ERCP in Romania in 2006; a National Programme seems mandatory.

BACKGROUND: Endoscopic retrograde cholangio-pancreato-graphy (ERCP) is a procedure used in the diagnosis and treatment of biliary and pancreatic diseases, more preferable to open surgery in terms of a lower risk of morbidity and mortality and costing much less. METHODS: This was a retrospective, multicenter study, in which we tried to involve the largest medical centers in Romania. They were asked to complete a questionnaire detailing the number of ERCPs performed in 2006, the type of and accessibility to radiology equipment, indications for ERCP, the availability of skilled endoscopists for ERCP and if there were any training pro-grammes. RESULTS: The number of ERCP procedures performed in 2006 by the participating centers was 2647. There was a strong correlation between the availability of radiology equipment, the number of days allocated by the radiology department for the procedure, and the number of ERCPs performed. Gallstone removal accounted for most (50%) of the therapeutic ERCP indications. CONCLUSIONS: For a large country such as Romania, a total number of 2647 ERCPs for 2006 is too low. Various important factors such as lack of access to equipment and few skilled ERCP endosco-pists were identified as possible causes. The number of ERCPs performed in Romania should be reorganized to perform 20000 per year in 5 years from now (2012) and give our population access to proper intervention endoscopy. The National Gastroenterology Society should actively encou-rage training in interventional endoscopy, and collaborate with Ministry of Health to have a National Task-force for Endoscop.

An epidemiological study of gastric cancer in the adult population referred to gastroenterology medical services in Romania -- a multicentric study.

AIM: The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevalence of gastric cancer in the adult population referred to gastroenterology medical services, and also the demographic features of this pathology. METHODS: . The study was carried out over the period 1 January 2003 - 31 December 2003 in 11 academic centers in Romania, specialized in gastroenterology, with a uniform national distribution (all areas in the country were represented) and with adequate diagnostic and therapeutic facilities. All centers used identical definition criteria and reported the data using the same protocol and a Microsoft Excel database. RESULTS: During the study period, 640 cases of gastric cancer were reported. In the first stage, the prevalence in each geographical region was calculated. The national prevalence of gastric cancer in the population referred to gastro-intestinal endoscopy services was 2.9 per 100,000 inhabitants over 18 years of age. The demographic data of the studied group were the following: 66.4% men, 33.6% women, 51.7% urban population, 48.3% rural population, mean age 63.07 +/- 12.10 years. The most frequent indications for upper digestive endoscopy were: dyspepsia, weight loss and appetite. 88% of patients had no history of disease with a high risk of gastric cancer. The majority of patients (95.5 %) had advanced gastric cancer at the time of diagnosis, located in the gastric body (40.1 %) and in the antrum (33.8 %). According to Borrmann's classification, 31.4% had type I fungating gastric cancer and 32.1% had type III ulcero-infiltrative gastric cancer. According to the Lauren classification, the most frequent histological type was intestinal adenocarcinoma (63.8 %). Early gastric cancer was found in 4.4% of patients. CONCLUSIONS: The prevalence of gastric cancer in the population referred to digestive endoscopy services in Romania is 2.9%, with relatively wide variations at a national level. The study confirms the fact that Romania is a country with a low prevalence of gastric cancer, in accordance with the literature data published for the south of Europe.

The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (a multicentre study).

UNLABELLED: The incidence and prevalence of coeliac disease vary internationally. In Eastern Europe little is known about the prevalence of coeliac disease. THE AIM: of this study was to evaluate the prevalence and the clinical features of coeliac disease in adults biopsied during upper endoscopy in Romania. This is the first incidence study of the coeliac disease in Romania. METHODS: The study was initiated by the Romanian Society of Digestive Endoscopy for the period 1 January 2002 - 31 May 2002. It was carried out in 9 Academic Centres in Romania, which ensured an even geographical distribution and therefore significant statistical results at a national level. The study included 2436 patients according to following criteria: age over 16 years, with no known history of coeliac disease, visiting the participating upper endoscopy units or patients with documented coeliac disease presenting for follow-up check or recurrence of clinical symptoms. At least two bioptic samples were obtained from the distal duodenum, as distally as possible, which were submitted to histopathological examination and scored according to the modified UEGW Marsh criteria (2001). A database was set up to include all the patients with data regarding sex, age, urban or rural background, full clinical diagnosis, clinical symptoms, history of the coeliac disease. RESULTS: Of the 2436 patients studied, 54 (2.22%) were diagnosed with coeliac disease. Their demographic features: 48.15% men, 51.85% women, 68.52% living in urban areas, 31.48% in rural ones, mean age 42 +/-17.0 years. The most frequent reasons for performing upper digestive endoscopy were: dyspeptic syndrome - 15.93%, anemia - 24.07%, and chronic diarrhoea - 22.22%. The most frequently recorded clinical manifestations were: chronic diarrhoea in 46.3%, asthenia in 29.63%, anemia in 24.07%, aphthae in 24.07%. Histopathological results according to Marsh classification were: Marsh III- 64.81 %, Marsh II-35.19%. CONCLUSIONS: The prevalence of the coeliac disease in Romania is 2.22%: its sex distribution is fairly equal, the age distribution includes two peaks, at 30-40 and 50-60 years respectively, and patients from urban areas predominate. The most frequent (over 50% of the cases) histological type was M III. The most common clinical symptoms were diarrhoea, asthenia, anemia, aphthae, while the most frequent associated diseases were diabetes mellitus and Duhring-Brocq dermatiti