Failure to Diagnose Colorectal Carcinoma at Colonoscopy

We read with interest the paper by Leaper et al. on ”Reasons for failure to diagnose colorectal carcinoma at colonoscopy” [1], and would like to discuss certain issues raised by the paper. The authors regard both incomplete examinations and missing lesions as causes of failure in colorectal cancer diagnosis. However, one has the impression that the gastroenterologists in the study conducted incomplete examinations more frequently, whereas general surgeons appeared to be more likely to miss lesions. We would be interested to know whether Leaper et al. would agree with this impression.

Overall, surgeons were more likely to fail to diagnose a colorectal cancer. Cancer was missed by a surgeon in 10 cases among the 2317 colonoscopies the authors describe, while gastroenterologists failed to diagnose colorectal cancer in four cases out of 2738 colonoscopies; three cancers were missed by both surgeons and gastroenterologists. The difference is statistically significant (P = 0.048 on Fisher’s exact test). Is there a reason for this?

In two cases, a polyp was snared but not retrieved. In our own series, we have been unable to retrieve polyps in two cases among 250 polypectomies. We would be interested to know whether the authors’ practice is to retrieve, or attempt to retrieve, all snared polyps.

Reference

• 1 Leaper M, Johnston M J, Barclay M. et al . Reasons for failure to diagnose colorectal carcinoma at colonoscopy.  Endoscopy. 2004;  36 499-503