Rate of missed oesophageal cancer at routine endoscopy and survival outcomes: A multicentric cohort study

Abstract

Background: Missed oesophageal cancer (MEC) at upper gastrointestinal endoscopy (UGE) is poorly documented. Objective: The objectives of this study were: (1) to assess the rate, predictors and survival of MEC; (2) to compare MEC and non-MEC tumours. Methods: This was a retrospective cohort study conducted at four tertiary centres. Oesophageal cancers (ECs) diagnosed between 2008 and 2015 were included. Patients with a premalignant condition (Barrett, achalasia), prior diagnosis of EC or oesophagogastric junction tumour of gastric origin were excluded. MEC was defined as EC detected within 36 months after negative UGE. Results: 123,395 UGEs were performed during the study period, with 502 ECs being diagnosed (0.4%). A total of 391 ECs were finally included. Overall MEC rate was 6.4% (95% confidence intervals (CI): 4.4-9.3%). The interval between negative and diagnostic UGE was less than 2 years in 84% of the cases. Multivariate analysis showed that a negative endoscopy was associated with proton pump inhibitor (PPI) therapy and less experienced endoscopists. MEC was smaller than non-MEC at diagnosis (25 versus 40 mm, p ¼ 0.021), more often flat or depressed (p ¼ 0.013) and less frequently diagnosed as metastatic disease (p ¼ 0.013). Overall 2-year survival rate was similar for MEC (20%) and non-MEC (24.1%) (p ¼ 0.95). Conclusions: MEC accounted for 6.4% of all ECs and was associated with poor survival. High-quality UGE and awareness of MEC may help to reduce its incidence.

Setting the stage for research in endoscopy

“…Furthermore, large, randomised, multi centre trials are warranted for evaluation of new endoscopic techniques and tools in clinical practice. Last but not least, as also highlighted in the present issue of United European Gastroenterology Journal , we should constantly evaluate the efficacy of certain endoscopic procedures in a ‘real life setting’ 8–10 …”

“…Last but not least, as also highlighted in the present issue of United European Gastroenterology Journal, we should constantly evaluate the efficacy of certain endoscopic procedures in a 'real life setting'. [8][9][10] As the endoscopy section editor of United European Gastroenterology Journal, I therefore encourage you not only to read those papers but also to plan, conduct and publish endoscopical studies of your own. Submit papers on something that is really new and has not been appeared within the endoscopic arena.…”

Artificial intelligence for non‐polypoid colorectal neoplasms

“…However, there is some evidence outside the colonoscopy field that the miss rate for flat neoplasia may be very high even if advanced. For instance, a 76% miss rate for visible Barrett neoplasia has been reported when patients with high‐grade dysplasia on random biopsies have been rescoped by expert endoscopists 22,23 …”

Artificial intelligence in upper GI endoscopy ‐ current status, challenges and future promise

“…A multicenter study highlighted this point, showing the miss rates of early esophageal cancer to be as high as 6%. 1 The cancer miss rate was associated with less-experienced endoscopists and smaller lesions. The use of advanced imaging technology such as narrow band imaging (NBI) was similarly associated with low sensitivity (53%) for detecting esophageal squamous cell cancer (SCC) when used by inexperienced endoscopists.…”

“…Biopsy sampling can be problematic due to sampling error. A multicenter study highlighted this point, showing the miss rates of early esophageal cancer to be as high as 6% 1 . The cancer miss rate was associated with less‐experienced endoscopists and smaller lesions.…”