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 categorized into quartiles based on PEUGIC rates and those in the highest and lowest quartiles studied. Data for diagnostic upper gastrointestinal (UGI) endoscopy performed between January 2019 and February 2020 were 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 endoscopy 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 in providers with the lowest PEUGIC rates. DISCUSSION: Training sessions, more endoscopists with minimum annual endoscopy volumes > 100, more intravenous sedation, less biopsies and 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 the future.