Time To Start Paying Attention to Postendoscopy Upper GI Cancers

Time To Start Paying Attention to Postendoscopy Upper GI Cancers

Prateek Sharma, MD, FASGE, reviewing Kamran U, et al. Endoscopy 2023 Feb.

Upper gastrointestinal cancers (UGICs) are typically diagnosed through endoscopy, but some cases may be missed and diagnosed later, known as postendoscopy UGICs (PEUGICs). PEUGICs are becoming a more significant concern, with rates ranging from 6.7% to 9.4%. Factors associated with PEUGICs include younger age, female sex, lack of access to endoscopy, and inadequate biopsies. A systematic analysis of the cause is lacking in our current literature. 

The study developed a system for root cause analysis of missed UGIC at endoscopy, defined as PEUGIC, and examined the electronic records of patients with UGIC at 2 National Health Service providers. Of the 1327 UGICs studied, 89 (6.7%) were PEUGICs. The study categorized PEUGICs into 6 categories and found that 71% of PEUGICs were potentially avoidable. The study also found a negative correlation between endoscopists‘ mean annual number of endoscopies and the technically attributable PEUGIC rate. The study suggests that root cause analysis can standardize future investigation of PEUGIC and guide quality improvement efforts.

Prateek Sharma, MD, FASGE


Postendoscopy upper gastrointestinal cancers are linked to inadequate assessment or decision-making concerning premalignant, focal, or cancer-associated lesions. A systematic approach using a root cause analysis framework can differentiate the technical, endoscopic, decision-making, and administrative factors that can lead to missing UGICs and guide quality improvement efforts to reduce the PEUGIC rate.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Kamran U, King D, Abbasi A, et al. A root cause analysis system to establish the most plausible explanation for post-endoscopy upper gastrointestinal cancer. Endoscopy 2023;55:109-118. (https://doi.org/10.1055/a-1917-0192)


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