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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest, Korányi Sándor u. 2/A, 1083
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Absztrakt:

Bevezetés és célkitűzés: A Semmelweis Egyetem I. Belgyógyászati Klinikájának endoszkópos laboratóriumában vizsgálták a felső és alsó endoszkópiák indikációit, a diagnózisok megoszlását indikációk szerint, valamint a kolonoszkópiák minőségi mutatóit. Módszer: 2010. január 1. és 2011. december 31. között 2987 beteg felső és alsó endoszkópos vizsgálatának adatait elemezték (férfi/nő: 1361/1626, átlagéletkor: 60,7 év, SD: 16,7 év) a fekvő- és járóbeteg-megjelenések riportjaiból. Eredmények: A felső endoszkópiák során a jóindulatú fekélybetegség, nyelőcső-varicositas, gyomorpolip és gyomorrák előfordulási gyakorisága 10,8%, 4,5%, 6,1% és 2,9% volt. Az alsó endoszkópos vizsgálatok vastagbélpolipot, diverticulosist, daganatot és gyulladásos bélbetegséget 29,9%, 22,4%, 6,9% és 9,7%-ban írtak le. A betegek 26,3%-át vizsgálták okkult/manifeszt GI-vérzés indikációjával. A vérzés indikációjával vizsgált betegek idősebbek voltak (p<0,01), több volt a férfi (p<0,001, OR: 1,64), gyakrabban szedtek acenocoumarol- vagy heparinkészítményeket (p<0,001), gyakoribb volt a jóindulatú fekélybetegség (p<0,001, OR: 2,83) és nyelőcső-varicositas (p<0,001, OR: 2,79), a gasztroszkópiák, valamint a kolonoszkópiák során a colorectalis daganat (p<0,001, OR: 3,27). A kolonoszkópiák 81%-a volt komplett. Az inkomplett vizsgálat hátterében elégtelen előkészítés (38,2%), technikai nehézség (25,1%) és daganat miatti szűkület (20,5%) állt. Következtetés: A diagnózisok megoszlása és a minőségi mutatók (adenomatalálat, komplettálási arány) megfeleltek az adott populációban várhatónak. Orv. Hetil., 2016, 157(52), 2074–2081.

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  • 1

    ASGE Standards of Practice Committee, Early, D. S., Ben-Menachem, T., Decker, G. A., et al.: Appropriate use of GI endoscopy. Gastrointest. Endosc., 2012, 75(6), 1127–1131.

  • 2

    Blatchford, O., Davidson, L. A., Murray, W. R., et al.: Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ, 1997, 315(7107), 510–514.

  • 3

    Yavorski, R. T., Wong, R. K., Maydonovitch, C., et al.: Analysis of 3,294 cases of upper gastrointestinal bleeding in military medical facilities. Am. J. Gastroenterol., 1995, 90(4), 568–573.

  • 4

    Longstreth, G. F.: Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am. J. Gastroenterol., 1997, 92(3), 419–424.

  • 5

    Hreinsson, J. P., Gumundsson, S., Kalaitzakis, E., et al.: Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting. Eur. J. Gastroenterol. Hepatol., 2013, 25(1), 37–43.

  • 6

    Esrailian, E., Gralnek, I. M.: Nonvariceal upper gastrointestinal bleeding: epidemiology and diagnosis. Gastroenterol. Clin. North Am., 2005, 34(4), 589–605.

  • 7

    Strate, L. L.: Lower GI bleeding: epidemiology and diagnosis. Gastroenterol. Clin. North Am., 2005, 34(4), 643–664.

  • 8

    Lanas, A., García-Rodríguez, L. A., Polo-Tomás, M., et al.: Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am. J. Gastroenterol., 2009, 104(7), 1633–1641.

  • 9

    Van Leerdam, M. E., Vreeburg, E. M., Rauws, E. A., et al.: Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am. J. Gastroenterol., 2003, 98(7), 1494–1499.

  • 10

    Loperfido, S., Baldo, V., Piovesana, E., et al.: Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest. Endosc., 2009, 70(2), 212–224.

  • 11

    Rácz, I., Kárász, T., Lukács, K., et al.: Management of peptic ulcer bleeding in different case volume workplaces: results of a nationwide inquiry in Hungary. Gastroenterol. Res. Pract., 2012, 2012, Article ID 956434.

  • 12

    Szőcs, K., Kárász, T., Saleh, H., et al.: The value of routine second-look endoscopy in the management of the acute gastroduodenal ulcer bleeding. [A tervezett ellenőrző endoszkópia értéke az akut gastroduodenalis fekélyvérzés ellátásában.] Orv. Hetil., 2009, 150(42), 1932–1936. [Hungarian]

  • 13

    Dávid, G., Mester, G., Pandúr, T., et al.: Management strategies of acute lower gastrointestinal bleeding (ALGIB) of our department. Results of the last two years (2004–2005). Z. Gastroenterol., 2006, 44(5), A19.

  • 14

    Peery, A. F., Dellon, E. S., Lund, J., et al.: Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 2012, 143(5), 1179–1187.e3

  • 15

    Wanders, L. K., van Doorn, S. C., Fockens, P., et al.: Quality of colonoscopy and advances in detection of colorectal lesions: a current overview. Expert Rev. Gastroenterol. Hepatol., 2015, 9(4), 417–430.

  • 16

    ASGE Standards of Practice Committee, Pasha, S. F., Shergill, A., Acosta, R. D., et al.: The role of endoscopy in the patient with lower GI bleeding. Gastrointest. Endosc., 2014, 79(6), 875–885.

  • 17

    Bressler, B., Paszat, L. F., Chen, Z., et al.: Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology, 2007, 132(1), 96–102.

  • 18

    Hosokawa, O., Shirasaki, S., Kaizaki, Y., et al.: Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer. Endoscopy, 2003, 35(6), 506–510.

  • 19

    Farrar, W. D., Sawhney, M. S., Nelson, D. B., et al.: Colorectal cancers found after a complete colonoscopy. Clin. Gastroenterol. Hepatol., 2006, 4(10), 1259–1264.

  • 20

    Gellad, Z. F., Voils, C. I., Lin, L. et al.: Physician perceptions on colonoscopy quality: results of a National Survey of Gastroenterologists. Gastroenterol. Res. Pract., 2014, 2014, Article ID 510494.

  • 21

    Rex, D. K., Bond, J. H., Winawer, S., et al.: Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am. J. Gastroenterol., 2002, 97(6), 1296–1308.

  • 22

    Van Leerdam, M. E.: Epidemiology of acute upper gastrointestinal bleeding. Best Pract. Res. Clin. Gastroenterol., 2008, 22(2), 209–224.

  • 23

    Fonseca, J., Alves, C. C., Neto, R., et al.: Nonvariceal upper gastrointestinal bleeding in Portugal: A multicentric retrospective study in twelve Portuguese hospitals. Gastroenterol. Hepatol., 2012, 35(6), 377–385.

  • 24

    Lanas, A., Aabakken, L., Fonseca, J., et al.: Variability in the management of nonvariceal upper gastrointestinal bleeding in Europe: an observational study. Adv. Ther., 2012, 29(12), 1026–1036.

  • 25

    Kim, J. J., Sheibani, S., Park, S., et al.: Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J. Clin. Gastroenterol., 2014, 48(2), 113–118.

  • 26

    Zuccaro, G.: Epidemiology of lower gastrointestinal bleeding. Best Prac. Res. Clin. Gastroenterol., 2008, 22(2), 225–232.

  • 27

    Strate, L. L., Ayanian, J. Z., Kotler, G., et. al.: Risk factors for mortality in lower intestinal bleeding. Clin. Gastroenterol. Hepatol., 2008, 6(9), 1004–1010.

  • 28

    Zullo, A., Esposito, G., Ridola, L., et al.: Prevalence of lesions detected at upper endoscopy: An Italian survey. Eur. J. Intern. Med., 2014, 25(8), 772–776.

  • 29

    Park, W. G., Shaheen, N. J., Cohen, J., et al.: Quality indicators for EGD. Gastrointestinal Endoscopy, 2015, 81(1), 17–30.

  • 30

    Voutilainen, M., Mäntynen, T., Färkkilä, M., et al.: Impact of nonsteroidal anti-inflammatory drug and aspirin use on the prevalence of dyspepsia and uncomplicated peptic ulcer disease. Scand. J. Gastroenterol., 2001, 36(8), 817–821.

  • 31

    Lassen, A., Hallas, J., De Muckadell, O. B., et al.: First-time endoscopy and use of antisecretory medication: a population-based cohort study. Scand. J. Gastroenterol., 2005, 40(6), 705–712.

  • 32

    Thomson, A. B., Barkun, A. N., Armstrong, D., et al.: The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment – Prompt Endoscopy (CADET-PE) study. Aliment. Pharmacol. Ther., 2003, 17(12), 1481–1491.

  • 33

    Buri, L., Zullo, A., Hassan, C., et al.: Upper GI endoscopy in elderly patients: predictive factors of relevant endoscopic findings. Intern. Emerg. Med., 2013, 8(2), 141–146.

  • 34

    Triantos, C., Kalafateli, M., et al.: Endoscopic treatment of esophageal varices in patients with liver cirrhosis. World J. Gastroenterol., 2014, 20(36), 13015–13026.

  • 35

    Singh, H., Kaita, L., Taylor, G., et al.: Practice and documentation of performance of colonoscopy in a central Canadian health region. Can. J. Gastroenterol. Hepatol., 2014, 28(4), 185–190.

  • 36

    Rai, T., Navaneethan, U., Gohel, T., et al.: Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates. Gastroenterol. Rep. (Oxf.), 2016, 4(2), 148–153.

  • 37

    Rembacken, B., Hassan, C., Riemann, J. F., et al.: Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy, 2012, 44(10), 957–968.

  • 38

    Altenhofen, L., Kretschmann, J., et al.: Trends in adenoma detection rates during the first 10 years of the German Screening Colonoscopy Program. Gastroenterology, 2015, 149(2), 356–366.

  • 39

    Lieberman, D. A., Weiss, D. G., Bond, J. H., et al.: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N. Engl. J. Med., 2000, 343(3), 162–168.

  • 40

    Ure, T., Dehghan, K., Vernava, A. M. 3rd, et al.: Colonoscopy in the elderly. Low risk, high yield. Surg. Endosc., 1995, 9(5), 505–508.

  • 41

    Karajeh, M. A., Sanders, D. S., Hurlstone, D. P., et al.: Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy, 2006, 38(3), 226–230.

  • 42

    Manousos, O. N., Truelove, S. C., Lumsden, K., et al.: Prevalence of colonic diverticulosis in general population of Oxford area. Br. Med. J., 1967, 3(5568), 762–763.

  • 43

    Gohil, V. B., Patrie, J. T., Shami, V. M., et al.: Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy. J. Interv. Gastroenterol., 2012, 2(2), 70–75.

  • 44

    Zuckerman, G. R., Prakash, C., Askin, M. P., et al.: AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology, 2000, 118(1), 201–221.

  • 45

    Rockall, T. A., Logan, R. F., Devlin, H. B., et al.: Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ, 1995, 311(6999) 222–226.

  • 46

    Czernichow, P., Hochain, P., Nousbaum, J. B., et al.: Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur. J. Gastroenterol. Hepatol., 2000, 12(2), 175–181.

  • 47

    Lingenfelser, T., Ell, C.: Lower intestinal bleeding. Best Pract. Res. Clin. Gastroenterol., 2001, 15(1), 135–153.

  • 48

    Niikura, R., Nagata, N., Shimbo, T., et al.: Natural history of bleeding risk in colonic diverticulosis patients: a long-term colonoscopy-based cohort study. Aliment. Pharmacol. Ther., 2015, 41(9), 888–894.

  • 49

    Rex, D. K.: Colonoscopy: a review of its yield for cancers and adenomas by indication. Am. J. Gastroenterol., 1995, 90(3), 353–365.

  • 50

    Neely, D., Campbell, W., Davey, P., et al.: Colorectal cancer screening: the northern trust experience. Ulster Med. J., 2013, 82(3), 160–163.

  • 51

    Saidi, H. S., Karuri, D., Nyaim, E. O., et al.: Correlation of clinical data, anatomical site and disease stage in colorectal cancer. East Afr. Med. J., 2008, 85(6), 259–262.

  • 52

    Majumdar, S. R., Fletcher, R. H., Evans, A. T.: How does colorectal cancer present? Symptoms, duration, and clues to location. Am. J. Gastroenterol., 1999, 94(10), 3039–3045.

  • 53

    Wolfe, M. M., Lichtenstein, D. R., Singh, G.: Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N. Engl. J. Med., 1999, 340(24), 1888–1899.

  • 54

    Leontiadis, G. I., Molloy-Bland, M., Moayyedi, P., et al.: Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis. Am. J. Gastroenterol., 2013, 108(3), 331–345.

  • 55

    Quirke, P., Risio, M., Lambert, R., et al.: European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Quality assurance in pathology in colorectal cancer screening and diagnosis. Endoscopy, 2012, 44(Suppl. 3), SE116–SE130.

  • 56

    Rabeneck, L., Rumble, R. B., Axler, J., et al.: Cancer Care Ontario Colonoscopy Standards: standards and evidentiary base. Can. J. Gastroenterol., 2007, 21(Supl. D), 5D–24D.

  • 57

    Oh, C. H., Lee, C. K., Kim, J. W.: Suboptimal bowel preparation significantly impairs colonoscopic detection of non-polypoid colorectal neoplasms. Dig. Dis. Sci., 2015, 60(8), 2294–2303.