ABSTRACT
Introduction Missed upper gastrointestinal (GI) cancers are associated with poorer survival outcomes. Missed cancer is defined as having had a negative upper GI endoscopy within three years of confirmatory diagnosis. The aims of this study are to quantify cases of missed upper GI cancer at endoscopy from a district general hospital and identify potential predisposing factors to improve future outcomes. Methods In this project, retrospective patient records were obtained from MDT meetings run between 2019 and 2020. For data comparison, similar records from previous cohorts were reviewed. The endoscopy records of these patients were extracted from the CIPTS endoscopy recording system and analysed to see if any patient had an endoscopy within the three years prior to diagnosis of their upper GI cancer. Previous endoscopies were scrutinised for the following factors: indication, visible abnormality, biopsy, endoscopist grade, sedation, presentation type, histology and follow up. Results Of the 280 patients in total, 20 (7.1%) had a negative endoscopy in three years prior to diagnosis. Subgroup analysis of 2019-20 patients showed identified 78 cases of upper GI cancer. We identified five formal cases of missed upper GI cancer in this subgroup. In the 2019-20 cohort the average age in the missed cancer group and non-missed cancer group were 83.8 and 73.2 years, respectively. Factors identified in missed cancer groups from earlier cohorts included emergency bleeding, visible abnormality not biopsied, administrative delay in rescope and lack of recognition of pathology. Conclusions The incidence of missed upper GI cancer diagnosis within this centre is similar to that of recent studies from other centres. Our study has highlighted that advanced age, accurate recognition and biopsy, and timely re-biopsy may be factors influencing missed upper GI cancers. This evidence has highlighted the importance of endoscopy training in the recognition and biopsy of pre neoplastic lesions. Furthermore, we intend to analyse data for the year 2020-21 to monitor the impact of COVID-19 on missed upper GI cancer diagnosis.