A root cause analysis system to establish the most plausible explanation for post-endoscopy upper gastrointestinal cancer.
Endoscopy
; 55(2): 109-118, 2023 02.
Article
em En
| MEDLINE
| ID: mdl-36044914
ABSTRACT
BACKGROUND:
Missing upper gastrointestinal cancer (UGIC) at endoscopy may prevent curative treatment. We have developed a root cause analysis system for potentially missed UGICs at endoscopy (post-endoscopy UGIC [PEUGIC]) to establish the most plausible explanations.METHODS:
The electronic records of patients with UGIC at two National Health Service providers were examined. PEUGICs were defined as UGICs diagnosed 6-36 months after an endoscopy that did not diagnose cancer. An algorithm based on the World Endoscopy Organization post-colonoscopy colorectal cancer algorithm was developed to categorize and identify potentially avoidable PEUGICs.RESULTS:
Of 1327 UGICs studied, 89 (6.7â%) were PEUGICs (patient median [IQR] age at endoscopy 73.5 (63.5-81.0); 60.7â% men). Of the PEUGICs, 40â% were diagnosed in patients with Barrett's esophagus. PEUGICs were categorized as A - lesion detected, adequate assessment and decision-making, but PEUGIC occurred (16.9â%); B - lesion detected, inadequate assessment or decision-making (34.8â%); C - possible missed lesion, endoscopy and decision-making adequate (8.9â%); D - possible missed lesion, endoscopy or decision-making inadequate (33.7â%); E - deviated from management pathway but appropriate (5.6â%); F - deviated inappropriately from management pathway (3.4â%). The majority of PEUGICs (71â%) were potentially avoidable and in 45â% the cancer outcome could have been different if it had been diagnosed on the initial endoscopy. There was a negative correlation between endoscopists' mean annual number of endoscopies and the technically attributable PEUGIC rate (correlation coefficient -0.57; Pâ=â0.004).CONCLUSION:
Missed opportunities to avoid PEUGIC were identified in 71â% of cases. Root cause analysis can standardize future investigation of PEUGIC and guide quality improvement efforts.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Esôfago de Barrett
/
Neoplasias Esofágicas
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Neoplasias Gastrointestinais
Limite:
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article