Kamran Umair, Evison Felicity, Morris Eva Judith Ann, Brookes Matthew J, Rutter Matthew David, McCord Mimi, Adderley Nicola J, Trudgill Nigel
Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland.
Data Science, Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland.
Endoscopy. 2025 Jan;57(1):17-28. doi: 10.1055/a-2378-1464. Epub 2024 Aug 29.
Post-endoscopy upper gastrointestinal cancer (PEUGIC) is an important key performance indicator for endoscopy quality. We examined variation in PEUGIC rates among endoscopy providers in England and explored associated factors.
The was a population-based, retrospective, case-control study, examining data from National Cancer Registration and Analysis Service and Hospital Episode Statistics databases for esophageal and gastric cancers diagnosed between 2009 and 2018 in England. PEUGIC were cancers diagnosed 6 to 36 months after an endoscopy that did not diagnose cancer. Associated factors were identified using multivariable logistic regression analyses.
The national PEUGIC rate was 8.5%, varying from 5% to 13% among endoscopy providers. Factors associated with PEUGIC included: female sex (odds ratio [OR] 1.29 [95%CI 1.23-1.36]); younger age (age >80 years, OR 0.52 [0.48-0.56], compared with ≤60 years); increasing comorbidity (Charlson score >4, OR 5.06 [4.45-5.76]); history of esophageal ulcer (OR 3.30 [3.11-3.50]), Barrett's esophagus (OR 3.21 [3.02-3.42]), esophageal stricture (OR 1.28 [1.20-1.37]), or gastric ulcer (OR 1.55 [1.44-1.66]); squamous cell carcinoma (OR 1.50 [1.39-1.61]); and UK national endoscopy accreditation status - providers requiring improvement (OR 1.10 [1.01-1.20]), providers never assessed (OR 1.24 [1.04-1.47]).
PEUGIC rates varied threefold among endoscopy providers, suggesting unwarranted differences in endoscopy quality. PEUGIC was associated with endoscopy findings known to be associated with upper gastrointestinal cancer and a lack of national endoscopy provider accreditation. PEUGIC variations suggest an opportunity to raise performance standards to detect upper gastrointestinal cancers earlier and improve outcomes.
内镜检查后上消化道癌（PEUGIC）是内镜检查质量的一项重要关键绩效指标。我们研究了英格兰内镜检查提供者之间PEUGIC发生率的差异，并探讨了相关因素。
这是一项基于人群的回顾性病例对照研究，研究数据来自国家癌症登记与分析服务以及医院事件统计数据库，涉及2009年至2018年在英格兰诊断出的食管癌和胃癌。PEUGIC是指在内镜检查未诊断出癌症6至36个月后诊断出的癌症。使用多变量逻辑回归分析确定相关因素。
全国PEUGIC发生率为8.5%，内镜检查提供者之间的发生率在5%至13%之间。与PEUGIC相关的因素包括：女性（比值比[OR]1.29[95%置信区间1.23 - 1.36]）；年龄较小（年龄>80岁，OR 0.52[0.48 - 0.56]，与≤60岁相比）；合并症增加（Charlson评分>4，OR 5.06[4.45 - 5.76]）；食管溃疡病史（OR 3.30[3.11 - 3.50]）、巴雷特食管（OR 3.21[3.02 - 3.42]）、食管狭窄（OR 1.28[1.20 - 1.37]）或胃溃疡病史（OR 1.55[1.44 - 1.66]）；鳞状细胞癌（OR 1.50[1.39 - 1.61]）；以及英国国家内镜检查认证状态——需要改进的提供者（OR 1.10[1.01 - 1.20]）、从未接受评估的提供者（OR 1.24[1.04 - 1.47]）。
内镜检查提供者之间的PEUGIC发生率相差三倍，表明内镜检查质量存在不必要的差异。PEUGIC与已知与上消化道癌相关的内镜检查结果以及缺乏国家内镜检查提供者认证有关。PEUGIC的差异表明有机会提高绩效标准，以便更早地检测上消化道癌并改善治疗结果。
