Tai Foong Way David, Wray Nicholas, Sidhu Reena, Hopper Andrew, McAlindon Mark
Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Frontline Gastroenterol. 2019 Jul 11;11(3):194-201. doi: 10.1136/flgastro-2019-101217. eCollection 2020.
There is increasing demand for gastroscopy in the United Kingdom. In around 10% of patients, gastroscopy is presumed to have missed oesophagogastric (OG) cancer prior to diagnosis. We examine patient, endoscopist and service level factors that may affect rates of missed OG cancers.
Gastroscopies presumed to have missed OG cancers performed up to 3 years prior to diagnosis were identified over 6 years in Sheffield, UK. Factors related to the patient, endoscopist and endoscopy lists were examined in a case-control study. Procedures which missed cancer were compared with two procedure controls: the procedures which subsequently diagnosed cancer in the same patient, and second, endoscopist matched procedures diagnostic of small benign focal lesions.
We identified 48 (7.7%) cases of missed OG cancer. Endoscopy lists on which OG cancer diagnoses were missed contained a greater number of total procedures compared with lists on which diagnoses were subsequently made (OR 1.42 95% CI 1.13 to 1.78) and when compared with lists during which matched endoscopists diagnosed benign small focal lesions (OR 1.25, 95% CI 1.02 to 1.52). The use of sedation, endoscopist profession and experience, or time of procedure were not associated with a missed cancer.
7.7% of patients diagnosed with OG cancer could have been diagnosed and treated earlier. Our study suggests that endoscopy lists with greater numbers of procedures may be associated with missed OG cancers. The use of sedation, endoscopist background or time of procedure did not increase the risk of missed cancer procedures.
英国对胃镜检查的需求日益增加。在大约10%的患者中，胃镜检查被认为在诊断前漏诊了食管胃癌（OG癌）。我们研究了可能影响OG癌漏诊率的患者、内镜医师和服务层面的因素。
在英国谢菲尔德，对诊断前长达3年被认为漏诊OG癌的胃镜检查进行了为期6年的识别。在一项病例对照研究中，检查了与患者、内镜医师和内镜检查清单相关的因素。将漏诊癌症的检查与两个检查对照进行比较：一是同一患者随后诊断出癌症的检查，二是内镜医师匹配的诊断小良性局灶性病变的检查。
我们识别出48例（7.7%）OG癌漏诊病例。与随后做出诊断的清单相比，漏诊OG癌诊断的内镜检查清单上的总检查数量更多（比值比1.42，95%置信区间1.13至1.78），与匹配的内镜医师诊断良性小局灶性病变的清单相比也是如此（比值比1.25，95%置信区间1.02至1.52）。使用镇静剂、内镜医师的职业和经验或检查时间与癌症漏诊无关。
7.7%被诊断为OG癌的患者本可以更早得到诊断和治疗。我们的研究表明，检查数量较多的内镜检查清单可能与OG癌漏诊有关。使用镇静剂、内镜医师背景或检查时间并不会增加癌症漏诊检查的风险。
