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Screening of the Upper Gastrointestinal Tract Diseases in Practice: Endoscopy as the first examination S. Takasu 1 , T. Funatomi 1 , F. Ikegami 1 , Y. Sakurai 1 , H. Tsuchiya 1 , A. Kitamura 1 1Department of Gastroenterology, Kanto-Teishin Hospital pp.33-39
Published Date 1983/1/25
DOI https://doi.org/10.11477/mf.1403109234
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 Since 1976, we had been gradually changing the “fluoroscopy first”policy in the examination of the upper GI tract to “endoscopy first”one. Its influence on diagnosis was investigated.

 Age, sex and symptoms matched 910 pairs were made from fluoroscopy-first group in 1976 and endoscopy-first one in 1978. For endoscopy a skinny endoscope was used and biopsy was performed when it was indicated. Over two years follow-up was performed in 61% of the cases. Overall usefulness of endoscopy was same to, or rather higher than that of fluoroscopy. The detection of esophageal varices, esophagitis, early gastric cancer and erosions was higher in endoscopy and that of diverticulum and deformity in fluoroscopy. Significantly high rate of false positive diagnosis was present in fluoroscopy.

 In the next, 271 cases of esophageal and gastric cancer newly detected in our department between 1972 to 1981 were divided into two groups depending on whether they underwent fluoroscopy or endoscopy as the first examination. The superficial esophageal cancer was only detected in the endoscopy group. The frequency of early gastric cancer was significantly higher in the endoscopy group (28% vs 43%). Early gastric cancer in the proximal one third of the stomach was present only in the endoscopy group. In the endoscopy group the diagnosis was established in 96% by the first examination but in the fluoroscopy one further examination was necessary in 37%.

 Nine gastric cancers were overlooked by endoscopy and five foci were false negative in biopsy. Most of them were located at the oral side above the gastric angle. The gastric juice should be sucked before examination. Very careful investigation is requested in cardiac area. We stress to observe each part of the gastric corpus from two or more different directions. Some scirrhous cancer was difficult to be diagnosed.

 In conclusion fluoroscopy of the upper GI tract must be replaced by endoscopy with a skinny instrument such as GIF-P3 or its equivalent. Medico-economic effect which may be provoked by this change must be carefully considered.


Copyright © 1983, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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