Provide a brief overview of the diagnostic pathway for upper gastrointestinal (GI) cancer. Audit the imaging of confirmed upper GI cancer patients to assess the role of barium studies in diagnosis. Audit referrals for barium studies to assess if clinicians are correctly applying guidelines.

Prompt investigation with oesophago-gastroduodenoscopy (OGD) and tissue biopsy are vital for the rapid diagnosis and treatment of upper GI cancer.1 In the UK, NICE guidelines recommend OGD as the gold standard investigation.2 Barium imaging is suggested as a suitable substitute when OGD is refused or fails according to Royal College of Radiology (RCR) iRefer guidelines.3 However, barium imaging does not exclude malignancy and positive findings require further evaluation by OGD or alternative modalities.1 This audit aims to assess the role of barium imaging in the...

Section 1 - Does Firstline Barium Imaging aid Diagnosis in Upper GI Cancer? 107 patients were diagnosed with upper GI cancer in the year 2017 with 8 patients (7.5%) having barium imaging prior to OGD. 7 patients (87.5%) had barium swallows and 1 (12.5%) had a barium meal. 4patients (50%) were referred due to non-tolerance/refusal of OGD. The clinical information for the remaining patients did not justify why OGD was not preferentially requested. Only 4 studies (50%) were actively marked with an "Urgent" label. 6...

Barium investigations have a comparitively low sensitivity, delay time to OGD and diagnosis of upper GI cancer. They can falsely reassure clinicians leading to potentially significant delays in diagnosis. Patients continueto beinappropriatelyreferred for barium investigations, or the reasons for referral are being incompletely documented. The RCR iRefer guidelines are subject to misinterpretation leading clinicians to continue referring patients for barium imaging against the recommendation of NICE and BSG guidelines.

J. D. Yeomans; Cardiff/UK - nothing to disclose E. I. R. Parks; Cardiff/UK - nothing to disclose R. E. Owen; Cardiff/UK - nothing to disclose M. Booth; Cardiff/UK - nothing to disclose E. Boggon; Cardiff/UK - nothing to disclose J. Fleming; Cardiff/UK - nothing to disclose

Meves V, Behrens A, Pohl J. Diagnostics and early diagnosis of esophageal cancer. Visceral Medicine. 2015;31(5):315-8. NICE.Oesophago-gastric cancer: assessment and management in adults. Available at: nice.org.uk/guidance/ng83 [Accessed: 12/01/2020] RCR. CA07:Oesophageal cancer: diagnosis. Available at: irefer.org.uk/guideline/oesophageal-cancer-diagnosis [Accessed: 12/01/2020] El-Feky M, Gaillard F et al.Oesophageal carcinoma. Available at: radiopaedia.org/articles/oesophageal-carcinoma-1 [Accessed: 12/01/2020]