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DOI: 10.1055/s-0044-1783246
Characteristics and causes of post-endoscopy Barrett’s adenocarcinoma
Aims While considerable attention has been devoted to post-colonoscopy colorectal cancer, the attributes of missed Barrett's adenocarcinoma (BAC) remain unexplored. Our aim was to elucidate the characteristics of BAC instances that eluded detection during screening endoscopy.
Methods Among the 91 patients undergoing treatment for superficial BAC at our institutions, 31 patients who had undergone endoscopy within three years before diagnosis were included. The patient cohort was stratified into two categories according to the cause of errors: “exposure errors,” where no images were taken of the area where the BAC was eventually diagnosed, and “perceptual errors,” where the BAC was missed even though endoscopists took endoscopic images of the location where the BAC eventually diagnosed. [1]
Results Most cases were attributed to perceptual errors (n=22, 71%). When analyzing subjects based on the cause of errors, lesions within long-segment Barrett's esophagus (LSBE) were more likely to be overlooked because of exposure errors (67% vs. 18%, P=0.02), and lesions at the 0 to 3 o’clock position were more likely to be missed due to perceptual errors (76% vs. 33%, P=0.04).
Conclusions Cancers within LSBE were mostly overlooked owing to inadequate observation. At the same time, cancers at the 0 to 3 o'clock position were frequently missed due to misdiagnosis, particularly as esophagitis. Thorough scrutiny is imperative, especially for LSBE, necessitating, for example, a minimum of 1-minute inspection time per cm of Barrett’s length based on ESGE guidelines during surveillance endoscopy. Additionally, the presence of cancer should always be suspected upon encountering esophagitis in the 0-3 o'clock position.
Publication History
Article published online:
15 April 2024
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