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CC BY 4.0 · Endosc Int Open 2026; 14: a27816649
DOI: 10.1055/a-2781-6649
Original article

Characteristics and causes of post-endoscopy Barrett’s neoplasia: Retrospective multicenter study

Authors

  • Satoko Kako

    1   Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan (Ringgold ID: RIN34808)

  • Yugo Iwaya

    1   Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan (Ringgold ID: RIN34808)

  • Atsuhiro Hirayama

    1   Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan (Ringgold ID: RIN34808)

  • Takuma Okamura

    1   Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan (Ringgold ID: RIN34808)

  • Norikazu Arakura

    2   Department of Gastroenterology, Aizawa Hospital, Matsumoto, Japan (Ringgold ID: RIN73464)

  • Tomoaki Suga

    3   Department of Gastroenterology, Suwa Red Cross Hospital, Suwa, Japan (Ringgold ID: RIN26863)

  • Takayuki Watanabe

    4   Department of Gastroenterology, Iiyama Red Cross Hospital, Iiyama, Japan (Ringgold ID: RIN73703)

  • Akihiro Ito

    5   Department of Gastroenterology, Matsumoto City Hospital, Matsumoto, Japan (Ringgold ID: RIN631885)

  • Daichi Hara

    6   Department of Gastroenterology, Nagano Municipal Hospital, Nagano, Japan (Ringgold ID: RIN13682)

  • Tadanobu Nagaya

    7   Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan (Ringgold ID: RIN118108)
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Referred to by:

Barrett's esophagus: How can we miss high-grade dysplasia/cancer?Endosc Int Open 2026; 14(CP):
DOI: 10.1055/a-2763-8674

Abstract

Background and study aims

Missed high-grade dysplasia (HGD) or adenocarcinoma in Barrett's esophagus (BE) may have serious consequences, although the attributes of post-endoscopy Barrett's neoplasia (PEBN) remain unexplored. We analyzed the characteristics of Barrett’s neoplasia (BN) eluding detection during screening endoscopy.

Methods

We retrospectively reviewed endoscopic images of BN, including HGD and adenocarcinoma, diagnosed at six centers in Nagano prefecture. Eligible patients had index endoscopic images obtained 7 to 36 months before BN diagnosis. Causes of PEBN were classified as perceptual error, in which BN was missed despite images taken where it was eventually diagnosed, or exposure error, whereby no images were obtained in the area of BN development.

Results

Among the 91 patients with BN, 31 were judged as having PEBN. The majority of PEBN cases were attributed to perceptual error (22 patients, 71%). Lesions within long-segment BE (LSBE) were significantly more likely to be overlooked due to exposure error (67% vs. 18%, P = 0.02), whereas lesions at the 0 to 3 o’clock position in short-segment BE (SSBE) tended to be missed due to perceptual error (76% vs. 33%, P = 0.04). Notably, 39% of perceptual error cases were misdiagnosed as esophagitis on index endoscopy. In the nine patients requiring surgery for PEBN, eight cases were attributed to perceptual error.

Conclusions

PEBN occurring in LSBE was mostly overlooked because of inadequate observation, whereas PEBN at the 0 to 3 o'clock position in SSBE was frequently misdiagnosed as esophagitis. Bearing these results in mind may improve quality of endoscopic screening and reduce incidence of PEBN.

Keywords

Endoscopy Upper GI Tract - Barrett's and adenocarcinoma - Quality and logistical aspects - Quality management - Image and data processing, documentatiton


Publication History

Received: 15 April 2025

Accepted after revision: 05 January 2026

Accepted Manuscript online:
06 January 2026

Article published online:
22 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Satoko Kako, Yugo Iwaya, Atsuhiro Hirayama, Takuma Okamura, Norikazu Arakura, Tomoaki Suga, Takayuki Watanabe, Akihiro Ito, Daichi Hara, Tadanobu Nagaya. Characteristics and causes of post-endoscopy Barrett’s neoplasia: Retrospective multicenter study. Endosc Int Open 2026; 14: a27816649.
DOI: 10.1055/a-2781-6649
 

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