北陸地区におけるスクリーニング上部消化管内視鏡検査での咽頭観察の現状

[背景・目的] 現在, スクリーニング上部消化管内視鏡検査における咽頭領域の観察が十分に浸透しているとはいい難い状況である. 北陸地区における上部消化管内視鏡での咽頭観察の現状について調査した. [方法] 日本消化器内視鏡学会専門医114名にアンケートを送付し, 回答のあった73名を対象とし調査した. [結果] 咽頭観察を全例に行っている医師は79.5%, スクリーニングに画像強調観察(image-enhanced endoscopy:IEE)を用いた(I群)のは61.6%であった. 観察時間はI群が白色光(W群)と比べ有意に長く(p<0.001), 1年以内の癌の発見率はI群がW群と比べ有意に高かった(p=0.007). 問題点として, 観察の困難さ, 苦痛増強の可能性などの意見が多かった. [結論] スクリーニングにおける咽頭観察において, 癌の発見にはIEEにて時間をかけて観察することが重要である可能性が示唆された. 今後, さらなる咽頭観察の啓蒙活動が重要と考えられる.出版者照会後に全文公

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era