[Gastroscopy and early stages of stomach cancer-- cost-effectiveness aspects].
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The work is based upon the study of findings obtained in the examination and treatment of 27 cases of stomach stump polyposis. The fibrogastroscopy revealed polyps in all 27 patients. The target gastrobiopsy was carried out upon all the case of adenomatous polyps of the stomach stump, which permitted to find out the true character of the disease in 26 of them. Hence, the fibrogastroscopy done together with the target gastrobiopsy proves to be the most effective method of the diagnosis of polyps of the stomach stump.
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The results of oesophago-gastro-duodenoscopy in 630 consecutive elderly patients, age 65 years or over, were reviewed in order to asses the efficacy, safety and acceptability of the technique in this age group. The study showed that the use of endoscopy is attended by relatively few contra-indications, that considerations restricting its use are also relatively few, and that endoscopy can be invaluable in confirming or refuting the diagnosis of malignancy and in detecting bleeding lesions. It was also shown that, in this age group, the use of endoscopy can be of vital importance in expanding or qualifying radiological data. Special attention was paid to gastric lesions caused by anti-inflammatory treatment. The overall incidence in this series was 37%, and this correlated very closely with the incidence of 31% previously documented by the same authors in a middle-aged population of rheumatic patients. It is concluded that endoscopy is of indisputable value in facilitating the diagnosis and treatment of gastro-intestinal disorders in the elderly.
In an elective gastroscopic series of 3837 patients, gastric mucosal erosions were observed in 404 (10.5%) patients, 215 (5.6%) having only erosions without other endoscopic findings in the upper gastrointestinal tract. The male to female ratio was 1.3:1. The number of patients with erosions was highest in the age groups 41-60 years. The patients with erosions were younger than those with peptic ulcer studied during same period. The erosions were located in the distal part of stomach only in 86% of patients. Erosions were observed in 3.5% of patients with stomach resected for peptic ulcer. The positive association with active duodenal ulcer was significant, but there was a negative correlation to gastric cancer, with an almost significant difference compared with patients without gastric erosions randomly selected from the same elective gastroscopic series. The seasonal variation of occurrence resembled more that of gastric than duodenal ulcer.
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The evaluation of 535 patients with gastric cancer observed in two 5-years periods with low (3%) and high (84%) preoperative endoscopic frequence demonstrated: 1. Change of the diagnostic procedure, mainly on the basis of out-patients examination, 2. a diminished role of preoperative X-ray examination for decisions about the further proceeding. 3. no more unnecessary probatory laparotomies without a lesion requiring surgery, 4. improved preoperative exclusion from surgery of patients supposed to be not operable, resulting in a reduction of explorative laparotomies and a relative increase of gastrectomies, and finally 5. a significant increase in early gastric cancer with a concomitant decrease of stage 2 and 3. The percentage of the largest group of gastric cancer in stage 4 remained constant, however.
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