title: A population-based, retrospective, cohort study of esophageal cancer missed at endoscopy.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.
authors: Georgina
authors: G
authors: Chadwick
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.
authors: Oliver
authors: O
authors: Groene
authors: Department of Gastroenterology, St. Mary's Hospital, London, United Kingdom.
authors: Jonathan
authors: J
authors: Hoare
authors: Department of Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
authors: Richard H
authors: RH
authors: Hardwick
authors: Department of Gastroenterology, Northern General Hospital, Sheffield, United Kingdom.
authors: Stuart
authors: S
authors: Riley
authors: Velindre Cancer Centre, Cardiff, Wales, United Kingdom.
authors: Tom D
authors: TD
authors: Crosby
authors: Department of Surgery and Cancer, St. Mary's Hospital, London, United Kingdom.
authors: George B
authors: GB
authors: Hanna
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.
authors: David A
authors: DA
authors: Cromwell
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D015331:Cohort Studies; D016208:Databases, Factual; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004739:England; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult