Disparities in Socioeconomic Factors Mediate the Impact of Racial Segregation Among Patients With Hepatopancreaticobiliary Cancer.

BACKGROUND: Structural racism within the U.S. health care system contributes to disparities in oncologic care. This study sought to examine the socioeconomic factors that underlie the impact of racial segregation on hepatopancreaticobiliary (HPB) cancer inequities. METHODS: Both Black and White patients who presented with HPB cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2005-2015) and 2010 Census data. The Index of Dissimilarity (IoD), a validated measure of segregation, was examined relative to cancer stage at diagnosis, surgical resection, and overall mortality. Principal component analysis and structural equation modeling were used to determine the mediating effect of socioeconomic factors. RESULTS: Among 39,063 patients, 86.4 % (n = 33,749) were White and 13.6 % (n = 5314) were Black. Black patients were more likely to reside in segregated areas than White patients (IoD, 0.62 vs. 0.52; p < 0.05). Black patients in highly segregated areas were less likely to present with early-stage disease (relative risk [RR], 0.89; 95 % confidence interval [CI] 0.82-0.95) or undergo surgery for localized disease (RR, 0.81; 95% CI 0.70-0.91), and had greater mortality hazards (hazard ratio 1.12, 95% CI 1.06-1.17) than White patients in low segregation areas (all p < 0.05). Mediation analysis identified poverty, lack of insurance, education level, crowded living conditions, commute time, and supportive income as contributing to 25 % of the disparities in early-stage presentation. Average income, house price, and income mobility explained 17 % of the disparities in surgical resection. Notably, average income, house price, and income mobility mediated 59 % of the effect that racial segregation had on long-term survival. CONCLUSION: Racial segregation, mediated through underlying socioeconomic factors, accounted for marked disparities in access to surgical care and outcomes for patients with HPB cancer.

Endoscopic ultrasound fine needle biopsy was not more cost-effective than fine-needle aspiration with rapid on-site evaluation in gastrointestinal lesions diagnosis.

BACKGROUND AND AIM: Cost-effectiveness comparison between endoscopic ultrasound (EUS)-guided acquisition techniques by fine-needle aspiration (FNA) and fine needle biopsy (FNB) in gastrointestinal lesions is still scarce. EUS-FNB has been shown to be more cost-effective than EUS-FNA, however, when adding rapid on-site evaluation (ROSE) to EUS-FNA, it is unclear whether EUS-FNB remains more cost-effective. Our aim was to assess cost-efficacy of EUS-FNB as compared to EUS-FNA with ROSE in gastrointestinal lesions. METHOD: All patients who underwent EUS-FNA with ROSE or EUS-FNB at Galilee Medical Center were retrospectively reviewed. Cost-effectiveness analysis was based on the additional EUS sessions needed and on the average cost expenditure to achieve one final pathological diagnosis. RESULTS: Seventy-four cases were included in the final analysis. Of them, 21 patients (28.4%) were in the EUS-FNB group (group A), as compared to 53 patients (71.6%) who underwent EUS-FNA with ROSE (group B). Additional EUS sessions needed to achieve one final pathological diagnosis were needed in 14.3% of group A patients vs 9.4% in group B patients (P = .5). and, the average cost for achieving one final pathological diagnosis was similar in both groups (1226 ± 369$ for group A vs 1158 ± 309.6.7$ for group B, P = .2). Notably, even after analyzing pancreatic and non-pancreatic gastrointestinal lesions separately, there was no cost benefit of EUS-FNB over EUS-FNA with ROSE. CONCLUSIONS: Cost-effectiveness analysis was not different between EUS-FNB vs EUS-FNA with ROSE. Thus, the preference of one modality over the other should be based on availability and local expertise.

Changes in digestive cancer diagnosis during the SARS-CoV-2 pandemic in Italy: A nationwide survey.

BACKGROUND: The SARS-CoV-2 pandemic has had a huge impact on healthcare systems, resulting in many routine diagnostic procedures either being halted or postponed. AIMS: To evaluate whether the diagnoses of colorectal, gastric and pancreatic cancers have been impacted by the SARS-CoV-2 pandemic in Italy. METHODS: A survey designed to collect the number of histologically-proven diagnoses of the three cancers in gastroenterology services across Italy from January 1 to October 31 in 2017-2020. Non-parametric ANOVA for repeated measurements was applied to compare distributions by years and macro-areas. RESULTS: Compared to 2019, in 2020 gastric cancer diagnoses decreased by 15.9%, CRC by 11.9% and pancreatic by 9.9%. CRC distributions showed significant differences between all years, stomach cancer between 2018 and 2020 and 2019-2020, and pancreatic cancer only between 2017 and 2019. The 2019-2020 comparison showed fewer CRC diagnoses in the North (-13.7%), Center (-16.5%) and South (-4.1%), fewer stomach cancers in the North (-19.0%) and South (-9.4%), and fewer pancreatic cancers in the North (-14.1%) and Center (-4.7%), with an increase in the South (+12.3%). Distributions of CRC and gastric cancer were significantly different between all years in the North. CONCLUSIONS: This survey highlights the concerning effects of the COVID-19 pandemic on the diagnostic yield of gastroenterology services for stomach, colorectal and pancreatic cancers in Italy.

Digestive tract neoplasms in young individuals: Demographics, staging and risk factors.

BACKGROUND: Digestive tract neoplasms (DTN) have become increasingly common worldwide among young individuals (YIs) over the last few decades. AIM: Aim of this research was to study the types, demographics, stage at presentation and risk factors of digestive tract neoplasms in young individuals. METHODS AND RESULTS: In this cross-sectional study, YI (ie, ≤40 years) presenting with any DTN including gastrointestinal neoplasms (GIN), hepatobiliary neoplasms (HBN), periampullary neoplasms (PAN) and others from June 2016 to May 2020 were included. Baseline laboratory tests, tissue diagnosis and staging were performed while risk factors were documented. A total of 163 patients were included in the study, of whom 82 (50.3%) were males. Mean age was 29.9 (±9.57) (range: 8 months-40 years). Most DTN (93.3%; n = 152) were malignant. The commonest neoplasms were lower GIN (LGIN) 52 (31.9%), followed by HBN 46 (28.2%), upper GIN (UGIN) 44 (27%) and PAN 18 (11%). Commonest among LGIN were rectal 37; among HBN: hepatocellular cancer (HCC) 9, cholangiocarcinoma (CC) 9; and among UGIN: esophageal 25 and stomach 14. Rectal cancers were mostly sporadic (82.7%) with frequent signet ring cell histology (40.5%), and affected relatively younger ages compared to upper GIN and PAN. GIN were mostly locally advanced with higher resectability (LGIN 90.4%; UGIN 79.5%) while HBN were more advanced with lower resectability (HCC [44.4%]; CC [33.3%]). Poor dietary habits and poor socioeconomic status were common with UGIN (63.6%, 50%) and HBN (56.5%, 54.3%), respectively. CONCLUSION: The commonest DTN among YI were LGIN followed by HBN, UGIN and PAN. Rectal cancers affected relatively younger ages and were mostly sporadic. HBN were more advanced in stage and unresectable compared to GIN. Poor dietary habits and poor socioeconomic status may be important contributors in carcinogenesis.

Metabolic Biomarkers of Squamous Cell Carcinoma of the Aerodigestive Tract: A Systematic Review and Quality Assessment.

Introduction. Aerodigestive squamous cell carcinomas (ASCC) constitute a major source of global cancer deaths. Patients typically present with advanced, incurable disease, so new means of detecting early disease are a research priority. Metabolite quantitation is amenable to point-of-care analysis and can be performed in ASCC surrogates such as breath and saliva. The purpose of this systematic review is to summarise progress of ASCC metabolomic studies, with an emphasis on the critical appraisal of methodological quality and reporting. METHOD: A systematic online literature search was performed to identify studies reporting metabolic biomarkers of ASCC. This review was conducted in accordance with the recommendations of the Cochrane Library and MOOSE guidelines. RESULTS: Thirty studies comprising 2117 patients were included in the review. All publications represented phase-I biomarker discovery studies, and none validated their findings in an independent cohort. There was heterogeneity in study design and methodological and reporting quality. Sensitivities and specificities were higher in oesophageal and head and neck squamous cell carcinomas compared to those in lung squamous cell carcinoma. The metabolic phenotypes of these cancers were similar, as was the kinetics of metabolite groups when comparing blood, tissue, and breath/saliva concentrations. Deregulation of amino acid metabolism was the most frequently reported theme. CONCLUSION: Metabolite analysis has shown promising diagnostic performance, especially for oesophageal and head and neck ASCC subtypes, which are phenotypically similar. However, shortcomings in study design have led to inconsistencies between studies. To support future studies and ultimately clinical adoption, these limitations are discussed.

COVID-19: Revue des lignes directrices et recommandations pour la prise en charge des cancers digestifs hauts en contexte de pandémie / COVID-19: Review of guidelines and recommendations for the management of upper digestive cancers in the context of a pandemic

CONTEXTE: Le présent document a été rédigé en réponse à une interpellation du ministère de la Santé et des Services sociaux (MSSS) dans le contexte de l'urgence sanitaire liée à la maladie à coronavirus (COVID-19) au Québec. L'objectif est de réaliser une recension sommaire des recommandations publiées afin d'appuyer les travaux du MSSS visant à se doter de directives provinciales en matière de prise en charge des patients atteints d'un cancer digestif haut, destinées aux décideurs publics et aux professionnels de la santé et des services sociaux. Vu la nature rapide de cette réponse, les présents travaux ne reposent pas sur un repérage exhaustif des données publiées et une évaluation de la qualité méthodologique des publications avec une méthode systématique. Dans les circonstances d'une telle urgence de santé publique, l'INESSS reste à l'affût de toutes nouvelles publications susceptibles de lui faire modifier cette réponse rapide. PRÉSENTATION DE LA DEMANDE: Dans le présent contexte d'urgence sanitaire, une réorganisation significative des soins destinés aux patients atteints de cancer a été entreprise afin de protéger les patients des risques de contracter la COVID-19 et aussi de permettre une réallocation de certaines ressources à la prise en charge de la COVID-19. Le ministère de la Santé et des Services sociaux a entrepris des travaux dans le but d'orienter les équipes de soins sur ce qui devra être maintenu, délesté ou adapté dans un contexte où le système ne permettrait qu'un accès limité à certains services. Une recension sommaire des principales lignes directrices et prises de position par des associations, des sociétés savantes et des consensus d'experts en lien avec la priorisation des soins en contexte d'urgence sanitaire a été effectuée. Un comité d'experts québécois spécialisés en cancers digestifs hauts a par la suite été formé par le MSSS pour discuter des informations extraites de la littérature et formuler, par consensus, des recommandations en lien avec la priorisation des soins propres au contexte québécois. Le document présente la revue de la littérature qui a appuyé les travaux du groupe d'experts. Les recommandations finales sont disponibles sur le site du MSSS au lien suivant : Priorisation des patients. MÉTHODOLOGIE: Question d'évaluation Quels sont les principales lignes directrices et prises de position des associations, des sociétés savantes et des consensus d'experts en lien avec la priorisation des soins pour le traitement des cancers digestifs hauts en contexte d'urgence sanitaire? Revue de littérature Repérage des publications : Littérature scientifique : La revue de la littérature (langue anglaise et française) a été effectuée entre le 29 mars et le 1er avril 2020, dans PubMed avec les mots clés suivant : COVID, COVID-19, coronavirus, neoplasia, digestive cancer, esophageal cancer, pancreatic cancer, gastric cancer, liver cancer, biliary tract cancer. Les listes de références des documents retenues ont été consultées afin de repérer d'autres publications admissibles. Les liens similar articles et cited by de l'interface PubMed ont été consultés pour chacune des publications scientifiques retenues ainsi que des revues narratives pertinentes. Littérature grise: Une recherche dans google a été faite avec les mots-clés suivants : priorisation, adaptation, recommandations, guides, consensus, cancer du pancréas, cancer de l'œsophage, cancer de l'estomac, cancer des voies biliaires, cancer hépatique (langue française et anglaise). Sélection des publications : Les publications pertinentes (lignes directrices, orientations cliniques, éditoriaux, lettres d'opinion, communications scientifiques ou documents de travail) et spécifiques à la priorisation de cas et à la prise en charge des cancers digestifs hauts en contexte de pandémie de COVID-19 ont été retenues. Certains documents ont été transmis à l'INESSS et au MSSS mais ne sont pas disponibles en ligne. Les recommandations d'ordre général quant aux mesures de protection contre le coronavirus n'ont pas été retenues. La sélection des publications a été effectuée par une professionnelle scientifique en cancérologie selon les critères d'inclusion suivants: Population: patients atteints d'un cancer digestif haut (pancréas, œsophage, estomac, voies biliaires, foie, tumeur neuroendocrine, GIST); Intervention: procédure diagnostique, suivi, imagerie, chirurgie, radiothérapie, radio-chimiothérapie, chimiothérapie, thérapie ciblée. oContexte: priorisation des soins (maintien, délestage ou adaptation thérapeutique) en contexte d'urgence sanitaire liée à la pandémie de COVID19. Extraction des données et synthèse: L'extraction des données a été effectuée par une professionnelle scientifique en cancérologie. Les données extraites comprennent, s'il y a lieu (si applicable et selon la disponibilité de l'information): Caractéristiques de la publication : auteur, date de publication ou de diffusion, source des recommandations, type de publication, juridiction; Recommandations: siège tumoral, situation clinique (stade, grade, symptômes, etc.), intervention, risque de progression de la maladie, alternative de prise en charge proposée (maintien, délestage ou adaptation thérapeutique), technique, source des données probantes en appui à la décision (p. ex. une étude clinique), autres particularités. Les recommandations ont été extraites telles que publiées, et celles rédigées en anglais ont été traduites en français (traduction libre). Les recommandations ont été classées selon les sites tumoraux (pancréas, foie, voies biliaires, œsophage thoracique proximal et moyen, œsophage distal et jonction gastro-œsophagienne, estomac, tumeur neuroendocrine, GIST) et la situation clinique considérée. SOMMAIRE DES RÉSULTATS: Positions des sociétés savantes, associations médicales, consensus ou opinions d'experts: Neuf publications rapportant les prises de position et les lignes directrices relatives à la priorisation des soins selon le contexte d'urgence sanitaire ainsi que les alternatives thérapeutiques proposées concernant la prise en charge des cancers digestifs hauts ont été retenues. L'ensemble des recommandations se trouvent dans le tableau suivant.

Management of occluded self-expanding biliary metal stents in malignant biliary disease.

BACKGROUND: Occlusion of self-expanding metal stents (SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients. METHODS: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS, management strategies, stent patency, subsequent interventions, survival time and case charges. RESULTS: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency (88 vs. 143 days, P = 0.069), median survival time (95 vs. 192 days, P = 0.116), median subsequent intervention rate (53.4% vs. 40.0%, P = 0.501) and median case charge (€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months, significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS (93.3% vs. 57.1%, P = 0.037). CONCLUSIONS: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy.

Racial Disparity in Gastrointestinal Cancer Risk.

Cancer from the gastrointestinal tract and its associated excretory organs will occur in more than 300,000 Americans in 2017, with colorectal cancer responsible for >40% of that burden; there will be more than 150,000 deaths from this group of cancers in the same time period. Disparities among subgroups related to the incidence and mortality of these cancers exist. The epidemiology and risk factors associated with each cancer bear out differences for racial groups in the United States. Esophageal adenocarcinoma is more frequent in non-Hispanic whites, whereas esophageal squamous cell carcinoma with risk factors of tobacco and alcohol is more frequent among blacks. Liver cancer has been most frequent among Asian/Pacific Islanders, chiefly due to hepatitis B vertical transmission, but other racial groups show increasing rates due to hepatitis C and emergence of cirrhosis from non-alcoholic fatty liver disease. Gastric cancer incidence remains highest among Asian/Pacific Islanders likely due to gene-environment interaction. In addition to esophageal squamous cell carcinoma, cancers of the small bowel, pancreas, and colorectum show the highest rates among blacks, where the explanations for the disparity are not as obvious and are likely multifactorial, including socioeconomic and health care access, treatment, and prevention (vaccination and screening) differences, dietary and composition of the gut microbiome, as well as biologic and genetic influences. Cognizance of these disparities in gastrointestinal cancer risk, as well as approaches that apply precision medicine methods to populations with the increased risk, may reduce the observed disparities for digestive cancers.

Assessment of Factors Affecting the Usefulness and Diagnostic Yield of Core Biopsy Needles with a Side Hole in Endoscopic Ultrasound-Guided Fine-Needle Aspiration.

BACKGROUND/AIMS: A barbed puncture needle with a side hole was recently developed to improve sample quality and quantity in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In this study, we retrospectively assessed the usefulness of this puncture needle. METHODS: Factors affecting diagnostic yield, safety, and diagnostic accuracy were investigated in 76 patients who consecutively underwent EUS-FNA for neoplastic lesions at our hospital between January and December 2013. RESULTS: The procedure was successful in all cases; the rates of sample collection and determination of the correct diagnosis were 92.1% and 89.5%, respectively. The mean number of needle passes required for diagnosis was 1.1. Complications included mild intraluminal bleeding in two patients (2.6%). Multivariate analysis revealed that lesion size (≤20 mm) was significantly associated with a decreased chance of determining the correct diagnosis. CONCLUSIONS: Core biopsy needles with a side hole are safe and provide a satisfactory diagnostic yield. However, the side hole may potentially reduce the rate of making the correct diagnosis in small lesions.

A multistep cytological approach for patients with jaundice and biliary strictures of indeterminate origin.

AIMS: Fluorescence in situ hybridisation (FISH) increases the sensitivity for detecting pancreatobiliary tract cancer over routine cytology. In this study, diagnostic accuracy and costs of cytology and FISH in detecting cancer in patients with jaundice with biliary strictures were assessed. METHODS: Brushing specimens from 109 patients with jaundice were obtained during endoscopic retrograde cholangiopancreatography and examined by cytology and FISH. The specimens were considered FISH-positive for malignancy if at least five polysomic cells or 10 cells with homozygous or heterozygous 9p21/p16 deletion were detected. Definitive diagnosis of the stricture as benign or malignant relied on surgical pathology (45 cases) or clinical-radiological follow-up >18 months (64 cases). We calculated costs of cytology and FISH based on the reimbursement from the Piedmont region, Italy (respectively, €33 and €750). RESULTS: Ninety of 109 patients had evidence of malignancy (44 pancreatic carcinomas, 36 cholangiocarcinomas, 5 gallbladder carcinomas, 5 other cancers), while 19 had benign strictures. Routine cytology showed 42% sensitivity, but 100% specificity for the diagnosis of malignancy, while FISH-polysomy showed 70% sensitivity with 100% specificity and FISH-polysomy plus homozygous or heterozygous 9p21/p16 deletion showed 76% sensitivity with 100% specificity. The cost per additional correct diagnosis of cancer obtained by FISH, in comparison with cytology, was €1775 using a sequential cytological approach (ie, performing FISH only in patients with negative or indeterminate cytology). CONCLUSIONS: FISH should be recommended as the second step in detecting cancer in patients with jaundice with pancreatobiliary tract strictures and cytology negative or indeterminate for malignancy.

Digestive cancer management in Asia: position statements: a report on GI Oncology Summit in 2011.

BACKGROUND AND AIM: With the rising incidence of digestive cancers in the Asia Pacific region and the advancement in diagnosis, management and palliation in these conditions, the clinical burden on oncologists is ever increasing. This Summit meeting was called to discuss the optimal management of digestive cancers and the role of Gastroenterologists. METHOD: Experts from Asia Pacific countries in the fields of medical, oncologic, surgical and endoscopic management of cancers in the esophagus, stomach, colon/rectum and the liver reviewed the literature and their practice. 18 position statements were drafted, debated and voted. RESULTS: It was agreed that the burden on GI cancer is increasing. More research will be warranted on chemotherapy, chemoprevention, cost-effectiveness of treatment and nutrition. Cancer management guidelines should be developed in this region when more clinical data are available. In order to improve care to patients, a multi-disciplinary team coordinated by a "cancer therapist" is proposed. This cancer therapist can be a gastroenterologist, a surgeon or any related discipline who have acquired core competence training. This training should include an attachment in a center-of-excellence in cancer management for no less than 12 months. CONCLUSION: The management of GI cancer should be an integrated multi-disciplinary approach and training for GI cancer therapists should be provided for.

A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study.

UNLABELLED: Comprehensive geriatric assessment (CGA) is advocate to improved care of elderly with cancer but is not available in every hospital within a short delay. Therefore, a tool allowing gastroenterologist to detect rapidly specific abnormalities in elderly is needed. PATIENTS AND METHODS: the aim of our pilot study was to evaluate feasibility of a mini geriatric assessment (MGA) to adapt the anticancer treatments. MGA was done by a gastroenterologist and was taken into account during the cancer multidisciplinary team meeting for making decision. Then, CGA was realised and suggested adaptation of care. RESULTS: 21 patients over 75 years treated for different digestive cancers were enrolled. The treatments recommended by the cancer multidisciplinary team meeting after the GMA were: standard treatments in 9 (41%); modified in 10 (47%) and best supportive care in 2 (12%) patients. CGA led to an adaptation of the non-oncological treatment in 15 (72%) and of the social care in 8 (38%) patients, but never modified the oncological strategy. CONCLUSIONS: MGA could help gastroenterologists for adaptation of anticancer treatment. The characteristics of the patients that should subsequently have a geriatric follow-up remain to be defined.

Frequency of bacteremia after linear EUS of the upper GI tract with and without FNA.

BACKGROUND: Few data are available concerning the frequency of bacteremia after diagnostic EUS or EUS-guided FNA. This study was undertaken to provide these data and to determine whether present guidelines for prophylactic administration of antibiotics to prevent endocarditis during upper endoscopy are applicable to EUS and EUS-guided FNA. METHODS: A total of 100 patients who were to undergo diagnostic EUS of the upper-GI tract and 50 who were to have upper-GI EUS-guided FNA were enrolled in this prospective study. Blood cultures were obtained before and within 5 minutes after the conclusion of the procedure. In case of bacterial growth, patients were observed for at least 3 days for signs of infection. RESULTS: After diagnostic EUS, significant bacteremia was found in two patients with esophageal carcinoma (2%: 95% CI[0%, 4.8%]) and after EUS-guided FNA in two patients (4%: 95% CI[0%, 9.6%]). The difference was not statistically significant. None of these patients developed clinical signs of infection. Risk factors predisposing to bacteremia could not be identified. CONCLUSION: The frequency of bacteremia after EUS, with and without FNA, is within the range of that for diagnostic upper endoscopy. Therefore, the same recommendations for prophylactic administration of antibiotics to prevent endocarditis may be applied in patients undergoing EUS and EUS-guided FNA. The role of esophageal cancer as a predisposing factor to EUS-associated infection remains uncertain.

Evaluation of a 10-minute comprehensive MR imaging examination of the upper abdomen.

PURPOSE: To determine whether a 10-minute magnetic resonance (MR) imaging examination of the upper abdomen provides sufficiently comprehensive information to replace a longer MR protocol. MATERIALS AND METHODS: Images obtained with selected breathing-independent and breath hold MR sequences, with 2 minutes of total acquisition time and an estimated 10 minutes of total study time, in consecutive MR examinations of the upper abdomen in 72 patients (age range, 23-87 years) were retrospectively reviewed in a blinded fashion by two separate interpreters. Determination was made of major and minor findings, and the two separate retrospective interpretations and the prospective clinical interpretation were correlated by using kappa statistics. Surgical and clinical findings were also correlated with imaging findings. RESULTS: In 61 patients, all major and minor findings were identical in the original clinical interpretation and the two retrospective readings. In 66 patients, the major findings were identical in these three readings. Close agreement was present between the two separate retrospective readings and the prospective clinical interpretation (kappa = 0.49-1.00). CONCLUSION: The findings suggest that the diagnostic information provided by a shortened MR imaging protocol that includes breath-hold and breathing-independent sequences is in close agreement with lengthier MR protocols. The advantages of a shortened protocol include increased patient throughput and decreased study cost.

Digestive endoscopy: relevance of negative findings.

In patients with digestive complaints, endoscopy is the gold standard and is often the primary exploration. Positive findings in upper gastrointestinal endoscopy occur in 30 to 40% in relation to a benign or malignant structural disease. Negative findings occur therefore in 60 to 70% of cases: dyspepsia and/or reflux are functional diseases. Colonoscopy aims essentially at screening of colorectal cancer. Digestive cancer is very rare under 50 years, and most cases detected with symptoms are advanced; asymptomatic early and curable cancer is detected in screening. A negative finding at endoscopy is reliable in the hands of an experienced endoscopist controlling the risk of false negative and false positive findings. A reliable negative endoscopy is beneficial for the quality of life when it relieves anxiousness of the patient. It may be cost effective if drugs and consultations are decreased. Overuse of negative endoscopy is not so much through large indications, that in repetition of negative procedures. The relevance of negative endoscopy in screening for cancer in the upper and lower digestive tract, is whether is should be repeated. There is tendency to increased intervals in surveillance protocols. In the very near future the first role of endoscopy in the primary diagnosis could be challenged by concurrent techniques. Future progress is based upon a Quality Assurance program for quality, experience of the operator a control of the cost and a research programme on tolerance with a trend to reduced sedation.