Original Article

Missed Esophageal and Gastric Cancers after Esophagogastroduodenoscopy in a Midwestern Military Veteran Population

Authors: Qasim Khalil, MD, Narasimh Gopalswamy, MD, Sangeeta Agrawal, MD

Abstract

Objectives: Esophagogastroduodenoscopy (EGD) with biopsy has become the standard procedure for diagnosing esophageal and gastric cancers (EGC) and is considered to have high sensitivity and specificity. To date, few studies have attempted to examine the rates of missed EGC after EGD and no study addresses the rate of missed EGC in a military veteran patient population. This led to us examine missed EGCs at our VA Medical Center across a 10-year period.

Methods: An electronic database was used to identify patients who were diagnosed between 2000 and 2010 as having EGC. Missed cancers were defined as cancers diagnosed within 1 year of EGD, possible missed cancers as those diagnosed 1 to 3 years after EGD, and latent cancers as those diagnosed between 3 and 5 years after EGD.

Results: A total of 94 patients fulfilled the study criteria: 69 had esophageal cancer and 25 had gastric cancer diagnosed at our institution during the study period. Of the included cases, one patient had a missed cancer (1.06%) and four patients had possible missed cancers (4.26%); no patients had latent cancer.

Conclusions: The true incidence of missed EGC in military veteran patients is not known. It is difficult to compare our findings to those of other studies because of the heterogeneity of studies. Our study echoes the findings of the others: EGD remains an important and effective tool in diagnosing EGC. At the same time, it also points out an important limitation, that EGC can be missed on EGD. Our findings also emphasize the importance of obtaining biopsies of any abnormality and timely clinical follow-up and by repeat EGD as needed.

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