The completion rate of colonoscopy in normal daily practice: factors associated with failure.

BACKGROUND: Colonoscopy is an important diagnostic procedure for screening as well as for patients presenting with complaints. The completion of a colonoscopy is defined as cecal intubation. A large single center study was done in order to evaluate the completion rate of colonoscopy and identify reasons for failure. PATIENTS AND METHODS: We reviewed all consecutive endoscopies of the lower digestive tract done over a period of 15 years by 2 endoscopists. The main outcome measure was a successful cecal intubation. RESULTS: 14,139 consecutive colonoscopies were done. Overall cecal intubation was successful in 11,787 procedures (83.3%). Three hundred and sixty-one of the non-successful procedures were due to insufficient colon cleansing, and no significant abnormalities were seen in 362 procedures. In the remaining 1,629 endoscopies, significant diagnoses were made. The presence of colorectal cancer, diverticula and inflammatory bowel disease were significant findings in non-successful procedures. CONCLUSION: In normal daily practice, colonoscopy is completed in 83.3% of the procedures. Reasons for failure are obstructing tumors, diverticula and insufficient colon cleansing.

The annual yield of diagnostic endoscopy of the lower digestive tract.

BACKGROUND: Endoscopy of the colon and rectum has become a standard diagnostic procedure. No data are presented in the literature on the annual yield or on morbidity patterns. A large, cross-sectional, single-center study was done in order to detect the annual yield of endoscopy of the colon and rectum. METHODS: All consecutive endoscopies performed over an 11-year period were included. All files from a random year were taken in order to collect data on the indication for the endoscopy. A standardized endoscopy report was used. RESULTS: Over the 11-year period, 11,550 consecutive endoscopies of the lower digestive tract were performed. Seven hundred and fourteen procedures were excluded because they were done as a direct follow-up after the index procedure. The majority of endoscopies were scheduled as colonoscopy. The most common endoscopic diagnoses made each year remained constant in number. Cancer was diagnosed in 4-6% of cases, inflammation in 9-15%, polyps in 9-16%, and diverticular disease in 21-37%. The percentage of women undergoing the procedure each year ranged from 54% to 59%, that of men from 41% to 46%. CONCLUSION: From this study it can be concluded that the annual yield of endoscopy of the lower digestive tract remains rather constant. No major changes in morbidity are noted.

Helicobacter pylori and gastro-oesophageal reflux disease: a cross-sectional epidemiological study.

BACKGROUND: H. pylori infection is accompanied by a lower prevalence of reflux disease. There is still an ongoing debate as to whether H. pylori actually protects against the development of reflux oesophagitis or is merely an epiphenomenon. A cross-sectional study was performed to study the relation of H. pylori with reflux oesophagitis, hiatus hernia and Barrett's oesophagus. MATERIAL AND METHODS: Consecutive patients undergoing upper gastrointestinal endoscopy in a period of ten years were studied. Included were patients with active reflux oesophagitis and/or hiatus hernia and/or Barrett's oesophagus. As a reference group, patients without macroscopic abnormalities were included. H. pylori was detected applying routine diagnostic modalities. RESULTS: In the ten years 11,691 consecutive patients were studied. Reflux oesophagitis was seen in 1535 patients, 307 patients had Barrett's oesophagus and a hiatus hernia was present in 2116 patients. The reference group consisted of 5341 patients. H. pylori was significantly less often detected in patients with reflux oesophagitis or Barrett's oesophagus compared with the reference group, 20 vs 29% (p<0.001). Also presence of H. pylori was significantly lower in patients with hiatus hernia 20 vs 29% (p<0.0001). CONCLUSION: The present study confirms, in a very large group of patients studied in one single centre, the findings of earlier papers. Patients without H. pylori gastritis suffer more often from reflux disease. There is a relation between H. pylori and reflux disease. However, the consequence of this relation will not be the same in every patient.

Prevalence of gastroesophageal reflux disease in immigrants living in the Zaanstreek region in the Netherlands.

Racial differences in the incidence of reflux disease are reported but data on differences in ethnicity are rare. A study was undertaken to assess the prevalence of reflux disease, defined as the presence of reflux esophagitis, in immigrants and correlate the results with native inhabitants living in the same region. Consecutive patients with hiatus hernia and defective lower esophageal sphincter closure as well as reflux esophagitis were included. A large population of people of Turkish descent and a small contingent of people from northern Africa and the Middle East were studied separately. Reflux disease was diagnosed in 4165 patients. One hundred and sixty-seven (4%) were of Turkish descent, and 26 (0.6%) originated from Africa and the Middle East. Reflux disease occurred significantly less often in immigrants, 24% versus 55.5% (P < 0.0001). There was no difference relating to gender in the presence of reflux disease in native Dutch patients, while the number of men in the immigrant group with the condition was significantly higher than women; 51% versus 72%, respectively (P < 0.0001). The majority of immigrants only suffered from mild reflux esophagitis (P < 0.001). Immigrants with reflux disease are significantly younger than native Dutch patients, mean age 42 years versus 57 years, respectively (P < 0.0001). Reflux disease is less prevalent in immigrants, mostly people of Turkish descent. If the condition is present in this population, the majority of patients is male and belongs to the younger age cohorts.

Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy.

BACKGROUND: In the literature a lot of epidemiological data is present but little is known on the yearly incidence of oesophagitis and Barrett's oesophagus. For this reason a cross-sectional study was done to explore the yearly incidence of these conditions in patients sent for upper gastrointestinal endoscopy. METHODS: All patients diagnosed with reflux oesophagitis, Barrett's oesophagus or hiatus hernia in a 10-year period were included. RESULTS: In the period of 10 years 11,691 consecutive patients underwent endoscopic examination. Oesophagitis was diagnosed in 1,633 patients, Barrett's oesophagus in 275, and hiatus hernia without oesophagitis in 1,407 patients. The number of patients with oesophagitis almost doubled, while the number of patients with hiatus hernia or Barrett's oesophagus remained constant each year in this time period. The number of men diagnosed with oesophagitis or Barrett's oesophagus was significantly higher than the number of women. Hiatus hernia occurred significantly more often in women, and was present in 79-88% of patients with active reflux oesophagitis. CONCLUSION: This study clearly shows that the incidence of reflux oesophagitis shows a marked increase. The incidence doubled in a period of ten consecutive years. This data should be kept in mind in planning future health-care resources. It can be expected that the use of acid suppressive therapy will be rising in the years to come.

Changes in prevalence of Helicobacter pylori infection in two groups of patients undergoing endoscopy and living in the same region in the Netherlands.

BACKGROUND: There are few data on the prevalence of Helicobacter pylori in different populations and no data on changes in time. A cross-sectional study was done in a large population of patients undergoing endoscopy in order to relate the presence of H. pylori to ethnic background and to detect changes in time. METHODS: All consecutive patients over a 10-year period were included and biopsy specimens from the gastric antrum were taken for detection of H. pylori. A large population of immigrants living in the Zaanstreek region was studied separately. RESULTS: In the 10-year period, 14,909 consecutive diagnostic upper GI endoscopies were done in 11,691 consecutive patients. Only the first endoscopy done in a patient was included. Of 11,691 patients available for evaluation, there were 5669 men and 6022 women (mean age 55 years, range 4-99). Of these, 3201 (27.4%) were H. pylori-positive and 4988 (42.7%) were H. pylori-negative. No biopsy specimens were available for the remaining 3501 (29.9%) patients. In the group under study, 1309 (11%) patients were immigrants. H. pylori was present significantly more often in men and in immigrants, where prevalence was 75% versus 33% (P < 0.0001). The prevalence of H. pylori showed a marked decrease in both populations during the period of study. Extrapolating trend lines into the future indicates a prevalence of H. pylori below 10% by the year 2009. Among immigrants, this will be reached in approximately 2027. CONCLUSION: This study shows differences in prevalence of H. pylori in different populations. We found a decreasing prevalence that can be explained by the lower acquisition rate of the infection. It is important to be aware of the differences in prevalence of H. pylori in a population composed of different ethnicities.

The yield of UGIE: a study of a ten-year period in the 'Zaanstreek'.

BACKGROUND: Study of the occurrence of abnormalities in the oesophagus, stomach and duodenum, and of changes in specific diagnoses. METHODS: All consecutive upper gastrointestinal endoscopies (UGIEs) carried out in a period of ten years were included. RESULTS: In ten years 14,927 diagnostic UGIEs were performed (7335 men (49%) and 7592 women (51%)). These procedures were done at the request of the general practitioner in 4995 (33%) cases. A steady yearly increase in the number of open-access UGIEs was noted. Each year a mean of 796 abnormalities was seen in the oesophagus, a mean of 437 in the stomach, and of 162 in the duodenum. The presence of hiatal hernia and reflux oesophagitis significantly increased in the ten years (p < 0.001). The numbers of Barrett's oesophagus and oesophageal cancer remained constant. Gastritis showed a gradual increase (p < 0.001), while the number of gastric ulcers found per year decreased significantly in the ten-year period (p < 0.001). Gastric malignancy remained constant. Presence of duodenal ulcers and bulbitis significantly decreased (p = 0.01 and p = 0.06, respectively). CONCLUSIONS: The number of UGIEs carried out at the request of the general practitioner has significantly increased. Peptic ulcer disease shows a significant decrease, while reflux disease increases.

Newly developing hiatus hernia: a survey in patients undergoing upper gastrointestinal endoscopy.

BACKGROUND: Data on the incidence of hiatus hernia are lacking. A cross-sectional study was performed in a large population of consecutive patients undergoing endoscopy in order to assess the yearly incidence of hiatus hernia in this population. METHODS: Consecutive patients undergoing upper gastrointestinal endoscopy in whom no macroscopic abnormalities were seen and who, in addition, underwent a second endoscopy were included in the study. The presence of newly developed hiatus hernia was noted, as well as the time elapsed between both endoscopies. RESULTS: Over a period of 8 years, 12 122 endoscopies were performed in 9580 patients. Ninety patients developed a hiatus hernia; this was not the case in a control group of 353 patients. Patients who developed a hiatus hernia were significantly older than those who did not (P < 0.001). The number of women who developed hiatus hernia was higher than the number of men who developed hiatus hernia (P < 0.0001). The total time between both endoscopies in 443 patients was 897 patient years. Ninety patients (20.3%) developed a hiatus hernia. If these data are extrapolated to a yearly occurrence, then 35 of 176 patients will develop a hiatus hernia. It takes an average of 1.9 years for a hiatus hernia to develop. CONCLUSIONS: In the present study, it was calculated that 19.9% of the studied population would develop a hiatus hernia per year. Patients who developed a hiatus hernia were significantly older than patients who did not. The present study also shows that a hiatus hernia actually develops later in life.

Reflux esophagitis and hiatal hernia as concomitant abnormality in patients presenting with active duodenal or gastric ulcer: cross-sectional endoscopic study in consecutive patients.

BACKGROUND: Follow-up studies have shown that patients with ulcer disease are at risk of developing reflux esophagitis (RE) after successful eradication of Heliobacter pylori. It is still not clear whether this is induced by eradication of H. pylori or whether RE is already present at the time the ulcer is diagnosed. A cross-sectional study was done in consecutive patients suffering from active ulcer disease in order to assess coincidental RE. METHODS: Patients with an active duodenal or gastric ulcer were included in the study. Concomitant RE and the presence of hiatal hernia (HH) were scored. Biopsy specimens were taken for detection of H. pylori. RESULTS: In 375 patients (77%), an active duodenal ulcer was the only abnormality. In 43 patients (8.8%), duodenal ulcer and concomitant RE were present and 69 patients (14.2%) had a duodenal ulcer with concomitant HH. Patients with a duodenal ulcer were significantly younger than patients with concomitant RE or HH. From 374 patients (76.8%) with a duodenal ulcer, biopsy specimens were available for the detection of H. pylori. The majority of duodenal ulcer patients were H. pylori-positive. H. pylori was significantly more often present in patients with an active duodenal ulcer than it was in duodenal ulcer patients suffering from concomitant RE (P=0.04). In 218 patients (76%), a gastric ulcer was the only abnormality. Fifteen patients (5.2%) also had RE and 54 patients (18.8%) had a concomitant HH. There was no difference in H. pylori status in these three groups of patients. CONCLUSIONS: Given the low prevalence of concomitant RE, it is concluded that this condition is likely to occur in a large percentage of patients suffering from H. pylori-positive ulcer disease after successful eradication therapy.

Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel.

OBJECTIVE: To study the prevalence of diverticula and presence of concomitant pathology in consecutive patients undergoing endoscopic examination of the colon. METHODS: A cross-sectional analysis of the endoscopy reports of all patients sent for endoscopic evaluation of the colon in a period of 8.5 years. RESULTS: A total of 9086 endoscopies were performed. Of these 2259 (24.7%) were undertaken for follow-up. Diverticula were seen in 1849 patients (27%) (739 male, 1110 female, mean age 69 year). In 4978 patients (73%)(2162 male, 2816 female, mean age 52 year) no diverticula were seen, of these 2303 (46%) had no abnormalities in their colon. Patients with diverticula were significantly older, 69 vs 46.7 years (P < 0.001). No difference was present in gender. Colorectal cancer and inflammatory bowel disease were significantly more common in patients without diverticula, while polyps were more often seen in patient with diverticula. Patients with diverticula had a significantly lower incidence of colorectal cancer. In addition, the number of cancers located proximal to the splenic flexure was statistically higher in the group of patients presenting with diverticula (P < 0.001). CONCLUSIONS: The overall prevalence of diverticular disease in patients undergoing endoscopy is 27%, and increases with age. Patients with diverticulosis have significantly lower incidence of colorectal cancer and if cancer is detected then it is more common proximal to the splenic flexure.