Endoscopy in 2017: a national survey of practice in the UK

Shenbagaraj, Lavanya; Thomas-Gibson, Siwan; Stebbing, Justin; Broughton, Raphael; Dron, Michael; Johnston, Debbie; Shaw, Tim; Haboubi, Hasan; Green, John T.

doi:10.1136/flgastro-2018-100970

Cited by 83 publications

(79 citation statements)

References 10 publications

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“…The variation in number and types of procedures performed during a standard 4-hour endoscopy session was used as a surrogate marker for the workload of endoscopists. In addition, this is also presented using a point system (one point equivalent to a 20 min unit of time), described by the UK JAG 1 28. Gastroscopy is assigned one point; colonoscopy, two points; a planned therapeutic intervention attracts an additional point and both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound acquire three points.…”

Section: Methodsmentioning

confidence: 99%

“…Gastroscopy is the most common procedure performed in gastrointestinal endoscopy units,1 and there has been an over 40% increase in gastroscopies and over 80% increase in colonoscopies performed in the UK in the last 10 years 2. These gastroscopies are normal or yield benign pathology in the majority, however oesophagogastric (OG) cancer is diagnosed in between 1% and 2%, depending on the indication of procedure, and diagnostic yield has remained relatively static 3.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

Tai

Wray

Sidhu

et al. 2019

Frontline Gastroenterol

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IntroductionThere is increasing demand for gastroscopy in the United Kingdom. In around 10% of patients, gastroscopy is presumed to have missed oesophagogastric (OG) cancer prior to diagnosis. We examine patient, endoscopist and service level factors that may affect rates of missed OG cancers.MethodsGastroscopies presumed to have missed OG cancers performed up to 3 years prior to diagnosis were identified over 6 years in Sheffield, UK. Factors related to the patient, endoscopist and endoscopy lists were examined in a case–control study. Procedures which missed cancer were compared with two procedure controls: the procedures which subsequently diagnosed cancer in the same patient, and second, endoscopist matched procedures diagnostic of small benign focal lesions.ResultsWe identified 48 (7.7%) cases of missed OG cancer. Endoscopy lists on which OG cancer diagnoses were missed contained a greater number of total procedures compared with lists on which diagnoses were subsequently made (OR 1.42 95% CI 1.13 to 1.78) and when compared with lists during which matched endoscopists diagnosed benign small focal lesions (OR 1.25, 95% CI 1.02 to 1.52). The use of sedation, endoscopist profession and experience, or time of procedure were not associated with a missed cancer.Conclusion7.7% of patients diagnosed with OG cancer could have been diagnosed and treated earlier. Our study suggests that endoscopy lists with greater numbers of procedures may be associated with missed OG cancers. The use of sedation, endoscopist background or time of procedure did not increase the risk of missed cancer procedures.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

Tai

Wray

Sidhu

et al. 2019

Frontline Gastroenterol

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“…47 In the UK, increasing diagnostic activity in the UK related to 'alarm' symptoms with a PPV ≥ 3% is already stretching diagnostic capacity. 48,49 In this study the approximate PPVs for a cancer diagnosis within 3 months in men aged ≥50 years and women aged ≥70 years with unexpected weight loss were 2.4% and 1.5%, respectively, rising to 3.0% and 1.9% over a 6-month period. Research is urgently required to identify patients with unexpected weight loss at greatest risk of cancer and other serious diseases to Fig.…”

Section: Implications For Research and Practicementioning

confidence: 60%

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

et al. 2020

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Background We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. Methods This retrospective matched cohort study used cancer registry linked electronic health records from the UK’s Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage. Results In all, 63,973 patients had UWL recorded, of whom 1375 (2.2%) were diagnosed with cancer within 2 years (days-to-diagnosis: mean 181; median 80). Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. The association was greatest in men aged ≥50 years and women ≥70 years. The commonest cancers were pancreas, cancer of unknown primary, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel and renal-tract. The majority were late-stage, but there was some evidence of association with stage II and stage III cancers. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators. Conclusion UWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage.

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“…A recent nationwide survey identified the significantly increasing demand and lack of capacity in endoscopy 7. Together with increasingly therapeutic and complex procedures, these pressures will inevitably play a role in the quality and safety of endoscopy 8…”

Section: Introductionmentioning

confidence: 99%

Improving safety and reducing error in endoscopy: simulation training in human factors

Ravindran

Thomas-Gibson

Murray

et al. 2019

Frontline Gastroenterol

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Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in ‘human factors’ have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

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Endoscopy in 2017: a national survey of practice in the UK

Cited by 83 publications

References 10 publications

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

Improving safety and reducing error in endoscopy: simulation training in human factors

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