การศึกษา ประเมินค่าใช้จ่ายในการตรวจวินิจฉัย โดยการส่องกล้องระบบทางเดินอาหารส่วนต้น ในผู้ป่วยที่เริ่มมีอาการจุกแน่นท้องที่มีอายุมากกว่า 40 ปีเพื่อวินิจฉัยมะเร็งกระเพาะอาหาร / พิสุทธิ์ พรหมลิขิตชัย = Cost analysis of endoscopy for detection of gastric carcinoma in dyspeptic patients over 40 years old / Pisut Pormlikitchai
Objective : 1. To estimate the total cost of endoscopy for gastric carcinoma detection or other important stomach abnormalities in dyspeptic patients over 40 years old 2. To analyze the relationship between alarm symptoms and endoscopic findings Method: From January 2000 to January 2001, all dyspeptic patients over 40 years old who had undergone upper endoscopy as an out patient procedure were evaluated cost of endoscopy and loss of patients' income were analyzed to justify the validity of endoscopy. Results: There were 270 patients (99 men, 171 women) with mean age of 55.56+-19.88 years. Alarm symtoms were reported in 241 patients (no alarm symtom ; n = 65, at least 1 alarm symtoms ; n = 177). There were nocturnal pain in 139 patients (57.7%), significant weight loss in 6 patients (2.5%), history of upper gastrointestinal bleeding in 47 patients (19.5%), persistent vomiting after meals in 9 patients (3.7%), familial history of gastrointestinal malignancy in 8 patients (3.3%), dysphagia in 12 patients (5%), abdominal distension in 2 patients (0.8%), anemia in 2 patients (0.8%). Important endoscopic findings were peptic ulcer in 40 patients (14.8%), gastric cancer in 2 patients (0.7%), esophagitis in 4 patients (1.5%), 24 patients in this group (52.2%) were age over 60 years old. Endoscopic findings were normal study in 120 patients (44.4%) and showed non-important pathologies:gastritis in 101 patients (37.4%), other in 3 patients (1.1%). All gastric carcinoma patients were over 60 years old and one of them was in early stage whereas another case had advanced stage. 33 of 177 dyspeptic patients with at least one alarm symptoms and 6 of 64 patients with dyspepsia alone had important endoscopic findings, there were no statistic difference between groups (18.6% vs 9.4%; P = 0.114). Unit cost of endoscopy for detecting gastric carcinoma and important pathologies in stomach were 158,974.69 bahts per case and 6,911.94 bahts per case, respectively. Conclusion : Endoscopy in dyspeptic patients over 40 years old can detect early gastric carcinoma and other important pathologies in stomach. The unit cost of endoscopy for detecting gastric carcinoma and all important pathologies in stomach were 158,974.69 bahts and 6,911.94 bahts per case and was likely to decrease on age of the patients due to the greater incidence of abnormal pathologies were increased by age.
