The Complex Benign Upper GI MDT - A quality improvement initiative from a tertiary centre

Abstract Introduction The Upper GI cancer Multidisciplinary team (MDT) has become an essential and integral part of the cancer treatment pathway in the management of Oesophagogastric (OG) cancer. There exists an need for the MDT management of complex benign diseases of the oesophagus which can be equally rewarding if proper decision making for treatment is achieved in this potentially challenging group of patients. Methods We explore the utility of a Benign Complex MDT model consisting of Surgeons, Gastroenterologists, radiologists and GI Physiologists in a tertiary teaching hospital setting. A retrospective review of 72 patients who were discussed in the Complex Benign UGI MDT over a 2 year was undertaken. The referral pattern, decisions and outcomes have been analysed. All results were analysed using SPSS version 23. Results are reported in median +/- ranges or percentages where applicable. Results Patients had median age of 57 years with 62.5% being women. 30/72 (41.7%) patients had previous surgery. Majority of the referrals were made by surgeons 61/72 (84.7%) followed by gastroenterologist 10/72 (13.9%). Dysphagia was the predominant symptom in 34/72 (47.2%) patients followed by reflux in 31/72 (43%) patients and 19.4% patients had a combination. The purpose of an MDT referral was expert advice in 45/72 (62.5%) and consideration of surgery in 23/72 (31.9%) patients. The recommendations of the MDT was further clinic review (30%), further investigation (30.5%), surgery (18%), discharge (11%). MDT changed patient’s management in 30/72 (41.7%) cases. Conclusion Our results show that surgery was recommended less frequently after initial MDT discussions in patients who were initially referred for potential surgical advice. The management of complex benign conditions of the oesophagus can be challenging particularly after initial interventions. A MDT approach to the management of these patients can be recommended as equally vital to their management on recommending/avoiding further surgical or endoscopic interventions.