Gastric cancer remains the second leading cause of cancer death worldwide. About half of the incidence of gastric cancer is observed in East Asian countries, which show a higher mortality than other countries. The eff...Gastric cancer remains the second leading cause of cancer death worldwide. About half of the incidence of gastric cancer is observed in East Asian countries, which show a higher mortality than other countries. The effectiveness of 3 new gastric cancer screening techniques, namely, upper gastrointestinal endoscopy, serological testing, and “screen and treat” method were extensively reviewed. Moreover, the phases of development for cancer screening were analyzed on the basis of the biomarker development road map. Several observational studies have reported the effectiveness of endoscopic screening in reducing mortality from gastric cancer. On the other hand, serologic testing has mainly been used for targeting the high-risk group for gastric cancer. To date, the effectiveness of new techniques for gastric cancer screening has remained limited. However, endoscopic screening is presently in the last trial phase of development before their introduction to population-based screening. To effectively introduce new techniques for gastric cancer screening in a community, incidence and mortality reduction from gastric cancer must be initially and thoroughly evaluated by conducting reliable studies. In addition to effectiveness evaluation, the balance of benefits and harms must be carefully assessed before introducing these new techniques for population-based screening.展开更多
Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries ex...Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.展开更多
INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal ...INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.展开更多
AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Ser...AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Services Division(ISD) Scotland and National Records of Scotland(NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records(SMR01) database which holds data on inpatient and daycase hospital discharges from non-obstetric and nonpsychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10(International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB,30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January,2000 and October,2009. There was no significant change in annual number of admissions over time,but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8%(P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category(P < 0.05),although case fatality was higher for the patients from the least deprived category(P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays(P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weeke展开更多
BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases...BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in b展开更多
AIM:To determine the clinical presentation,underlying etiology and short-and long-term outcomes of acute variceal bleeding(AVB).METHODS:A retrospective descriptive cohort study of cirrhotic patients with AVB who were... AIM:To determine the clinical presentation,underlying etiology and short-and long-term outcomes of acute variceal bleeding(AVB).METHODS:A retrospective descriptive cohort study of cirrhotic patients with AVB who were admitted to King Abdul Aziz University Hospital between January 2005 and December 2009.We obtained demographic data for all patients.For each patient we also obtained the clinical data at presentation;cause of liver cirrhosis,bleeding presentation(hematemesis and/or melena),presence of ascites,hepatic encephalopathy and renal impairment(RI) or hepatorenal syndrome.We carried out complete blood count,prothrombin time evaluation,and liver function tests.We also report all episodes of re-bleeding after the first episode of AVB,both during the initial admission and after discharge.We recorded the length of stay for each patient and thereby calculated the mean duration of stay for all patients.The length of follow-up after the first AVB and the outcome for each patient at the end of the study period were recorded.Causes of mortality either related to liver disease or non-liver disease cause were determined.RESULTS:A 125 patients were enrolled in the study.The number of episodes of AVB for each patients varied between 1 and 10.Survival from the first attack of AVB to death was 20.38 mo(SD 30.86),while the length of follow-up for the living patients was 53.58 mo(SD 24.94).Total number of AVB admissions was 241.Chronic hepatitis C,the commonest underlying etiology for liver disease,was present in 46(36.8%) patients.Only 35(28%) patients had received a primary prophylactic β-blocker before the first bleeding episode.The mean hemoglobin level at the time of admission was 8.59 g/dL(SD 2.53).Most patients had Child-Pugh Class C 41(32.8%) or Class B 72(57.6%) disease.Hematemesis was the predominant symptom and was found in 119(95.2%) patients,followed by melena in 75(60.0%) patients.Ascites of variable extent was documented in 93(74.4%) patients.We identified hepatic encephalopathy in 31(28.8%) patients and spo展开更多
基金Supported by Grant-in-Aid for H22-Third Term Comprehensive Control Research for Cancer 022 from the Japanese Ministry of Health,Labour and Welfare
文摘Gastric cancer remains the second leading cause of cancer death worldwide. About half of the incidence of gastric cancer is observed in East Asian countries, which show a higher mortality than other countries. The effectiveness of 3 new gastric cancer screening techniques, namely, upper gastrointestinal endoscopy, serological testing, and “screen and treat” method were extensively reviewed. Moreover, the phases of development for cancer screening were analyzed on the basis of the biomarker development road map. Several observational studies have reported the effectiveness of endoscopic screening in reducing mortality from gastric cancer. On the other hand, serologic testing has mainly been used for targeting the high-risk group for gastric cancer. To date, the effectiveness of new techniques for gastric cancer screening has remained limited. However, endoscopic screening is presently in the last trial phase of development before their introduction to population-based screening. To effectively introduce new techniques for gastric cancer screening in a community, incidence and mortality reduction from gastric cancer must be initially and thoroughly evaluated by conducting reliable studies. In addition to effectiveness evaluation, the balance of benefits and harms must be carefully assessed before introducing these new techniques for population-based screening.
基金Supported by Summer studentships(2010,2011,and 2012)by Alberta Innovates-Health Solutions.Alexandra Frolkis is funded by an Alberta Innovates-Health Solutions studentship to Samuel QuanA New Investigator Award from the Canadian Institute of Health Research and a Clinical Investigator Award from Alberta Innovates-Health Solutions to Dr.MyersA New Investigator Award from the Canadian Institute of Health Research and a Population Health Investigator Award from Alberta Innovates-Health Solutions to Dr.Kaplan
文摘AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).
基金Supported by the National Cancer Center,Tokyo,Japan,No.26-A-30
文摘Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.
基金Supported by the Hebei Provincial Scientific Commission, No. 97276162D
文摘INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.
文摘AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Services Division(ISD) Scotland and National Records of Scotland(NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records(SMR01) database which holds data on inpatient and daycase hospital discharges from non-obstetric and nonpsychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10(International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB,30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January,2000 and October,2009. There was no significant change in annual number of admissions over time,but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8%(P < 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category(P < 0.05),although case fatality was higher for the patients from the least deprived category(P < 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays(P < 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weeke
文摘BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in b
文摘 AIM:To determine the clinical presentation,underlying etiology and short-and long-term outcomes of acute variceal bleeding(AVB).METHODS:A retrospective descriptive cohort study of cirrhotic patients with AVB who were admitted to King Abdul Aziz University Hospital between January 2005 and December 2009.We obtained demographic data for all patients.For each patient we also obtained the clinical data at presentation;cause of liver cirrhosis,bleeding presentation(hematemesis and/or melena),presence of ascites,hepatic encephalopathy and renal impairment(RI) or hepatorenal syndrome.We carried out complete blood count,prothrombin time evaluation,and liver function tests.We also report all episodes of re-bleeding after the first episode of AVB,both during the initial admission and after discharge.We recorded the length of stay for each patient and thereby calculated the mean duration of stay for all patients.The length of follow-up after the first AVB and the outcome for each patient at the end of the study period were recorded.Causes of mortality either related to liver disease or non-liver disease cause were determined.RESULTS:A 125 patients were enrolled in the study.The number of episodes of AVB for each patients varied between 1 and 10.Survival from the first attack of AVB to death was 20.38 mo(SD 30.86),while the length of follow-up for the living patients was 53.58 mo(SD 24.94).Total number of AVB admissions was 241.Chronic hepatitis C,the commonest underlying etiology for liver disease,was present in 46(36.8%) patients.Only 35(28%) patients had received a primary prophylactic β-blocker before the first bleeding episode.The mean hemoglobin level at the time of admission was 8.59 g/dL(SD 2.53).Most patients had Child-Pugh Class C 41(32.8%) or Class B 72(57.6%) disease.Hematemesis was the predominant symptom and was found in 119(95.2%) patients,followed by melena in 75(60.0%) patients.Ascites of variable extent was documented in 93(74.4%) patients.We identified hepatic encephalopathy in 31(28.8%) patients and spo
