Volume 73 - 2010 - Fasc.4 - Original articles
Impact of reimbursement policy in Belgium on the referral pattern and diagnostic yield of capsule endoscopy. A single-centre study
Introduction : Since the first of July 2008, capsule endoscopy (CE) is partially reimbursed for patients with obscure gastro- intestinal bleeding (OGIB).
Objective : To evaluate the impact of reimbursement of CE on the referral pattern and the diagnostic yield of CE.
Methods : We retrospectively selected data from patients who underwent a CE in the University Hospital of Ghent between July 2002 and June 2009. Following data were analysed : number of CEs, indication, number of transfusion-dependent patients, haemoglobin level and relevance of the CE findings.
Results : There was an increase in the number of patients referred for CE after the first of July 2008. Simultaneously, the number of relevant findings was decreasing. Between July 2002 and June 2003, 66.7% of the capsule endoscopies showed relevant bowel lesions. Over the last 2 years, the diagnostic yield has been decreasing to 40.5% in the period July 2007-June 2008 and only 30.2% in the period July 2008-June 2009. Transfusion need and haemoglobin level at the moment of CE had a significant influence on the diagnostic yield (P<0.001 for both parameters).
Conclusions : The number of patients referred for CE has risen since the reimbursement of CE. However, there is a trend towards referral of less severe bleeders, with less transfusion need and a higher haemoglobin level. This significantly lowers the diagnostic yield of CE. (Acta gastroenterol. belg., 2010, 73, 437-440).
What is the consequence of hyperplastic polyps ? Do adenomas and colorectal cancer develop in these patients ? A clinical study
Aim : Do patients with hyperplastic polyps (HP) have an increased risk for developing adenomas and colorectal cancer (CRC) ? A study was done to detect the number of patients developing adenomas and CRC.
Material and methods : From 1990-1995 all patients with a HP diagnosed via endoscopy and significant follow-up were studied. The patients were separated in three groups ; Group 1 HP in patients with previous adenoma and/or CRC. Group 2 HP with a concurrent adenoma and/or CRC. Group 3 patients with only HP.
Results : Group 1 consisted of 20 patients, group 2 of 39 patients, and group 3 of 136 patients The follow-up was 12.5, 12.6, and 13.4 years respectively. In group 1 there was one patient with an adenoma in the index investigation. In group 2 adenomas were seen coinciding to hyperplastic polyp(s) in 29 patients, while in 11 cases there was a colorectal cancer. Obviously patients in group 3 only had hyperplastic polyps. In group 1 7 patients previously had an adenoma and 12 previously had colorectal cancer. Four patients in group 3 developed cancer : 13, 14, 15, and 15 years after the detec- tion of a hyperplastic polyp. In group 2 only one patient developed cancer in the cecum 9 years after the index investigation. In the four patients of group 3 who developed cancer no one previously had a serrated adenoma at revision of the original histology. Twelve patients developed an adenoma.
Conclusion : Only five CRC's developed in patients with HP. Thus, at the best the risk for developing CRC in patients with HP is not very high and equals that of adenomas. (Acta gastroenterol. belg., 2010, 73, 441-444).
Prospective randomized study comparing double layer and Tannenbaum stents in distal malignant biliary stenosis
Backgrounds/Aims : Although the presence of autoimmune thyroiditis (AT) in celiac disease (CD) has been well documented among adults, CD in AT has been less reported in children. We aimed to investigate the frequency of CD in children with AT.
Lessons from a 20 year experience of Home Parenteral Nutrition in adult patients
Background : Home Parenteral Nutrition (HPN) is a method commonly used in patients with Chronic Intestinal Failure (CII) related to benign or malignant diseases. We report the experience from a 20 year programme of HPN in a single academic centre.
Methods : In this study, we have reviewed characteristics and outcome of a group of patients enrolled in a HPN program between 1987 and 2007. Focus was given to the prevalence and severity of cholestasis in these patients as well as on their oral food behaviour.
Results : In 20 years, 125 patients were included in a HPN pro- gramme ; 65 patients had benign diseases (BD) and 60 advanced cancer (AC). Short bowel was the most common indications in patients with BD. Almost 40% of patients with BD were weaned off HPN. Median survival was excellent in BD patients and extremely short in AC. Death related to HPN was very rare. Cholestasis has been observed in 84% of patients but it was mild to moderate in the majority of cases. Hyperphagia was observed in 50% of the patients with BD on long-term HPN.
Conclusions : This study confirms that HPN is the first line therapy in CII due to BD. Patients with AC should be carefully selected. Cholestasis is frequent but mostly without clinical impact. Half of the patients with CII due to BD become hyperphagic allowing to reduction of parenteral intake. The role of a multi- disciplinary nutrition support team is essential for optimizing HPN. (Acta gastroenterol. belg., 2010, 73, 451-456).