UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

ORGANISATIONAL FACTORS ASSOCIATED WITH POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER (PEUGIC): RESULTS OF THE ENGLISH NATIONAL PEUGIC PROJECT

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) are often missed opportunities to diagnose earlier or even prevent cancer. A national process for identifying all PEUGIC in the English National Health Service (NHS) and performing root cause analysis was developed. In parallel, a survey of NHS endoscopy providers diagnostic and surveillance UGI endoscopy practices was undertaken to investigate organisational factors which may contribute to endoscopy quality and PEUGIC.

Aims & Methods

PEUGIC occurring 3-36 months after an index endoscopy without a cancer diagnosis between 2017 and 2023 were identified from National Cancer Registration and Hospital Episode Statistics datasets. Data from local root cause analysis were uploaded onto a secure portal for national analysis. Endoscopy providers taking part in the project were asked to complete an online organisational survey, covering diagnostic and surveillance endoscopic practices, equipment and the management of dysplasia and early cancer.

Results

3151 PEUGIC were examined by local reviewers in 144 hospitals in England. 635 (20%) were excluded on local review. Data were available for 2516 PEUGIC. 1897 PEUGIC (75.4%) were following diagnostic endoscopy and 618 (24.6%) were undergoing surveillance. 80% of endoscopy providers responded to the survey.
For diagnostic PEUGIC, less than 20 minutes being allocated to UGI endoscopy was associated with no abnormalities detected in the PEUGIC segment at index endoscopy OR 1.25 (95% CI 1.04-1.50). Oesophageal squamous cell PEUGIC were associated with less time allocated per endoscopy OR 1.28 (95% CI 1.03-1.59). Endoscopy providers with lower number of procedures during an endoscopy session were associated more frequently with adequate management of lesions OR 2.6 (95% CI 1.03-6.87). Patient harm and adverse treatment outcomes were associated with an inadequate index endoscopy OR 1.56 (95% CI 1.28-1.91). The most common reason for inadequate endoscopy was inadequate management of lesions identified, which were most likely to be cancer associated lesions OR 1.43 (95% CI 1.11-1.69), specifically oesophageal strictures (24%) and gastric ulcers (23%).
For surveillance PEUGIC, organisational factors associated with increased detection of stage 1 (success of surveillance) PEUGIC compared with stage ≥2 were: dedicated surveillance sessions OR 2.08 (95% CI 1.46-2.98), >20 minutes allocated per endoscopy OR 2.05 (95% CI 1.48-2.84) and surveillance in an endoscopic resection centre OR 3.50 (95% CI 1.99-6.13).
Booking delays and errors were noted in 12% of PEUGIC, patient factors (e.g. non-attendance) were noted in 11% and clinical error in 11.7% (inappropriate decision 7.5% and histology not actioned in 4.2%). Surveillance was delayed in 27% of PEUGIC and associated with adverse treatment outcomes OR 1.79 (95%CI 1.72-2.73).

Conclusion

A survey of endoscopy providers’ organisational structure has revealed factors which contribute to PEUGIC not captured during individual root cause analysis. Less time allocated for endoscopy was associated with no abnormalities being found during endoscopies that lead to PEUGIC. Surveillance outcomes were better in patients who had their endoscopies in dedicated surveillance sessions, with more time allocated and undertaken in endoscopic resection centres. Surveillance delays are common and associated with worse outcomes.

ORGANISATIONAL FACTORS ASSOCIATED WITH POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER (PEUGIC): RESULTS OF THE ENGLISH NATIONAL PEUGIC PROJECT

Amar Srinivasa 1, Rebeca Fiadeiro 2, Karen Clements 2, Tameera Rahman 2, Shilpi Goel 2, Tim Gentry 2, Nicholas E Burr 3, Matthew Banks 4, Anjan Dhar 5, Chris Healey 6, Mimi McCord 7, Dipankar Mukherjee 8, warren chapman 9, Roland Valori 10, Nigel Trudgill 11

1 Sandwell and West Birmingham NHS Trust, Birmingham, 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 Darlington Memorial & Bishop Auckland Hospitals, Darlington, United Kingdom

6 Airedale Nhs foundation trust, Airdale, United Kingdom

7 Heartburn Cancer UK, Basingstoke, United Kingdom

8 Barking, Havering And Redbridge University Hospitals NHS Trust, Romford, United Kingdom

9 University Hospitals NHS Foundation Trust, Birmingham, United Kingdom

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

11 Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

DECREASED RISK OF OESOPHAGEAL AND GASTRIC CANCER AMONG USERS OF MENOPAUSAL HORMONE THERAPY IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

Not sure what you can access? Learn more about account types.

Introduction

The incidence of oesophago-gastric cancer has an age-dependent male predominance mirroring physiological changes in sex hormonal levels. Some previous studies suggest that menopausal hormone therapy (MHT) counteracts the occurrence of these tumours, but larger studies with longer follow-up and adjustment for confounders are needed, which prompted the present study.

Aims & Methods

To investigate the hypothesis that MHT decreases the risk of developing oesophago-gastric cancer, especially oesophageal adenocarcinoma.
This population-based case-control study included women aged ≥45 years in all five Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) between 1995-2020. Prospectively collected data came from national complete registries for medications, cancer, diagnoses, total populations, and death. The study included 19,518 case patients with oesophago-gastric cancer and 195,094 randomly identified control participants matched for age, country and calendar year. The participants were categorised into three equal-sized groups (tertiles) of defined daily doses (DDD) of MHT, with non-users as the reference group. MHT was also categorized as systemic or local, and oestrogen only or oestrogen combined with progesterone MHT. Oesophago-gastric cancer was divided into oesophageal or cardia adenocarcinoma, oesophageal squamous cell carcinoma, and gastric non-cardia adenocarcinoma as separate outcomes. Conditional logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), adjusted for age, calendar year, country, obesity, gastroesophageal reflux disease, smoking, alcohol, Helicobacter pylori eradication, use of statins and non-steroidal anti-inflammatory drugs.

Results

Compared to non-users of MHT, the adjusted ORs of oesophageal or cardia adenocarcinoma were 0.74 (95% CI 0.67-0.81) for low MHT-use (<158 DDDs), 0.68 (95% CI 0.61-0.75) for intermediate MHT-use (158-848 DDDs), and 0.68 (95% CI 0.61-0.75) for high MHT-use (>848 DDDs). The corresponding ORs were 0.69 (95% CI 0.62-0.77), 0.70 (95% CI 0.62-0.77), and 0.71 (95% CI 0.64-0.79) for oesophageal squamous cell carcinoma, and 0.90 (95% CI 0.84-0.96), 0.85 (95% CI 0.79-0.91), and 0.80 (95% CI 0.74-0.86) for gastric non-cardia adenocarcinoma.

Table. Odds ratios (OR) and 95% confidence intervals (CI) of oesophago-gastric cancer by tertiles of defined daily doses (DDD) of menopausal hormone therapy (MHT), MHT hormonal constitution and administration of MHT.

	Oesophageal and cardia adenocarcinoma	Oesophageal sqamous cell carcinoma	Gastric adenocarcinoma
MHT DDD's
<158	0.74 (0.67-0.81)	0.69 (0.62-0.77)	0.90 (0.84-0.96)
158-848	0.68 (0.61-0.75)	0.70 (0.62-0.77)	0.85 (0.79-0-91)
>848	0.68 (0.61-0.75)	0.71 (0.64-0.79)	0.80 (0.74-0.86)
MHT formulation, type
Oestrogen	0.77 (0.69-0.87)	0.77 (0.68-0.87)	0.88 (0.81-0.97)
Combined	0.68 (0.63-0.73)	0.68 (0.63-0.73)	0.85 (0.80-0.89)
Systemic	0.67 (0.61-0.74)	0.71 (0.65-0.78)	0.82 (0.76-0.88)
Local	0.72 (0.66-0.78)	0.69 (0.63-0.75)	0.87 (0.83-0.92)

Conclusion

This study provides support for the hypothesis of an inverse association between MHT and risk of developing oesophago-gastric cancer, and particularly for oesophageal adenocarcinoma where the association was seemingly dose-dependent and stronger for combined oestrogen and progesterone MHT and for systemic MHT. A limitation to the study was the inability to adjust for socioeconomic factors as confounders.

DECREASED RISK OF OESOPHAGEAL AND GASTRIC CANCER AMONG USERS OF MENOPAUSAL HORMONE THERAPY IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

Victoria Wocalewski 1, Giola Santoni 1, Helgi Birgisson 2, My von Euler-Chelpin 3, Joonas Kauppila 4, Eivind Ness-Jensen 5, Shao-Hua Xie 1, Jesper Lagergren 6

1 Karolinska Institutet, Stockholm, Sweden

2 The Icelandic Cancer Registry, Reykjavik, Iceland

3 University of Copenhagen, Copenhagen, Denmark

4 Karolinska Institutet, Stockholm, Sweden|||Oulu University Hospital and University of Oulu, Oulu, Finland

5 Karolinska Institutet, Stockholm, Sweden|||Levanger Hospital, Levanger, Norway|||NTNU, Norwegian University of Science and Technology, Levanger, Norway

6 Karolinska Institutet, Stockholm, Sweden|||Kings College London, London, United Kingdom