Difficulties in the endoscopic diagnosis of gastric and oesophageal cancer.

A study was made of 116 patients with gastric or oesophageal cancer, in whom endoscopy was negative, or biopsy was negative or not performed. The most common problems were the presence of pyloric or oesophageal stricture (sometimes with excessive luminal content) and difficulty in obtaining diagnostic biopsy material in linitis plastica, early gastric cancer, lymphoma and sarcoma. Problems also occurred from failure to biopsy apparently benign conditions and from delay in a second endoscopy. Some cancers were regarded as benign ulcers and treated as such by drugs or surgery because more reliance was placed on endoscopic biopsy than on the endoscopist's opinion of the macroscopic appearance. In 17 of the 16 patients there was delay, incorrect management or further difficulty in diagnosis.