RESUMO
BACKGROUND: Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. In the general population, sporadic duodenal adenomas are an uncommon finding. Among individuals with duodenal adenomas, the development of concurrent colonic adenomas has been proposed, suggesting a diffuse gastrointestinal mucosa proliferative process and thus surveillance with colonoscopy. METHODS: A total of 10,666 upper endoscopies were performed from January 1997 to July 2007. Four controls without duodenal adenomas were selected for each case. Association of duodenal polyposis with colonic adenomas was calculated using two sample proportions and chi square using SPSS. RESULTS: In the 10-year period, 21 patients met inclusion criteria. All the patients were male with a mean age of 67 years (range: 45-86 years). Among cases, the most common indication for upper gastrointestinal endoscopy (EGD) was an abnormal imaging (47.6%). For controls, the most common indication for EGD was gastrointestinal bleeding (29.8%). Most adenomas were located in the second portion of the duodenum (63%). Mean size for duodenal adenomas was 5mm (range 1-21mm). High grade dysplasia was reported in 4 (18%) adenomas. The prevalence of sporadic duodenal adenomas was 0.2%. Nine of 21(42.8%) duodenal adenoma cases were found with concurrent colonic adenomas. In the control group, 38 of 84 (45%) patients were found with colon adenomas (p = 0.21). There was no significant statistical association between duodenal polyposis and anemia, smoking, alcohol, medical history of diabetes mellitus or BMI. CONCLUSION: Prevalence of duodenal polyposis was low, although a high number of polyps exhibited high grade dysplasia. There was no statistically significant association between nonfamilial duodenal polyposis and colorectal adenomas. Our observations do not support early colonoscopy surveillance for patients with duodenal polyposis.
Assuntos
Adenoma/epidemiologia , Neoplasias Colorretais Hereditárias sem Polipose/epidemiologia , Neoplasias Duodenais/epidemiologia , Pólipos Intestinais/epidemiologia , Adenoma/patologia , Pólipos Adenomatosos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Anemia/epidemiologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Colonoscopia/estatística & dados numéricos , Comorbidade , Diabetes Mellitus/epidemiologia , Neoplasias Duodenais/patologia , Duodenoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Fumar/epidemiologiaRESUMO
BACKGROUND: The incidence of the two main subtypes of esophageal cancer has changed in Western countries in the past two decades, where an increasing trend is observed for adenocarcinoma. Up to date, there are no recent published data regarding esophageal cancer subtypes in Puerto Rico or its relationship with social habits. MATERIALS/METHODS: A total of 169 records from our patients with esophageal cancer for a 10 year period were reviewed. All of them were men, and the overall mean age at diagnosis was 69 years. RESULTS: Two thirds (66%) of the patients had squamous cell carcinoma (SCC), with 47% located at the upper third, 40% in the middle third and 13% in the distal third of the esophagus. Thirty four percent of the patients had a diagnosis of adenocarcinoma, mostly found in the distal third of the esophagus (71%), outnumbering those cases of squamous cell carcinoma found in the same area. There was a significant statistical difference in the location of adenocarcinomas (p = 0.0001). The most common presenting symptom at the moment of diagnosis was dysphagia accompanied by associated weight loss. Most of the patients were both smokers and alcohol drinkers at some moment during their lifetimes. The overall survival rate once the patients were diagnosed was 1.1 years. The survival rate for those with SCC was 1.1 years and for those with adenocarcinomas was 8 months. Most of the patients who received chemotherapy and radiotherapy had a diagnosis of squamous cell carcinoma, while those who had surgery were mostly adenocarcinoma cases. At the time of diagnosis, about half of the patients with either type of cancer had metastatic disease. According to the data collected, only 10 out of the 169 patients remained alive at the time of this record review, most of them with squamous cell carcinoma and after receiving chemotherapy and radiotherapy. Regarding treatment with a proton pump inhibitor, H2 blocker or both, 66.3% of the patients with squamous cell carcinoma received those therapies, in contrast to only 33.7% of patients with adenocarcinoma. CONCLUSIONS: There is an increasing trend for the frequency of adenocarcinoma compared to squamous cell carcinoma, which is comparable to the observed worldwide trend.