Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer.

BACKGROUND AND AIMS: Up to 14 % of upper gastrointestinal cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated. METHODS: UGIC subjects were identified from a UK primary care database. Post-EGD upper gastrointestinal cancers (PEUGIC) cases were subjects undergoing EGD 12-36 months prior to UGIC diagnosis. Controls had not undergone EGD during the same period. Logistic regression analysis examined associations with PEUGIC. RESULTS: 4249 gastric cancer (GC) subjects (44.8 %) and 5238 esophageal cancer (EC) subjects (55.2 %) were analyzed. There were 633 (6.7 %) PEUGIC subjects [279 EC and 354 GC]. Multivariate analysis revealed that younger age [OR 1.02, (95 % CI 1.01-1.03), p < 0.0001], female gender [1.39 (1.17-1.64), p < 0.0001], increasing comorbidity [1.35 (1.13-1.61), p < 0.0001], and greater deprivation [1.31 (1.09-1.59), p = 0.005] were associated with PEUGIC. Alarm symptoms on presentation [0.32 (0.26-0.40), p < 0.0001] were less likely to be associated with PEUGIC. GC was more likely to be associated with PEUGIC than EC [1.33 (1.13-1.58), p = 0.001]. PEUGIC EGDs reported findings associated with UGIC (stricture or ulceration) in 8.3 % of cases, and only 60.9 % had a follow-up EGD within 90 days. PEUGIC rate declined from 7.9 to 2.7 % for EC and 9.0-6.5 % for GC during the study period. CONCLUSIONS: PEUGIC occurs in 6.7 % of UGIC. PEUGIC was associated with GC, younger age, female gender, increasing comorbidity and deprivation, and a lack of alarm symptoms.

Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million.

The treatment of esophageal atresia is not centralized in Germany. Therefore, high numbers of departments are involved. Data on the results of esophageal atresia repair from Germany are lacking. The aim of this study was to evaluate the early postoperative results after repair of esophageal atresia based on unbiased data of a German health insurance. We aimed to determine whether characteristics of the departments had an impact on outcome and compared the results from this study with the literature data from centers with a high caseload. Data of a German health insurance covering ∼10% of the population were analyzed. All patients who had undergone esophageal atresia repair from January 2007 to August 2012 were included. Follow-up data of 1 year postoperatively were analyzed. The potential impact of various characteristics of the treating surgical institutions was assessed. Results were compared with the latest international literature. Seventy-five patients with esophageal atresia underwent reconstructive surgery in 37 departments. The incidences of anastomotic leak (3%) and recurrent tracheoesophageal fistula (7%) were comparable with the literature (both 2-8%). Anastomotic stricture required dilatation in 57% of patients (mean 5.1 ± 5.6 dilatations) comparing unfavorably to most, but not all international reports. During 1-year follow-up, 93% of the patients were readmitted at least once (mean 3.9 ± 3.1 admissions). The incidence of complications did not correlate with any of the characteristics of the treating institutions such as academic affiliation, the number of consultants, beds, and preterm infants treated per year (all P > 0.05). Based on unbiased data, postoperative results after repair of esophageal atresia in Germany are comparable with recently published reports from international single centers. A correlation between the complication rate and characteristics of the treating institutions was not identified.

LEVEL OF THE GUALITY OF LIFE OF THE PATIENTS AFTER ESOPHAGOPLASTY ON THE BASIS OF GASTROINTESTINAL INDEX ASSESSMENT.

The article presents the interview results of 55 patients after esophagoplasty (30 cases - after esophagogastroplasty, 25 cases - after esophagoplasty) using questionnaire GIQLI. The authors came to conclusions about advantages of extirpation of esophagus with esopagogastroplasty compared with subtotal shunt esophagocoloplasty because of high rate of gastrointestinal index of the quality of life and their components in patients after esophagogastroplasty compared with results of patients after esophagoplasty. There was noted an expessed growth in the scales and rise of gastrointestinal index in patients who underwent esophagogastroplasty after 3 years of follow-up.

Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly.

OBJECTIVES/HYPOTHESIS: To examine associations between quality of care, short- and long-term treatment-related outcomes, and costs in elderly patients treated for laryngeal squamous cell cancer (SCCA). STUDY DESIGN: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We evaluated longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate regression, and survival analysis. Using quality indicators derived from guidelines for recommended care and performance measures, an overall summary measure of quality was calculated incorporating summary quality measures for diagnosis, initial treatment, performance, surveillance, treatment for recurrence, and end-of-life care. RESULTS: Higher-quality care was associated with a lower likelihood of long-term weight loss (odds ratio [OR] = 0.6 [0.5-0.8]), stricture (OR = 0.5 [0.3-0.8]), gastrostomy dependence (OR = 0.5 [0.4-0.7]), airway obstruction (OR = 0.7 [0.6-0.9]), tracheostomy (OR = 0.5 [0.3-0.7]), and pneumonia (OR = 0.7 [0.5-0.9]), but had no impact on the likelihood of dysphagia. Higher-quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.7 [0.6-0.8]), weight loss (HR = 0.8 [0.6-0.9]), airway obstruction (HR = 0.7 [0.6-0.8]), tracheostomy (HR = 0.7 [0.5-0.9]), and pneumonia (HR = 0.8 [0.6-0.9]), but was not associated with survival differences in patients with gastrostomy dependence or stricture. Costs associated with dysphagia, weight loss, stricture, airway obstruction, and pneumonia were lower for patients receiving higher-quality care. CONCLUSIONS: Higher-quality larynx cancer care was associated with a reduced incidence of late airway and swallowing impairment after laryngeal SCCA treatment in elderly patients, with improved survival and reduced costs. These data suggest that greater attention to evidence-based practices associated with quality indicators may lead to improved functional outcomes in the elderly. LEVEL OF EVIDENCE: 2c.

Prevalence of gastroesophageal reflux disease in Korea and associated health-care utilization: a national population-based study.

BACKGROUND AND AIM: Few studies have reported temporal trends in the prevalence of gastroesophageal reflux disease (GERD) and associated health-care utilization in Asia. The aim of this study was to investigate temporal changes in the prevalence of GERD and associated health-care utilization. METHODS: Patients with a primary or secondary disease code for GERD, according to the Korean Standard Classification of Diseases, were defined as having "doctor-diagnosed GERD". The prevalence of GERD from 2005 to 2008 was evaluated using Korean National Health Insurance claim data. Claims for proton pump inhibitors (PPI) over this period were also evaluated. Complications of GERD and health-care utilization characteristics, such as the use of diagnostic tests and prescriptions, were investigated. RESULTS: The prevalence of doctor-diagnosed GERD increased rapidly from 4.6% to 7.3% between 2005 and 2008. Over the same period, the amount of PPI claims increased by 56%. People aged 30-39 years and females had a high frequency of GERD-related visits. Esophageal stricture was rare, and 23% of patients with GERD had peptic ulcers. Endoscopy was used as a diagnostic test in 34% of cases. Seventy-seven percent of patients with GERD were treated with PPI or H(2) receptor antagonists. CONCLUSIONS: The prevalence of GERD increased rapidly from 2005 to 2008. The rapid increase of PPI use reflects the real increase in the prevalence of GERD and demand for health care. Middle-aged people and women had a high frequency of GERD visits. Therefore, GERD might be a significant disease burden in Korea.

Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation.

OBJECTIVES: The aim of this study was to compare the incidence and endoscopic management of esophageal stricture formation, significant ulcer bleeding, massive esophageal hematoma, and perforation resulting from endoscopic band ligation or sclerotherapy of esophageal varices. METHODS: Consecutive esophagogastroduodenoscopies in which band ligation or sclerotherapy was performed for acute or obliterative therapy were entered into a computerized endoscopy database during a 7-yr period. Patients were excluded if they died within 72 h of treatment session from complications unrelated to the procedure. Sclerotherapy was performed using a 25-gauge needle with 1.5% sodium tetradecyl sulfate and banding was primarily performed with a Wilson-Cook 6 or 10 shooter. Complications were assessed at scheduled endoscopy and outpatient clinic visits, review of quality assurance data tallied on a monthly basis, and patient records. RESULTS: Two hundred twenty-one cases of sclerotherapy were performed in 59 patients compared to 110 cases of band ligation in 52 patients. Five patients were excluded because of death within 72 h of the procedure. The incidence of complications from sclerotherapy:banding on a per patient basis included: esophageal stricture formation 25.6%:1.9%, ulcer bleed 25.4%:5.7%, esophageal perforation 2.2%:0%, and massive esophageal hematoma 1.6%:0%. A significant difference in complications between sclerotherapy and band ligation was noted for both stricture formation (p < 0.0005) and ulcer bleeding (p < 0.0001). The majority of ulcer bleeds required no therapeutic intervention, whereas stricture formation required multiple dilation sessions. CONCLUSIONS: Band ligation has a significantly lower incidence of stricture formation and ulcer bleeding compared to sclerotherapy. The majority of complications can be managed with endoscopic interventions.

Hospital discharges resulting from esophagitis among Medicare beneficiaries.

Despite the frequent occurrence of gastroesophageal reflux disease, until now only very few studies have dealt with the epidemiology of this common disorder. The Health Care Financing Administration complies annually 10 million records of all hospital discharges among Medicare beneficiaries distributed throughout the United States. The purpose of the present study was to take advantage of this large data set and analyze the demographic characteristics of patients discharged with esophagitis, esophageal ulcer, or esophageal stricture. The hospital discharge rates of all three diagnoses showed an age-related rise, the rise being most pronounced for esophageal stricture and, less significant, esophageal ulcer. The marked age dependency of esophageal stricture and ulcer may reflect the time necessary for complications to develop. While simple esophagitis affected women more frequently than men, significantly more men contracted its severe forms involving ulcers and strictures. All forms were more common in whites than blacks, and living in the southern parts of the United States was associated with an increased risk for esophagitis and strictures. The data suggest that besides varying exposure to environmental risk factors, differences in the pathophysiology among demographically stratified groups contribute to the occurrence of esophagitis.