Bora Gumustop

A prospective, blinded study of diagnostic esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope

OBJECTIVES:A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE).METHODS:In phase I, 10 healthy volunteers underwent both peroral and transnasal esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently.RESULTS:In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances.CONCLUSIONS:Unsedated esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.

Striking trends in the cholangiocarcinoma incidence and mortality in the United States of America 1979–1998

Background and Methods: Cholangiocarcinoma (CCA) arises from both intra and extrahepatic bile ducts and has been considered a rare tumor in the United States. Recently, worldwide rising mortality due to primary liver tumors including intrahepatic cholangiocarcinoma (IHCC) has been reported. We have analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database to determine the age-adjusted incidence of cholangiocarcinoma and data from the U.S. Vital-Statistics database to determine age-adjusted mortality rates. Results: The incidence of I HCC (leD-9 155.1) progressively increased from 0.12 to 0.81 per 100,000 population between 1979 and 1996 (Figure) associated with a rise in mortality from 0.2 to 0.9 during 1979-1998. Increase in mortality was higher in men (0.2 to 1.1) compared with women (0.2 to 0.8). The percent change in mortality was higher in those aged >75 years. In contrast, the incidence of extrahepatic cholangiocarcinoma (EHCC lOB-9 156.1) decreased from 1.1 to 0.7 (Figure) and the mortality reduced from 0.6 to 0.3 associated with a similar reduction in mortality secondary to gall bladder cancer (iCD-9 156.B} from 1.2 to 0.7 per 100,000 population during this period. Conclusions: The incidence and mortality of intrahepatic cholangiocarcinoma in the USA has increased five fold in the last two decades, the rate of rise of which far exceeds that of hepatocellular carcinoma. This is not readily explained by diagnostic transfer from other tumors or improved diagnosis. Opposing trends in intra and extra hepatic cholangiocarcinoma suggest dissimilar pathogenesis.