The rate of endoscopic observation of the major duodenal papilla can be increased by simple guideline

Background:Ampullary lesions are being detected with increased frequency with the growing use of esophagogastroduodenoscopy. However, it is uncertain how frequently endoscopists properly visualize the major papilla in routine clinical practice. This study was undertaken to determine the actual rate of observing the major papilla by endoscopists and if there is a room for improvement in visualizing the duodenal major papilla when performing esophagogastroduodenoscopy.Methods:This was a single-center, prospective, randomized study involving 3,088 consecutive patients referred for diagnostic esophagogastroduodenoscopy at tertiary-care referral center between September and November 2010. Six fellows-in-training in the study group attempted to visualize the major papillaup to three times, while six fellows-in-training in the control group performed endoscopy in a standard fashion.Results:The overall observation rate was significantly higher in study group (975 of 1070 [91.1%]) than in control group (624 of 1022 [61%], p<0.001). 揅omplete observation� was achieved in 68.2% of the cases in study group compared to 45.0% of the cases in control group (p<0.001). The total procedure time was slightly, but significantly longer in the study group (5.82�38 min versus5.52�11 min, p=0.003).Conclusions:The rate of observing the major papilla for endoscopists is not as high as expected in routine clinical practice; however, the rate of observing the major papilla might improve significantly through application of additional effort with but a modest increase in procedural time.

Comparison between early gall bladdercancer and advanced gall bladdercancer in terms of clinicopathologic factors: large volume tertiary center experience

Background:Early diagnosis of gallbladder cancer (GBC) which enables to surgical resection is key for improve prognosis. Aim of this study was to investigate clinical features of early GBC patients compare to advanced ones.Methods:We retrospectively reviewed medical records of all pathologically confirmed primary GBC patients between in single tertiary referral center.Results:250 patients (57.3%) were early GBC (stage IandII) and 186 (42.7%) were advanced GBC (stage IIIandIV). Less patients with early GBC had symptom at initial diagnosis (69.2% versus90.8%, p<0.001). Large number of patients with early GBC were diagnosed GBC incidentally after surgical resection which initially suspected benign gallbladder polyp or symptomatic gallbladder stones (71/250, 28.4% versus7/186, 3.8%) (p<0.001). Patients who initially diagnosed gallbladder stone or cholecystitis tended to more advanced than gallbladder polyp.Conclusions:There were no definitive symptoms which can detect early GBCs. Large number of early GBCs were diagnosed incidentally and many of these initially diagnosed with or accompany with benign cholecystic disease. Careful examination should be performed before diagnosis and after treatment, even in patient with vague symptom or benign cholecystic disease without elevated tumor markers.