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PEUGIC Root Cause Analysis


15,800 people in the UK are diagnosed with oesophageal or stomach (together termed upper gastrointestinal) cancer every year. Endoscopy is the main diagnostic test that is used to identify gastrointestinal cancers but it is not perfect and sometimes a cancer, or lesion that may turn into cancer, is not found. This is known as post-endoscopy upper gastrointestinal cancer (PEUGIC). The earlier gastrointestinal cancers are identified, the more treatable they are and the better the outcome. Previous research has shown that rate of PEUGICs varies between endoscopists and endoscopy providers. This project aims to investigate the causes of missed cancers at endoscopy by investigating PEUGICs within each endoscopy service. 

Further details:

This research will build on lessons learned from the recent Post Colonoscopy Colorectal Cancer Audit. An online root cause analysis form to review PEUGIC cases will be created by adapting data extraction and software methods previously developed for the National Cancer Diagnosis Audit. Using the root cause analysis form, all endoscopy units in England will review cases and the data collected will be extracted and analysed to get a national understanding of why PEUGICs occur.  


2022 – 2024 

Desired Outcomes: 

  1. Publication of aggregated analysed data inserted into the root cause analysis portal by individual trusts for a more complete picture of why PEUGICs occur that can be shared across the NHS to enable endoscopy services to address causes of PEUGIC  
  2. Making the root cause analysis portal available for continued use once it is fully developed and has been rolled out nationally. Root cause analysing PEUGIC cases using the form can is recognised by the Joint Advisory Group on Upper Gastrointestinal Endoscopy in the accreditation process for participating services 
  3. A dedicated website for the project which will be used to host background information about the project and to promote outputs from this project. It is hoped that this will be referenced and linked to by potential sponsors, Public Patient Involvement partners, or publishers of the project’s scientific output.


  • May – July 2023: Pilot phase with 13 NHS England endoscopy units across all seven NHS-E regions with 222 PEUGIC cases reviewed
  • October 2023: National roll out to all NHS England endoscopy units to review over 3000 cases

In collaboration with: 

Supported by a NIHR Research for Patient Benefit Grant, Lead by Sandwell and West Birmingham NHS Trust (Prof. Nigel Trudgill, Warren Chapman and Dr.Amar Srinivasa); Mid Yorkshire Hospitals NHS Trust (Dr. Nick Burr); Gloucestershire Hospitals NHS Foundation Trust (Dr. Roland Valori); The JAG and Airedale NHS Foundation Trust (Dr. Chris Healey); University College Hospitals NHS Foundation Trust (Dr. Matthew Banks); Portsmouth Hospitals NHS Trust (Dr. Pradeep Bhandar); Barking, Havering And Redbridge University Hospitals NHS Trust (Dr. Dipankar Mukherjee); University of Oxford (Prof. Eva Morris), NDRS in NHS E and Heartburn Cancer UK (Mimi McCord) .

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