[Cost-benefit of upper digestive endoscopy. Frequency of early gastric cancer and negative endoscopy in relation to indications]. / Costi-benefici dell'endoscopia digestiva superiore. Frequenza degli early gastric cancers e delle endoscopie negative in rapporto alle indicazioni.

The increasing demand for upper gastrointestinal endoscopies (184% from 1974 to 1985) led to a review of cases in an attempt to improve the cost-benefit ratio of this diagnostic procedure (E.G.C.). Two parameters were evaluated: the frequency of early gastric cancers and, on the other hand, the incidence of negative endoscopic findings with respect to indications. The increase in the number of endoscopies performed was not matched by an increased frequency of E.G.C. diagnosed: 8.9% in 1974-1979 and 7.5% in 1980-1985 with an E.G.C./endoscopy ratio of 1:218 and 1:415 respectively; in the second period the diagnostic accuracy of endoscopy was enhanced from 42.8% to 100%. The overall frequency of negative endoscopic findings on 500 patients undergoing endoscopy in 1985, was 40.4%. The greatest number of negative findings was observed in patients with non-ulcerous dyspepsia under 50 years of age and in those with ulcerous dyspepsia with prior duodenal ulcer; on the other hand, a significant prevalence of cancerous and precancerous lesions was observed in patients over 50 with non-ulcerous dyspepsia. The results of this study suggest that patients over 50 years with non-ulcerous dyspepsia should receive early endoscopic investigation, in those under 50 an initial therapeutic approach appears reasonable. In the patients with prior duodenal ulcer endoscopy is of limited value for the assessment of response to therapy.

[Early gastric cancer: a retrospective study of our cases (1974-1979)]. / Early gastric cancer: studio retrospettivo sulla nostra casistica (1974-1979).

A retrospective analysis of 3052 gastroscopies made by our Digestive Endoscopy Department from 1974 to 1979 was carried out. 14 Early Gastric Cancers out of a total of 157 gastric carcinomas were diagnosed (8.9%), with an EGC: Gastroscopies ratio = 1:218. From the macroscopic point of view 8 were found to belong to type III, 5 to type II, and 1 to type I. The main location was the lesser curvature (angulus-antrum). With regard to the degree of infiltration, 2 were found to belong to stage 0a, 8 to stage 0b, and 5 to stage I. The endoscopic observation gave reason to suspect the presence of a malignant lesion in 6 of the 14 cases. The bioptic examination proved positive in 10 cases, while in 4 the diagnosis was made on the operatory piece. The importance of multiple bioptic samples is again confirmed. Cytology performed by brushing showed malignant tumoral cells in 4 cases, and again in 4 cases the radiological examination led to suspicion of degenerated gastric ulcer. 13 patients were subjected to surgery during which no metastases to the locoregional lymphonodes were found; the patients are all alive. We started gastric carcinoma screening by selecting the patients on the basis of a worksheet covering epidemiological, clinical, biohumoural and instrumental parameters, since the prognosis for the disease is directly proportional to the earliness of its diagnosis.