title: Diagnostic failures in endoscopy for acute upper gastrointestinal haemorrhage.
abstract: BACKGROUND
  Oesophagogastroduodenoscopy (OGD) is the diagnostic tool of choice in acute upper gastrointestinal haemorrhage. However, the factors causing diagnostic failure are not well documented or discussed.
  
  
  METHODS
  OGDs performed by a single surgeon for acute upper gastrointestinal haemorrhage were reviewed retrospectively for 'missed' diagnosis.
  
  
  RESULTS
  There were nine cases (1.4 per cent) of 'missed' diagnosis in 638 OGDs performed over a 3-year period. Incomplete examination caused by a fundal pool precluded three examinations in which two Dieulafoy's lesions and one chronic gastric ulcer were later found. Other difficult examination sites were the cardia/high lesser curve (three cases), the stomal line of a gastrojejunostomy anastomosis (two) and at the junction of the first and second part of the duodenum (one). Four of the overlooked diagnoses were Dieulafoy's lesions.
  
  
  CONCLUSIONS
  OGD was able to diagnose the cause of bleeding in 98.6 per cent of patients with acute upper gastrointestinal haemorrhage. The factors that caused diagnostic failure were a difficult examination site and failure to recognize lesions (Dieulafoy's).
authors.affiliation: Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Y F
authors.initials: YF
authors.lastname: Chung
authors.forename: W K
authors.initials: WK
authors.lastname: Wong
authors.forename: K C
authors.initials: KC
authors.lastname: Soo
mesh_terms: D003951:Diagnostic Errors; D004381:Duodenal Ulcer / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis; D012189:Retrospective Studies