Missed duodenal tumors at upper endoscopy: a five year retrospective cohort study at West China hospital (2019–2023)

BACKGROUND: Duodenal tumors constitute 35%-55% of small bowel neoplasms, yet the misdiagnosis rate remains substantial. This study investigated the clinical features of duodenal tumors missed during endoscopic examination. METHODS: This retrospective cohort analysis included patients who were diagnosed with duodenal tumors between 2019 and 2023 at West China Hospital. Demographic data, tumor characteristics, endoscopic findings, and missed diagnosis records were extracted from electronic medical records and telephone follow-ups. The exploratory analysis identified the reasons for the missed diagnosis during endoscopy. RESULTS: Among the 307 enrolled patients with duodenal tumors, 36 patients (34 with adenocarcinomas and 2 with neuroendocrine tumors) had undergone previous endoscopic examinations without a definitive diagnosis, yielding a missed detection rate of 11.7%. In all missed cases, the mean number of endoscopic procedures performed prior to definitive diagnosis was 2 (range: 1-8), with an average interval of 11.1 months (range: 3-36 months). The anatomical distribution of missed lesions included the duodenal papilla (44.4%, 16/36), duodenal bulb (25.0%, 9/36), bulb-descending junction (5.6%, 2/36), descending (13.9%, 5/36) and horizontal (5.6%, 2/36) parts. The causes of missed diagnoses included exposure errors (n = 20), judgment errors (n = 5), biopsy errors (n = 8), and unclassified errors (n = 3). The difference in the pattern of missed duodenal tumors between tertiary hospitals and non-tertiary hospitals was not statistically significant (P > 0.05). CONCLUSION: The missed diagnosis rate of duodenal tumors is high during endoscopic examination. Comprehensive endoscopic observation and improved detection awareness of duodenal tumors are essential in both tertiary and nontertiary hospitals.