Differences in endoscopy characteristics between providers with the highest and lowest Post Endoscopy Upper Gastrointestinal Cancer rates in England

Background
Post-endoscopy upper gastrointestinal cancer (PEUGIC) rates vary over threefold between endoscopy providers in England. To determine if variations in endoscopy characteristics contribute, providers with the lowest and highest PEUGIC rates were compared.

Methods
Endoscopy providers were categorised into quartiles based on PEUGIC rates and those in the highest and lowest quartiles studied. Data for diagnostic upper gastrointestinal (UGI) endoscopies performed between January 2019 and February 2020 extracted from the National Endoscopy Database. Multivariable regression analysis explored the endoscopy characteristics associated with the lowest PEUGIC rate providers, after adjusting for patient characteristics and indications.

Results
In total, 328,354 diagnostic UGI endoscopies performed by 54 providers were included. Endoscopy characteristics positively associated with the lowest PEUGIC rate providers included: training sessions (Odds Ratio 1.85 (95% CI 1.81-1.90)); intravenous sedation use (1.09 (1.07-1.11)); endoscopist average UGI endoscopy annual volume 101-200 (1.05 (1.02-1.07) and 201-300 (1.16 (1.13-1.19)). Endoscopy characteristics inversely associated with the lowest PEUGIC rate providers included: endoscopy half-day sessions with average ≥9 points (0.72 (0.71-0.74)); endoscopists not on nursing, specialty or trainee register (0.83 (0.81-0.85)); and biopsies during endoscopy (0.84 (0.83-0.86)). Compliance with national quality standards to biopsy high risk conditions was better by providers with lowest PEUGIC rates.

Discussion
Training sessions, more endoscopists with minimum annual endoscopy volumes >100, more intravenous sedation, less biopsies and more lower intensity endoscopy sessions were associated with the lowest PEUGIC rate providers. These findings may help guide efforts to reduce PEUGIC and improve endoscopy quality in future.