Effectiveness of a colonoscopic screening programme in first-degree relatives of patients with colorectal cancer.

AIM: The study aimed to assess the diagnostic yield of a colonoscopy screening programme in first-degree relatives of colorectal cancer (CRC) patients and to identify factors associated with advanced neoplasia. METHOD: We conducted a cross-sectional study. Individual characteristics, family trees and colonoscopy findings of asymptomatic first-degree relatives of CRC patients were collected. The findings were classified into cancer (invasive carcinoma and/or non-invasive high-grade neoplasia), high-risk adenomas (≥ 10 mm and/or a villous component) and low-risk adenomas (tubular < 10 mm). The dependent variable was the presence of advanced neoplasia, defined as cancer and/or high-risk adenoma. RESULTS: Two hundred and sixty-three relatives (147 females), 50.0 ± 11.5 (range, 25-75) years of age, agreed to participate out of a total of 618 who were invited (acceptance rate 42.5%). Index cases were diagnosed at 63.8 ± 12.4 (range, 37-88) years of age. The closest familial relationship was parent/offspring in 168 (63.9%) participants and sibling in 95 (36.1%) participants; 14.8% had three or more relatives with CRC/cancer associated with Lynch syndrome, and two or more affected generations were identified in 24.0%. Advanced neoplasia was found in 56 (21.3%) participants. Of these, invasive cancer, non-invasive high-grade neoplasia and high-risk adenomas were detected in five (1.9%), six (2.3%) and 45 (17.1%) participants, respectively. Low-risk adenomas were detected in 20 (7.6%) participants. Male sex (odds ratio, 2.59; P = 0.003) and sibling relationship (odds ratio, 2.74; P = 0.001) were independently associated with advanced neoplasia. CONCLUSION: We detected advanced neoplasia in a considerable number of participants. Our data support colonoscopy screening in first-degree relatives of patients with CRC at an earlier age than in the medium-risk population. Male sex and sibling relationship were predictors of advanced neoplasia.

[Referrals to a gastroenterology outpatient clinic: differences according to patients' geographical origin]. / Derivaciones a consultas de aparato digestivo: diferencias en función del medio geográfico de procedencia.

INTRODUCTION: The characteristics of users of the Spanish public health system have been evaluated in multiple studies. However, these studies usually refer to users of primary care and emergency services and less frequently to users of specialized services. Some studies have described differences according to patients' geographical origin. OBJECTIVE: To analyze the demographic profile of patients attending our gastroenterology outpatient clinic over a prolonged period. PATIENTS AND METHOD: The geographical origin, age and sex of all patients referred for an initial consultation in the gastroenterology outpatient clinic from 2001-2003 were analyzed. RESULTS: Women accounted for 53.7% of all appointments but no significant differences in referral rates were observed in comparison with men. A total of 65.5% of patients were from urban areas and the referral rate was significantly higher in these patients than in those from rural areas, although attendance rates were equal between patients from the two types of area. Referral rates increased in direct proportion with age; a predominance of referrals was observed in women aged < 74 years and in men aged 75 years or older. Some discrepancies were found among the distinct years analyzed. CONCLUSIONS: In our catchment area, demand is greater in the urban population than in the rural population. No overall differences were found in sex but significant differences were found in age and length of follow-up.

Derivaciones a consultas de aparato digestivo: diferencias en función del medio geográfico de procedencia / Referrals to a gastroenterology outpatient clinic: differences according to patients' geographical origin

Introducción: Las características de los usuarios del sistema sanitario público español han sido evaluadas en múltiples publicaciones. Sin embargo, éstas suelen hacer referencia a los usuarios de atención primaria y urgencias, y menos a la atención especializada. En algunos trabajos se han descrito diferencias en relación con el medio geográfico de procedencia del paciente. Objetivo: Se pretende analizar el perfil demográfico del paciente que acude a nuestras consultas externas de aparato digestivo durante un período prolongado de estudio. Pacientes y método: Se analizó el origen, la edad y el sexo de todas las solicitudes de primera cita para las consultas externas de aparato digestivo durante el trienio 2001-2003. Resultados: El 53,7% del total de las citas fueron generadas por mujeres, pero no se observaron diferencias significativas en las tasas de derivación respecto a los varones. El 65,5,% procedía del área urbana, con una significativa mayor tasa de derivación que el área rural, aunque con iguales índices de frecuentación. Respecto a la edad, se observó un incremento de tasas directamente proporcional a los años, con un predominio de derivaciones femeninas en pacientes = 75 años. Se encontraron algunas discrepancias entre los distintos años analizados. Conclusiones: En nuestra área de referencia se observa una mayor demanda sanitaria de la población urbana respecto a la rural. No se han evidenciado diferencias globales respecto al sexo, pero sí con relación a la edad y el tiempo de seguimiento

Introduction: The characteristics of users of the Spanish public health system have been evaluated in multiple studies. However, these studies usually refer to users of primary care and emergency services and less frequently to users of specialized services. Some studies have described differences according to patients' geographical origin. Objective: To analyze the demographic profile of patients attending our gastroenterology outpatient clinic over a prolonged period. Patients and method: The geographical origin, age and sex of all patients referred for an initial consultation in the gastroenterology outpatient clinic from 2001-2003 were analyzed. Results: Women accounted for 53.7% of all appointments but no significant differences in referral rates were observed in comparison with men. A total of 65.5% of patients were from urban areas and the referral rate was significantly higher in these patients than in those from rural areas, although attendance rates were equal between patients from the two types of area. Referral rates increased in direct proportion with age; a predominance of referrals was observed in women aged < 74 years and in men aged 75 years or older. Some discrepancies were found among the distinct years analyzed. Conclusions: In our catchment area, demand is greater in the urban population than in the rural population. No overall differences were found in sex but significant differences were found in age and length of follow-up

[Resident physician training in the digestive system. The point of view of the residents]. / Formación MIR en aparato digestivo. El punto de vista de los residentes.

AIM: To evaluate various aspects of current training of Spanish residents in gastroenterology. METHOD: An anonymous postal questionnaire was sent to fourth-year resident physicians in Spanish hospitals with accredited gastroenterology residency programs. RESULTS: Forty residents in the fourth year (53% offered positions), four from the second year and one from the first year (20 men, 25 women) answered the survey. Mean age was 29.7 years (26-42 years). Fifty-one percent of the departments did not have ultrasonography facilities apart from those in the radiology department. Endoscopic retrograde cholangiopancreatography (ERCP) was available in all the departments but in 55% of these, residents did not receive training in this technique. Forty-one percent of residents did not know the objectives of the various training periods. Eighty-four percent evaluated the pressure of clinical work as "intense" or "very intense" with 67% reporting that it disturbed their training "seriously" or "very seriously" and 71% that it disturbed their personal lives. Supervision in ultrasonography, endoscopy and clinical work were mainly evaluated as "good" or "very good". Supervision was rated lower in outpatient departments and while on duty. Forty-two percent of residents rated the supervision of the personal tutor as "average". Seventy-six percent were "fairly" or "very interested" in the introduction of "areas of specific training". CONCLUSIONS: The quality of residents' training in general and of gastroenterology training in particular is high. There are, however, several aspects which could be improved.