Post Capsule Endoscopy Small Bowel Cancer Rate-An Australian Data Linkage Analysis

Area of Science:

• Gastroenterology
• Oncology
• Diagnostic Imaging

Background:

• Small bowel capsule endoscopy (CE) is crucial for diagnosing small bowel pathology.
• Limited research exists on the diagnostic miss rate of small bowel cancer using CE.
• A novel root-cause analysis (RCA) method was employed to evaluate missed cancers.

Purpose of the Study:

• To assess the risk of developing small bowel cancer within 36 months of a cancer-negative CE (PCSBC-3Y).
• To utilize a novel root-cause analysis (RCA) method for evaluating missed small bowel cancers.

Main Methods:

• A prospective CE database and state cancer registry data were linked for patients undergoing CE (2007-2019).
• Small bowel cancers were categorized as 'detected' (from CE) or 'missed' (diagnosed within 36 months post-CE).
• All PCSBC-3Y cases underwent RCA for detailed evaluation.

Main Results:

• Twenty small bowel cancers were diagnosed within 36 months of CE; 18 were detected, and 2 were missed.
• The overall PCSBC-3Y rate was 10% (95% CI 2.6-28.7%).
• RCA determined the two missed cancers (jejunal GIST, duodenal adenocarcinoma) were unavoidable upon retrospective review.

Conclusions:

• Introduces the PCSBC-3Y rate and a novel RCA algorithm for evaluating missed small bowel cancers.
• The PCSBC-3Y rate in this quaternary referral CE cohort was 10%.
• The study suggests that missed small bowel cancers identified via RCA were unavoidable in this cohort.