Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endosc...Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endoscopic practices was p erformed, ranking them according their cost- effectiveness, as viewed from the payer perspective. The cost- effectiveness of four currently accepted standard endoscopic practices was examined: small bowel biopsy to assess for celiac sprue , colonoscopic biopsy to assess formicroscopic colitis, surveillance of Barrett’ s esophagus, and surveillance of chronic ulcerative colitis (CUC). Parameter est imates were obtained from the published literature. Charges were based on Medica re professional plus facility/technical fees. Performing colonoscopic biopsies f or microscopic colitis in the setting of chronic nonbloody diarrhea was the most cost- effective practice (＄ 2447/case detected), while small bowel biopsy for sprue in the setting of a patient with a first- degree relative with sprue (＄ 3042/case detected) or with anemia (＄ 2982/case detected) was also a cost- ef fective approach. Small bowel biopsy in the setting of diarrhea (＄ 3900/case de tected) was less cost- effective, while CUC surveillance (＄ 14,119/ detection of dysplasia) and performance of small bowel biopsy in an asymptomatic patient ( ＄ 15,209/case detected) were clearly the least economical. As efforts are made to reduce the costs of health care, more attention will be focused on the cost- effectiveness of routine endoscopic practices. Although, our findings put endos copic practices into economic perspective, future perspective, future prospectiv e trials are required to confirm the validity of these findings.展开更多
Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endos...Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endoscopically obtained histopathology specimens were used as the standard of reference. Materials and methods: Fifteen normal subjects and 23 patients with suspected IBD of the large bowel underwent MRC. Three dimensional T1 weighted data sets were collected following rectal administration of water prior to and 75 seconds after intravenous administration of paramagnetic contrast (gadolinium-BOPTA). The presence of inflammatory changes in patients was documented based on bowel wall contrast enhancement, bowel wall thickness, presence of perifocal lymph nodes, and loss of haustral folds. All four criteria were quantified relative to data obtained from normal subjects and summarised in a single score. This MRC based score was compared with histopathological data based on conventional endoscopic findings. Results: MRC correctly identified 68 of 73 segments found to reveal IBD changes by histopathology. All severely inflamed segments were correctly identified as such and there were no false positive findings. Based on the proposed composite score,MRC detected and characterised clinically relevant IBD of the large bowel with sensitivity and specificity values of 87%and 100%, respectively, for all investigated colonic segments. Conclusion: MRC may be considered a promising alternative to endoscopic biopsy in monitoring IBD activity or assessing therapeutic effectiveness.展开更多
文摘Health care costs are an increasingly important study outcome. Endoscopic pra ctice consumes a large proportion of gastroenterology- related health expenses. An economic comparison of several currently accepted endoscopic practices was p erformed, ranking them according their cost- effectiveness, as viewed from the payer perspective. The cost- effectiveness of four currently accepted standard endoscopic practices was examined: small bowel biopsy to assess for celiac sprue , colonoscopic biopsy to assess formicroscopic colitis, surveillance of Barrett’ s esophagus, and surveillance of chronic ulcerative colitis (CUC). Parameter est imates were obtained from the published literature. Charges were based on Medica re professional plus facility/technical fees. Performing colonoscopic biopsies f or microscopic colitis in the setting of chronic nonbloody diarrhea was the most cost- effective practice (＄ 2447/case detected), while small bowel biopsy for sprue in the setting of a patient with a first- degree relative with sprue (＄ 3042/case detected) or with anemia (＄ 2982/case detected) was also a cost- ef fective approach. Small bowel biopsy in the setting of diarrhea (＄ 3900/case de tected) was less cost- effective, while CUC surveillance (＄ 14,119/ detection of dysplasia) and performance of small bowel biopsy in an asymptomatic patient ( ＄ 15,209/case detected) were clearly the least economical. As efforts are made to reduce the costs of health care, more attention will be focused on the cost- effectiveness of routine endoscopic practices. Although, our findings put endos copic practices into economic perspective, future perspective, future prospectiv e trials are required to confirm the validity of these findings.
文摘Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endoscopically obtained histopathology specimens were used as the standard of reference. Materials and methods: Fifteen normal subjects and 23 patients with suspected IBD of the large bowel underwent MRC. Three dimensional T1 weighted data sets were collected following rectal administration of water prior to and 75 seconds after intravenous administration of paramagnetic contrast (gadolinium-BOPTA). The presence of inflammatory changes in patients was documented based on bowel wall contrast enhancement, bowel wall thickness, presence of perifocal lymph nodes, and loss of haustral folds. All four criteria were quantified relative to data obtained from normal subjects and summarised in a single score. This MRC based score was compared with histopathological data based on conventional endoscopic findings. Results: MRC correctly identified 68 of 73 segments found to reveal IBD changes by histopathology. All severely inflamed segments were correctly identified as such and there were no false positive findings. Based on the proposed composite score,MRC detected and characterised clinically relevant IBD of the large bowel with sensitivity and specificity values of 87%and 100%, respectively, for all investigated colonic segments. Conclusion: MRC may be considered a promising alternative to endoscopic biopsy in monitoring IBD activity or assessing therapeutic effectiveness.
