Missed cancers in Wexford prompt changes for endoscopies

HSE review of BowelScreen service at Wexford General Hospital results in 10 recommendations.

A HSE review prompted by 13 missed cancer cases at Wexford General Hospital and one death has led to 10 recommendations for the country’s endoscopy services.

In October 2014, two cases of caecal cancer were detected in patients who had recently undergone a colonoscopy, but were not diagnosed at that time. Both those patients had been screened by the same endoscopist.

Agreement was reached between the hospital, BowelScreen, and the consultant that, until reviews of the cases were undertaken, the consultant would stop performing BowelScreen colonoscopies.

All BowelScreen colonoscopy reports since the programme commenced were also reviewed.

That review revealed that there was no evidence the caecum — a pouch at the beginning of the large intestine — was reached in roughly 30% of the consultant’s screening colonoscopies, the area where the cancer had been detected in the two patients.

The consultant has been on leave since 2015.

A Safety Incident Management Team (SIMT) was assembled, made up from members of BowelScreen, medical professionals, and patient focus representatives.

All colonoscopy patients under the consultant’s care between March 2013 and November 2014 and their GPs were contacted.

A total of 615 patients were recalled, 401 of whom, following review, were deemed necessary to have a repeat colonoscopy which were carried out at St Vincent’s University Hospital and the Mater Misericordiae University Hospital in Dublin, as well as Wexford General Hospital.

The re-tests detected 13 cancers, including the case of one man who died before the “lookback” began.

In addition to those patients diagnosed with cancer, a number of patients were referred for surgical removal of polyps, which were subsequently found to be benign, or were placed on appropriate surveillance.

“The clinical subgroup of the SIMT for this lookback has categorised all cancers detected as ‘probable missed’,” said the HSE.

A 70-page report on the review and its 10 recommendations had been given to patients and their families in the last couple of days before being published.

Those recommendations include that the endoscopy service must develop a competency framework and that, until an appropriate national framework has been agreed, “BowelScreen should continually review/update appropriate methods of assurance regarding competency in endoscopy from individual endoscopists before participation in the BowelScreen programme”.

It also says the quality of BowelScreen and symptomatic endoscopy activity should be audited at unit and individual endoscopist level and that each unit should be held accountable for local audits.

In relation to the Wexford incidents, a spokesperson said: “The HSE is assured that services are operating to a high standard, but given the gravity and scale of this incident, the HSE is commissioning an external expert to review the quality assurance measures put in place and the overall management of the incident.”