Quality control in upper gastrointestinal endoscopy: detection rates of gastric cancer in Oxford 2005-2008.

Journal article

BACKGROUND: Gastric cancer (GC) represents the sum of advanced gastric cancer (AGC) and early gastric cancer (EGC). Endoscopy (with biopsies) is the gold standard for detection of GC, but a false-negative rate of up to 19% is reported. AIM: To determine whether patients with GC had had an oesophagogastroduodenoscopy (OGD) in the year preceding diagnosis that might reasonably have been expected to detect the cancer, as a measure of quality assurance of endoscopic practice. METHODS: Patients with histologically proven GC were identified from pathology records. Endoscopy reports and case notes were examined to identify any OGD before diagnosis, the interval and endoscopic findings. A false-negative OGD was defined as one where GC was neither suspected nor shown at pathology, but where a diagnosis of GC was made within 12 months. RESULTS: Between January 2005 and February 2008, 9764 OGDs were performed. GC was diagnosed in 74 patients (male/female ratio 2.89; median age 76, range 38-95). Nine (12%) patients had EGC. There were no differences in age, sex or symptoms between the EGC and AGC group. Sixty-eight of the 74 patients with GC (92%) presented with alarm symptoms. Ten of the 74 had had an OGD within 12 months before definitive diagnosis; all these were planned because of suspicious lesions. Significantly fewer biopsies were performed at OGDs preceding definitive diagnosis (median 2 (0-10) vs 6 (2-12); p=0.002). CONCLUSION: False-negative rates of 0% (within 12 months) and 8% (within 3 years) for diagnosis of GC are reassuring, but an inadequate number of biopsies compromises the quality assurance of endoscopy. GC presents without alarm symptoms in <10%.

Authors: Vradelis, S; Maynard, N; Warren, B; Keshav, S; Travis, S

• Publication status: Published
• Journal: Postgraduate medical journal
• Volume: 87
• Issue: 1027
• Pages: 335-339
• Publication date: 2011-05-01
• DOI: 10.1136/pgmj.2010.101832
• EISSN: 1469-0756
• ISSN: 0032-5473
• Language: English
• Keywords: False Negative Reactions; Time Factors; Endoscopy, Digestive System; Early Detection of Cancer; Quality Control; Treatment Outcome; Adult; Middle Aged; Aged; Stomach Neoplasms; Male; Clinical Competence; Aged, 80 and over; England; Humans; Female; Biopsy