Bytzer P
Dept. of Medical Gastroenterology S, Odense University Hospital, Denmark.
Scand J Gastroenterol. 1991 Nov;26(11):1193-9. doi: 10.3109/00365529108998613.
Endoscopic follow-up study of gastric ulcer to detect cancer is held to be mandatory. To evaluate the benefits of this routine strategy, 913 index endoscopies for gastric ulcer in 773 patients during the 3-year period 1985-87 were analyzed. Correctness of diagnosis was verified through surgery, autopsy, or clinical follow-up. Endoscopic follow-up was done in 83% of the cases, totaling 1269 endoscopies, showing gastric cancer in 10 patients. Clinical outcome, however, was poor for five of these (early death). Five additional cancer cases were missed by the endoscopic follow-up. In the same period 63 gastric cancers were found at the first endoscopy; 9 of these were diagnosed through biopsies only. Predictive values of the macroscopic judgements of benign lesion or probable/definite malignancy were 0.98 and 0.40, respectively. Evaluation of case records did not indicate characteristics that would have helped in the correct differentiation between benign and malignant lesions. Thus, each case of curable gastric cancer is found at the expense of approximately 250 follow-up endoscopies. We are in need of sensitive and specific markers for possible malignancy in the patient with apparently benign gastric ulcer.
对胃溃疡进行内镜随访以检测癌症被认为是必不可少的。为评估这一常规策略的益处，对1985年至1987年3年间773例患者的913次胃溃疡初次内镜检查进行了分析。通过手术、尸检或临床随访来验证诊断的正确性。83%的病例进行了内镜随访，共1269次内镜检查，其中10例发现胃癌。然而，其中5例临床结局不佳（早期死亡）。内镜随访还漏诊了另外5例癌症病例。同期，初次内镜检查发现63例胃癌；其中9例仅通过活检确诊。良性病变或可能/肯定恶性病变的宏观判断的预测值分别为0.98和0.40。对病例记录的评估未显示有助于正确区分良性和恶性病变的特征。因此，每发现1例可治愈的胃癌，大约需要进行250次随访内镜检查。我们需要针对明显良性胃溃疡患者可能存在的恶性病变的敏感且特异的标志物。
