Management and screening of patients with cancer-prone lesions of the stomach

Les procédés de dépistage constituent un luxe propre aux pays riches. Le coût de la découverte d'une lésion au stade clinique doit toujours être apprécié en fonction du rapport coût/bénéfice d'autres méthodes de diagnostic. Le procédé de dépistage le plus coûteux du cancer de l'estomac est celui qui concerne une population générale, même à haut risque, comme c'est le cas en Amérique du Sud, au Japon, en Italie et au Portugal. Le dépistage devient plus abordable dans une population symptomatique («surconsommation d'endoscopies») ou dans des pathologies qui prédisposent au cancer (ex: l'anémie pernicieuse) ou encore chez des porteurs de «macro- ou micro-lésions précancéreuses». Les macro-lésions importantes sont la gastrite atrophique achlorhyridrique de type A, le moignon post-gastrectomie et éventuellement la gastrite atrophique de type B associée à H. pylori. Les micro-lésions précancéreuses sont la dysplasie et la métaplasie intestinale en particulier le sous-groupe III producteur de sulfomucines. Dans la gastrite atrophique achlorhydrique de type A et 15 à 20 ans après une gastrectomie partielle, une surveillance endoscopique tous les 3 à 5 ans est recommandée chez les patients bénéficiaires de mesures thérapeutiques. La dysplasie modérée et la métaplasie intestinale du sous-groupe III justifient des contrôles plus fréquents (annuels?). Chez les patients porteurs de façon répétée d'une dysplasie sévère, une gastrectomie totale est indiquée à titre thérapeutique pour un cancer déjà présent ou à titre préventif vis-à-vis d'un cancer potentie

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases. Armbrecht U, Manus B, Bragelmann R, Stockbrugger RW, Stolte M. Marbachtalklinik, Bad Kissingen. Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.s.) accepted a sigmoidoscopy. Of 658 (m = 403, f = 255) patients with complete investigation, 153 (23%) (m = 104, 26%; f = 49, 19%; n.s.) had a total of 272 neoplastic polyps, including 1 carcinoma. Adenomas = /> 10 mm were found exclusively in male patients (n = 25, p 10 mm were 2%/10% (p 10 mm. In 5 cases with positive FOBT sigmoidoscopy and complementary colonoscopy did not reveal any patholog

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases. Armbrecht U, Manus B, Bragelmann R, Stockbrugger RW, Stolte M. Marbachtalklinik, Bad Kissingen. Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.s.) accepted a sigmoidoscopy. Of 658 (m = 403, f = 255) patients with complete investigation, 153 (23%) (m = 104, 26%; f = 49, 19%; n.s.) had a total of 272 neoplastic polyps, including 1 carcinoma. Adenomas = /> 10 mm were found exclusively in male patients (n = 25, p 10 mm were 2%/10% (p 10 mm. In 5 cases with positive FOBT sigmoidoscopy and complementary colonoscopy did not reveal any patholog

Screening for gastrointestinal neoplasia: efficacy and cost of two different approaches in a clinical rehabilitation centre

Mortality from colorectal cancer (CRC) can be reduced by screening of asymptomatic individuals and by removal of colorectal adenomas (CRA). It is still under debate which screening method should be used. In a clinical rehabilitation centre we compared two widely different approaches: faecal occult blood testing (FOBT) with subsequent endoscopy of test-positives in an unselected patient group, and primary sigmoidoscopy of asymptomatic persons between 50 and 60 years of age. Between January 1988 and October 1991 a FOBT was offered to all--symptomatic and asymptomatic--6,500 in-patients of a clinical rehabilitation centre and lower/upper GI-endoscopy was suggested to test-positives (study A). In the latter half of this period 1,166 persons without bowel symptoms and/or disease and aged 50-60 years were invited to a screening sigmoidoscopy (study B). In study A 95% of the patients (n = 6,234) returned a complete FOBT, which was positive in 186 (2.98%). 126 of these 186 patients (68%) accepted further investigation, and a total of 78 sigmoidoscopies, 78 colonoscopies and 47 gastroscopies were performed. Six patients in whom a malignancy was detected (1 gastric, 1 rectal and 4 colonic; all in a curable stage) underwent surgery. In 28 patients CRA were identified and removed by snare excision. In study B 658/1,166 asymptomatic in-patients accepted the screening sigmoidoscopy (56%). Rectosigmoid adenomas were identified in 153 (23%). One rectal cancer was found. Of these cases, 116 underwent an additional colonoscopy, disclosing proximal adenomas in 39 patients (33.6%). The cost of identifying one CRA-bearer was $1,436 in study A and$271 in study B (assuming: FOBT = $3.00; sigmoidoscopy =$63.00; colonoscopy = $135; gastroscopy =$108). In study A, the cost of identifying one patient with cancer would have been $5,435, if the cost of identifying one CRA-bearer was set to$271 as in study B. Screening for CRC was well-accepted in the health-orientated environment of a rehabilitation centre. The cost of identifying a CRA-bearer with screening sigmoidoscopy was about one-fifth of that using preselection with a FOBT. However, with FOBT a higher number of cancers was found. For the discovery of CRA, mass-screening with sigmoidoscopy of persons above the age of 50 years can be advised. For the detection of both CRA and CRC, screening with FOBT and subsequent endoscopy is an acceptable and cost-effective method