Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2022; 14(5): 302-310
Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.302
Lessons learned: Preventable misses and near-misses of endoscopic procedures
Alla Turshudzhyan, Houman Rezaizadeh, Micheal Tadros
Alla Turshudzhyan, Department of Medicine, University of Connecticut, Farmington, CT 06030, United States
Houman Rezaizadeh, Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT 06030, United States
Micheal Tadros, Department of Gastroenterology and Hepatology, Albany Medical College, Albany, NY 12208, United States
Author contributions: Turshudzhyan A wrote the letter, Rezaizadeh H and Tadros M critically revised the manuscript.
Conflict-of-interest statement: Rezaizadeh H has financial interest associated with AstraZeneca and research funding/interest associated with Celgene/Bristol Meyers Squibb.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Micheal Tadros, FACG, MD, Associate Professor, Department of Gastroenterology and Hepatology, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, United States.
Received: November 4, 2021
Peer-review started: November 4, 2021
First decision: November 29, 2021
Revised: December 30, 2021
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 16, 2022

Endoscopy is a complex procedure that requires advanced training and a highly skilled practitioner. The advances in the field of endoscopy have made it an invaluable diagnostic tool, but the procedure remains provider dependent. The quality of endoscopy may vary from provider to provider and, as a result, is not perfect. Consequently, 11.3% of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9% of colorectal polyps or cancers are missed on colonoscopy. Pathology is overlooked if endoscopic exam is not done carefully, bypassing proper visualization of the scope’s entry and exit points or, if exam is not taken to completion, not visualizing the most distal bowel segments. We hope to shed light on this issue, establish areas of weakness, and propose possible solutions and preventative measures.

Keywords: High-quality colonoscopy, Esophagogastroduodenoscopy, EGD, Cancer screening, endoscopy, Missed lesions

Core Tip: Endoscopy has become a widely used diagnostic tool and plays an instrumental role in screening and surveillance of gastrointestinal pathology. Despite its wide acceptance, it remains provider dependents and, as a result, is not perfect. Both upper and lower endoscopy have weaknesses and shortcomings unless executed flawlessly. A high-quality endoscopy includes a complete examination of the bowel, including distal segments that are difficult to visualize, as well as scope’s entry and exit points. Better understanding of the shortcomings of endoscopy may help change training and improve physician awareness.