Missed Diagnoses in Patients with Gastric Cancer in Endoscopic Screening

Abstract

Background and Aim: In Korea, a high incidence area of gastric cancer, screening of asymptomatic population has been advocated. A large number of patients are examined using endoscopy for screening gastric cancer. A few studies have been published on gastric cancer missed on previous endoscopy. But data is lacking on the analysis of causes for missed diagnoses. The aim of this study was to examine why gastric cancer is missed on endoscopic screening. Patients and Methods: Out of consecutive series of 440 patients diagnosed with early and advanced gastric cancer in endoscopic screening, we retrospectively identified patients who had endoscopic screening within 3 years before the diagnosis. The timing of previous endoscopies, endoscopic findings, endoscopist's years of experience and observation time of endoscopic procedure were recorded. Missed diagnoses were categorized as either definitely or possibly missed and the reasons for being missed were documented. For patients with definitely missed diagnoses, previous endoscopic procedure was compared with final diagnostic procedure in observation time. Results Out of 440 patients, 114 (25.9%) had endoscopic screening within the previous 3 years and 27 (6.1%) of these within the previous 1 year. Among those patients with definitely missed diagnoses (24: 5.4%), errors by endoscopist accounted for majority of the reasons for being missed (95.8%). In those patients with definitely missed diagnoses, previous and final diagnostic endoscopic mean observation time were 3.8 min and 6.3 min respectively (P<0.01). There was no difference in endoscopist's years of experience. Conclusion: Missed gastric cancer was a frequent finding on endoscopic screening and errors by endoscopist accounted for the majority of missed lesions. Errors by endoscopist were related to observation time. This study emphasizes the importance of sufficient observation time on endoscopic gastric cancer screening.