title: Gastric adenocarcinoma missed at endoscopy.
abstract: OBJECTIVE
  The diagnosis of gastric cancer is based on histological confirmation at endoscopy with the emphasis on early detection to improve prognosis. The aims of this study were to identify the proportion of patients with gastric adenocarcinoma in whom the diagnosis was missed at first endoscopy and the subsequent delay which occurred before the histological diagnosis was established.
  
  
  METHODS
  Retrospective review of 137 consecutive patients with biopsy-proven gastric adenocarcinoma presenting to one surgical unit over a five-year period.
  
  
  RESULTS
  Two patients with a biopsy diagnosis at laparotomy and 6 patients in whom case notes could not be traced were excluded from the study. Of the remaining 129 patients, the diagnosis of gastric adenocarcinoma was missed at first endoscopy in 18 (14%). The median delay to histological diagnosis in this subgroup of patients was 13 weeks (range 3-102).
  
  
  CONCLUSIONS
  Delays in establishing the diagnosis of gastric adenocarcinoma following initial endoscopy occur in a number of patients. Greater suspicion and a more rigorous protocol for repeat endoscopy and biopsy must be implemented in order to reduce the number of missed diagnoses after initial endoscopy.
authors.affiliation: Department of Surgey, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, UK.
authors.forename: A
authors.initials: A
authors.lastname: Amin
authors.forename: H
authors.initials: H
authors.lastname: Gilmour
authors.forename: L
authors.initials: L
authors.lastname: Graham
authors.forename: S
authors.initials: S
authors.lastname: Paterson-Brown
authors.forename: J
authors.initials: J
authors.lastname: Terrace
authors.forename: T J
authors.initials: TJ
authors.lastname: Crofts
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D001706:Biopsy; D003951:Diagnostic Errors; D005773:Gastroscopy; D006801:Humans; D013274:Stomach Neoplasms / Q000175:diagnosis*; D013997:Time Factors