Improvement in the quality of the endoscopic/bioptic diagnosis of gastric ulcers between 1990 and 1997--an analysis of 1,658 patients

Abstract

Background: Helicobacter pylori research has greatly improved the diagnosis and treatment of gastric ulcer. The aim of the present study was to investigate the question whether the new perceptions had been incorporated into the daily diagnostic routine of the nineteen-nineties.

Patients and methods: Analysis of the biopsy material at the institute of Pathology of the Klinikum Bayreuth obtained from 1,658 patients with gastric ulcers in the months of January and February 1990 (n = 506), 1992 (n = 525), 1994 (n = 532), 1995 (n = 432) and 1997 (n = 400) with the aim of determining the quality of the endoscopic assessment of biological significance, and the number of biopsy specimens obtained from the ulcer, as well as the number of additional biopsies taken from the antrum and corpus.

Results: 1,436 (88.9%) of the endoscopically diagnosed ulcers proved to be histologically benign and 222 (11.1%) malignant, of which 192 (86.5%) were carcinomas, 24 (10.8%) MALT lymphomas, 2 (0.9%) sarcomas, and 4 (1.8%) ulcerated metastases. The percentage of false-negative endoscopic assessments of biological significance was 1.8%, that of the false-positive assessments 4.1%, that is, both very low figures. In the case of endoscopically suspicious findings, the histological examination revealed an ulcerated malignant tumor in almost 30% of the cases. The average number of biopsies harvested from the ulcer increased from 5.9 in 1990 to 7.1 in 1997. The frequency of biopsies obtained additionally from antrum and corpus rose statistically significantly from 14.1% of the cases in 1990 to 43.0% in 1997.

Conclusion: During the course of the nineteen-nineties, the quality of the endoscopic/bioptic diagnosis improved noticeably. In terms of the number of biopsy specimens obtained from the ulcer to identify its biological significance, and the number of additional biopsies from antrum and corpus to identify underlying diseases, there is, however, still room for improvement.