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TOPLINE:

A consensus on major and minor key performance indicators (KPIs) was established to improve the quality of upper gastrointestinal (GI) endoscopy and reduce post-endoscopy upper GI cancer. The adoption of the proposed recommendations could minimise the threefold variation in post-endoscopy cancer rates among providers in England.

METHODOLOGY:

• Researchers identified potential KPIs from the systematic review (up to December 2021), National Cancer Registry and Hospital Episode Statistics Database Analysis, and National Endoscopy Database Analysis.
• The cancer registry analysis included the data of 98,801 patients diagnosed with upper GI cancer within 3 years of a cancer-negative endoscopy in England between 2009 and 2018.
• Researchers used the modified nominal group technique through two online workshops moderated by James Lind Alliance facilitators. Overall, this study included 14 clinicians, three nurse endoscopists, two upper GI cancer nurse specialists, 14 patients and their relatives and representatives, and four observers.
• KPIs were categorised as endoscopy provider or endoscopist/procedure related.
• The ranking of KPIs was based on their relative importance in reducing post-endoscopy upper GI cancer, where the top 10 with lower scores were designated as major indicators and the remaining ones minor.

TAKEAWAY:

• Four major provider-related KPIs were identified, of which the monitoring of post-endoscopy upper GI cancer rates with minimum standards of 7% or less and maintaining less intense endoscopy lists with less than 10 points per list were ranked the highest.
• A total of six major endoscopist-related KPIs were specified, of which adequate examination time of at least 7 minutes and dedicated training in the recognition of early upper GI neoplasia were ranked the highest.
• Five KPIs were ranked as minor, which included the detection rate for premalignant conditions, use of image enhancement techniques, photo documentation of anatomical sites for minimum standards of more than 90% of diagnostic upper GI endoscopies, neoplasia detection rate, and use of artificial intelligence.

IN PRACTICE:

"This consensus provides a list of major and minor KPIs to improve the quality of endoscopy and reduce PEUGIC [post-endoscopy upper GI cancer]," the authors wrote, suggesting that, "this framework will enable endoscopy providers to monitor their performance and ensure the provision of a high-quality UGI endoscopy service for their patients."

SOURCE:

This study was led by Umair Kamran, Sandwell and West Birmingham NHS Trust, Birmingham, England. It was published online on July 24, 2025, in United European Gastroenterology Journal.

LIMITATIONS:

Most of the evidence examined was graded as low-to-moderate quality due to the lack of well-designed trials. The applicability of the recommendations may be limited outside the UK because the consensus included only UK participants. Additional limitations included insufficient evidence to suggest minimum standards for some measures and bias in consensus statements due to weak evidence. 

DISCLOSURES:

This study received funding from the National Institute for Health and Care Research under its Research for Patient Benefit Programme. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.