional exhaustion (63,3%)
Excessive workload (73,3%) and high-pressure job (52,6%), as well as poor workplace relationships (73,7%) are the main precursors highlighted by professionals for the appearance of burn out.

Conclusion

These data show that this is a latent problem and it is therefore necessary to take measures, both of an organisational nature and to intervene in the
nursing staff.

References

Maslach C, Schaufeli WB, Leiter M. 2001. Job burnout. Annual Review of Psychology. 52, 397-422.Gordon, S. 2005.
ICN (13 January 2021). Mass Trauma Experienced by the Global Nursing Workforce. [Internet] 2021 [Access 30/03/2025] Available at: https://www.icn.ch/sites/default/files/inline-files/ICN%20COVID19%20update%20report%20FINAL.pdf
Nursing against the odds: How health care cost cutting, media stereotypes, and medical hubris undermine nurses and patient care. Ithaca, NY: ILR Press (Cornell University Press).
Baiget, D, Chapela, R, López-Pérez, A, Milà, A. Síndrome de burnout entre el personal de enfermería del Servicio de Endoscopia Digestiva del HUVH. Enferm Endosc Dig. [Internet] 2016 [Access 30/03/2025];3(2): 30-37. Available at: http://aeeed.com/documentos/publicos/revista/octubre2016/Enferm%20Endosc %20Dig.%202016;3(2)30-37.pdf