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Early Cancer Institute


Oesophago-gastric cancer has very poor prognosis. One of the reasons for this is that the majority of these cancers are diagnosed at late stage, when oncological therapies are unlikely to cure the disease. Despite the perpetual increase in the referral rate for upper GI endoscopy, there is evidence that about 11% of upper GI cancers are missed at previous endoscopies. Some of the premalignant conditions such as gastric atrophy/intestinal metaplasia and oesophageal dysplasia are difficult to diagnose. There are no accepted diagnostic key performance indicators to rate performance in routine upper GI endoscopy and the published quality standards for upper GI endoscopy do not reflect detection rate of pathologies. This is due to the fact that there is limited evidence on the true prevalence of upper GI premalignant conditions in patients referred for upper GI endoscopy.

In the PROSPERO study we prospectively recruit patients undergoing upper GI endoscopy with no known premalignant conditions of the upper GI tract. We perform a standardised endoscopy protocol to determine the true estimate of the prevalence of premalignant upper GI conditions. This study will inform future development of diagnostic key performance indicators in upper GI endoscopy which are priorities for the quality assurance bodies of British Society of Gastroenterology (BSG) and Joint Advisory Group for GI endoscopy (JAG).

Chief Investigator: Dr Massimiliano di Pietro

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