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Quality control in upper gastrointestinal endoscopy: detection rates of gastric cancer in Oxford 2005–2008
  1. S Vradelis1,2,
  2. N Maynard3,
  3. B F Warren4,
  4. S Keshav1,
  5. S P L Travis1
  1. 1Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Upper Gastrointestinal Surgery, Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
  4. 4Department of Internal Medicine, General University Hospital of Alexandroupolis, Democritus University of Thrace, Region Dragana, Alexandroupolis, Greece
  1. Correspondence to Dr S P L Travis, Gastroenterology Unit, John Radcliffe Hospital, Oxford OX3 9DU, UK; simon.travis{at}


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%.

  • Adult gastroenterology
  • endoscopy
  • gastrointestinal tumours
  • clinical audit
  • quality in healthcare

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.