Endoscopy 2014; 46(07): 553-560
DOI: 10.1055/s-0034-1365646
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A population-based, retrospective, cohort study of esophageal cancer missed at endoscopy

Authors

  • Georgina Chadwick

    1   Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
  • Oliver Groene

    1   Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
    2   Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • Jonathan Hoare

    3   Department of Gastroenterology, St. Mary’s Hospital, London, United Kingdom
  • Richard H. Hardwick

    4   Department of Surgery, Addenbrookes Hospital, Cambridge, United Kingdom
  • Stuart Riley

    5   Department of Gastroenterology, Northern General Hospital, Sheffield, United Kingdom
  • Tom D. Crosby

    6   Velindre Cancer Centre, Cardiff, Wales, United Kingdom
  • George B. Hanna

    7   Department of Surgery and Cancer, St. Mary’s Hospital, London, United Kingdom
  • David A. Cromwell

    1   Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
    2   Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
Further Information

Publication History

submitted 05 September 2013

accepted after revision 18 March 2014

Publication Date:
27 June 2014 (online)

Preview

Background and study aims: Several studies have suggested that a significant minority of esophageal cancers are missed at endoscopy The aim of this study was to estimate the proportion of esophageal cancers missed at endoscopy on a national level, and to investigate the relationship between miss rates and patient and tumor characteristics.

Patients and methods: This retrospective, population-based, cohort study identified patients diagnosed with esophageal cancer between April 2011 and March 2012 in England, using two linked databases (National Oesophago-Gastric Cancer Audit and Hospital Episode Statistics). The main outcome was the rate of previous endoscopy within 3 – 36 months of cancer diagnosis. This was calculated for the overall cohort and by patient characteristics, including tumor site and disease stage.

Results: A total of 6943 new cases of esophageal cancer were identified, of which 7.8 % (95 % confidence interval 7.1 – 8.4) had undergone endoscopy in the 3 – 36 months preceding diagnosis. Of patients with stage 0/1 cancers, 34.0 % had undergone endoscopy in the 3 – 36 months before diagnosis compared with 10.0 % of stage 2 cancers and 4.5 % of stage 3/4 cancers. Of patients with stage 0/1 cancers, 22.1 % were diagnosed after ≥ 3 endoscopies in the previous 3 years. Patients diagnosed with an upper esophageal lesion were more likely to have had an endoscopy in the previous 3 – 12 months (P = 0.040). The most common diagnosis at previous endoscopy was an esophageal ulcer (48.2 % of investigations).

Conclusion: Esophageal cancer may be missed at endoscopy in up to 7.8 % of patients who are subsequently diagnosed with cancer. Endoscopists should make a detailed examination of the whole esophageal mucosa to avoid missing subtle early cancers and lesions in the proximal esophagus. Patients with an esophageal cancer may be misdiagnosed as having a benign esophageal ulcer.