Öz
Aim: It is well established to repeat endoscopy in patients with gastric ulcers to diff erentiate malign ulcers from benign ones. In clinical practice it is not always easy to convince patients for repeated endoscopies. Gastroenterologists must have evidence based indications to off er a patient second endoscopy. We aimed to evaluate our repeat gastroscopy indications, fi ndings and yield.Methods: We included the patients who underwent repeat endoscopy to assess ulcer healing and exclude malignancy in our center within 12 months duration. They were evaluated for the fi nal diagnosis, numbers of endoscopic procedure to reach the exact diagnosis, and endoscopic and pathological fi ndings. All patients were examined by same endoscopist.Results: In this period 83 patients with gastric ulcer underwent repeat gastroscopy. Average numbers of endoscopy was 2.15. In nine patients, 3 gastroscopy procedures were needed wheras only two patients were in need of fourth gastroscopy and no one needed fi fth. Seventy-seven of 83 patients were ulcer free at repeat endoscopies. But 6 7.2% patients were shown to have malignant ulcers. Four of them were diagnosed after second endoscopy but two patients’ malignancies could be diagnosed at the third third procedure. Five of the patients had gastric adenocancer and the other single case had gastric lymphoma. Two of 5 40% adenocancers were early gastric cancer.Conclusion: Our study re-enforced the recommendation that all patient with gastric ulcers should undergo repeat endoscopy to exclude malignancy. The malignancy rate was 7.2% in our cases. This high rate must encourage clinicians and endoscopist to insist on repeating endoscopy to assess ulcer healing
Anahtar Kelimeler
gastric ulcer gastric cancer gastric early cancer endoscopy repeat gastroscopy
Kaynakça
- Hooper A.N, Stephans MR, Lewis WG, et al. Relative value of repeat gastric ulcer surveillance gastroscopy in diagnosing gastric cancer. Gastric Cancer 2006; 9: 217-22.
- Rollag A, Jacobsen CD. Gastric ulcer and risk of cancer. A 5-year follow up study. Acta Med Scand 1984; 216: 105-9.
- British Societey of Gastroenterology. Dyspepsia management guideline (online). British Society of Gastroenterology, 2004. www. nice.org.uk.
- Mountford RA, Brown P, Salmon PR, et al. Gastric cancer detection in gastric ulcer disease. Gut 1980; 21: 9-17.
- Binici DN, Koca T, Dursun H. Dietary habits, demographical and socio- economical risk factors of the newly diagnosed gastric cancers in Eastern Anatolia Region of Turkey: An endemic upper gastrointestinal cancer region. Dig Dis Sci 2008.
- Choi IJ. Gastric cancer screening and diagnosis. Korean J Gastroenterol 2009; 54(2):67-76 (Abstract).
- Nieminen A, Kokkola A, Yla-Liedenpohja J, et al. Early gastric cancer: clinical characteristics and results of surgery. Dig Surg 2009; 26(5):378- 83.
- Blackshaw GR, Barry JD, Edwards P, Allison MC, Lewis WG. Open Access gastroscopy is associated with improved outcomes in gastric cancer. Eur J Gastroenterol Hepatol 2003; 15: 1333-7.
- Tragardh B, Haglund U. Endoscopic diagnosis of gastric ulcer. Evaluation of the benefi ts of endoscopic follow up observation for malignancy. Acta Chir Scand 1985; 151:37-41.
- Bustomante M, Devesa F, Borghol A, Ortuno J, Ferrando MJ. Accuracy of the initial endoscopic diagnosis in the discrimination of gastric ulcers: is endoscopic follow up study always needed? J Clin Gastroenterol 2002;35:25-8.
- Saruc M, Sertdemir A, Turkel N, Tuzcuoglu I, Ozden N, Yuceyar H. Midazolam-indıced seadtion for upper gastrointestinal endoscopy: assessment of endoscopist and patient satisfaction. Gastroenterol Nurs 2003;26(4):164-7.
Öz
Giriş ve Amaç: Midede izlenen lezyonlarda benign olanlar ile malign olanların ayrımında tekrar endoskopi gerekliliği yaygın olarak kabul edilmiş bir yaklaşımdır. Fakat klinik pratikte hastaları ikinci veya üçüncü gastroskopi için ikna etmek kolay olmamaktadır. Gastroenteroloğun kendi kliniği tabanlı verileri ile endikasyonlarını kontrol etmesi, hastalarına kanıta dayalı tıp uygulayabilmesi için gereklidir. Bu çalışmada kliniğimizdeki tekrar endoskopi endikasyon ve sonuçlarını değerlendirdik. Yöntem: Tekrar endoskopiyi kabul eden ve ilk endoskopisinde malign olduğu kanıtlanabilen lezyonu olmayan hastalar çalışmamıza alındı. Hastalar son tanı, tanıya ulaşabilmek için gereken endoskopik işlem sayısı ile endoskopik ve patolojik bulgular yönünden değerlendirildiler. Bulgular: Gastrik ülserli seksen üç hastaya tekrar endoskopisi yapıldı. Ortalama endoskopi sayısı 2.15 idi. Dokuz hastada 3, 3 hastada 4 endoskopi işlemi gerekli olmuşken, hiç bir hastada 5.kez endoskopi işlemi yapmak gerekli olmamıştır. Seksen üç hastanın 77’sinde tekrar endoskopide ülser gözlenmedi. Fakat 6 hastada %7.2 malign ülser olduğu kanıtlandı. Bunların 4’ü ikinci endoskopide tanınırken, iki hastanın tanısı ancak 3. işlemler sonrasında doğrulanabildi. Hastaların 5’inde gastrik adenokanser bulunurken, diğer olguda gastrik lenfoma saptandı. Beş gastrik kanserli hastanın 2’sinde %40 erken mide kanseri olduğu görüldü. Sonuç: Çalışma sonuçlarımız gastrik ülser saptanan hastalarda tekrar endoskopilerinin gerekliliğini doğrulamaktadır. Olgularımızdaki malignansi oranı %7.2’dir. Bu yüksek oran klinisyeni ve endoskopisti tekrar endoskopileri yaparak gastrik ülser iyileşmesinin doğrulanması gerekliliği konusunda cesaretlendirmelidir.
Anahtar Kelimeler
mide ülseri mide kanseri erken mide kanseri endoskopi tekrar gastroskopi
Kaynakça
- Hooper A.N, Stephans MR, Lewis WG, et al. Relative value of repeat gastric ulcer surveillance gastroscopy in diagnosing gastric cancer. Gastric Cancer 2006; 9: 217-22.
- Rollag A, Jacobsen CD. Gastric ulcer and risk of cancer. A 5-year follow up study. Acta Med Scand 1984; 216: 105-9.
- British Societey of Gastroenterology. Dyspepsia management guideline (online). British Society of Gastroenterology, 2004. www. nice.org.uk.
- Mountford RA, Brown P, Salmon PR, et al. Gastric cancer detection in gastric ulcer disease. Gut 1980; 21: 9-17.
- Binici DN, Koca T, Dursun H. Dietary habits, demographical and socio- economical risk factors of the newly diagnosed gastric cancers in Eastern Anatolia Region of Turkey: An endemic upper gastrointestinal cancer region. Dig Dis Sci 2008.
- Choi IJ. Gastric cancer screening and diagnosis. Korean J Gastroenterol 2009; 54(2):67-76 (Abstract).
- Nieminen A, Kokkola A, Yla-Liedenpohja J, et al. Early gastric cancer: clinical characteristics and results of surgery. Dig Surg 2009; 26(5):378- 83.
- Blackshaw GR, Barry JD, Edwards P, Allison MC, Lewis WG. Open Access gastroscopy is associated with improved outcomes in gastric cancer. Eur J Gastroenterol Hepatol 2003; 15: 1333-7.
- Tragardh B, Haglund U. Endoscopic diagnosis of gastric ulcer. Evaluation of the benefi ts of endoscopic follow up observation for malignancy. Acta Chir Scand 1985; 151:37-41.
- Bustomante M, Devesa F, Borghol A, Ortuno J, Ferrando MJ. Accuracy of the initial endoscopic diagnosis in the discrimination of gastric ulcers: is endoscopic follow up study always needed? J Clin Gastroenterol 2002;35:25-8.
- Saruc M, Sertdemir A, Turkel N, Tuzcuoglu I, Ozden N, Yuceyar H. Midazolam-indıced seadtion for upper gastrointestinal endoscopy: assessment of endoscopist and patient satisfaction. Gastroenterol Nurs 2003;26(4):164-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Mart 2010 |
| Yayımlandığı Sayı | Yıl 2010Sayı: 1 |