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Lookup NU author(s): Professor Matt Rutter, Dr David Beaton
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology. 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.
Author(s): Kamran U, Evison F, Morris EJA, Brookes M, Rutter M, Beaton D, McCord M, Adderley NJ, Trudgill N
Publication type: Article
Publication status: Published
Journal: United European Gastroenterology Journal
Year: 2026
Volume: 14
Issue: 3
Online publication date: 02/04/2026
Acceptance date: 10/03/2026
Date deposited: 14/04/2026
ISSN (print): 2050-6406
ISSN (electronic): 2050-6414
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1002/ueg2.70206
DOI: 10.1002/ueg2.70206
Data Access Statement: The data that support the findings of this study are not available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. We are grateful to the Joint Advisory Group on GI Endoscopy for access to data from the National Endoscopy Database.
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