Discharging the duty of candor following delayed post-endoscopy cancer diagnosis

Endoscopic examination is not risk free. Not only are there well-known complications associated with the procedure, but malignant and pre-malignant lesions can be missed due to human factors or failures in organizational process. Duty of candor (DoC) is a legal requirement if significant harm occurs in delivery of healthcare. Post-colonoscopy colorectal cancer (PCCRC) and post-endoscopy upper gastrointestinal cancer (PEUGIC) audits have identified missed diagnoses that are associated with harm and require consideration of DoC. This article explores the new and unique challenges associated with DoC in endoscopy audits. There are unresolved questions around the place of DoC in retrospective audits, agreement of harm thresholds, and constitution of review teams. Involved departments must be committed to transparency and trained in governance processes. Fear of institutional and personal reputational damage, as well as future litigation, may influence decisions. Patient expectations need to be clarified, as do supportive structures for individual endoscopists who will be involved in DoC processes when significant lesions have been missed. Further consensus around DoC is required so that clear guidance can be given to endoscopy units.