Endoscopy 2004; 36(10): 874-879
DOI: 10.1055/s-2004-825853
Original Article
© Georg Thieme Verlag Stuttgart · New York

Missed Diagnoses in Patients with Upper Gastrointestinal Cancers

S.  Yalamarthi1 , P.  Witherspoon1 , D.  McCole1 , C.  D.  Auld1
  • 1 Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland, United Kingdom
Further Information

Publication History

Submitted 17 December 2003

Accepted after Revision 14 June 2004

Publication Date:
28 September 2004 (online)

Background and Study Aims: A few studies have been published on cancers missed at previous endoscopy, but detailed analyses of the causes for failure were lacking. The aims of our study were to determine the incidence of and causes for failure to detect oesophageal and gastric cancers after referral of patients to a surgical endoscopy unit.
Patients and Methods: Out of a consecutive series of 305 patients diagnosed with oesophageal and gastric cancers, we retrospectively identified patients who had undergone an endoscopy within 3 years before the diagnosis. The timing of previous endoscopies, indications for endoscopy, endoscopic findings and the number of biopsy specimens taken were recorded. Missed diagnoses were categorized as either definitely or possibly missed and the reasons for failure were documented.
Results: Of the 305 patients, 30 (9.8 %) had undergone a minimum of one endoscopy within the previous 3 years, 20 (67 %) of these within the previous 1 year. Sinister symptoms were present at the time of previous endoscopies in 75 % of patients with oesophageal cancer (n = 16) and in 57.2 % of patients with gastric cancer (n = 14). In 56 % of the patients with oesophageal cancers the initial diagnosis was oesophagitis or benign stricture; in 71.4 % of the patients with gastric cancers the initial diagnosis was gastritis, ulcer or ”suspicious lesion”. Among those patients with a definitely missed diagnosis (7.2 %), endoscopist errors accounted for the majority of failures (73 %) and the remainder were due to pathologist errors (27 %).
Conclusions: Missed cancers were a frequent finding in patients with oesophageal and gastric cancer who had undergone previous endoscopy, and errors by the endoscopists accounted for the majority of missed lesions. This study emphasizes the importance of identifying signs of early cancers and of having a low threshold for performing multiple biopsies of any suspicious-looking lesion.

References

  • 1 Saragoni L, Gaudio M, Vio A. et al . Early gastric cancer in the province of Forli: follow-up of 337 patients in a high-risk region for gastric cancer.  Oncol Rep. 1998;  5 945-948
  • 2 Muller J M, Erasmi H, Stelzner M. et al . Surgical therapy of oesophageal carcinoma.  Br J Surg. 1990;  77 845-857
  • 3 Allum W H, Powell D J, McConkey C C. et al . Gastric cancer: a 25-year review.  Br J Surg. 1989;  76 535-540
  • 4 Zhang Z, Wan J, Zhu C. et al . Direct gastroscopy for detecting gastric cancer in the elderly.  Chin Med J. 2002;  115 117-118
  • 5 Suvakovic Z, Bramble M G, Jones R. et al . Improving the detection rate of early gastric cancer requires more than open-access gastroscopy: a 5-year study.  Gut. 1997;  41 308-313
  • 6 Dekker W, Tytgat G N. Diagnostic accuracy of fiberendoscopy in the detection of upper intestinal malignancy: a follow-up analysis.  Gastroenterology. 1977;  3 1415-1420
  • 7 Llanos O, Guzman S, Duarte I. Accuracy of the first endoscopic procedure in the differential diagnosis of gastric lesions.  Ann Surg. 1982;  195 224-226
  • 8 Hosokawa O, Tsuda E, Kidani K. et al . Diagnosis of gastric cancer up to 3 years after negative upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 669-674
  • 9 Bhunchet E, Hatakawa H, Sakai Y. et al . Fluorescein electron endoscopy: a novel method to detect early gastric cancer not evident to routine endoscopy.  Gastrointest Endosc. 2002;  55 562-571
  • 10 Yokoyama A, Ohmori T, Makuuchi H. et al . Successful screening for early oesophageal cancer in alcoholics using endoscopy and mucosal iodine staining.  Cancer. 1995;  76 928-934
  • 11 UICC .TNM classification of malignant tumours. 5th edn. Berlin; Springer-Verlag 1997
  • 12 Tatsuta M, Iishi H, Okuda S. et al . Prospective evaluation of diagnostic accuracy of gastrofibrescopic biopsy in diagnosis of gastric cancer.  Cancer. 1989;  63 1415-1420
  • 13 Amin A, Gilmour H, Graham L. et al . Gastric adenocarcinoma missed at endoscopy.  J R Coll Surg Edinb. 2002;  47 681-684
  • 14 Gorski T F, Rosen L, Reither R. et al . Colorectal cancer after surveillance colonoscopy: false-negative examination or fast growth?.  Dis Colon Rectum. 1999;  42 877-880
  • 15 Rex D G, Rahmani E Y, Haseman J H. et al . Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.  Gastroenterology. 1997;  112 17-23
  • 16 Fujita S. Biology of early gastric carcinoma.  Pathol Res Pract. 1978;  163 297-309
  • 17 Bramble M G, Suvakovic Z, Hungin A PS. Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to gastroscopy.  Gut. 2000;  46 464-467
  • 18 Lal N, Bhasin D K, Malik A K. et al . Optimal number of biopsy specimens in the diagnosis of carcinoma of the oesophagus.  Gut. 1992;  33 724-726

C. D. Auld, Consultant Surgeon

Department of General Surgery, Dumfries and Galloway Royal Infirmary

Bankend Road · Dumfries GD1 4AP · Scotland, United Kingdom

Fax: +44-1387-241088 ·

Email: c.auld@dgri.scot.nhs.uk

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