Hepatitis B virus infection, diabetes mellitus, and their synergism for cholangiocarcinoma development: A casecontrol study in Korea

AIM: To identify possible risk factors and their synergism for cholangiocarcinoma development.METHODS: A hospital-based, case-control study in which we included 276 cholangiocarcinoma patients [193 extrahepatic cholangiocarcinoma(ECC) and 83 intrahepatic cholangiocarcinoma(ICC)], diagnosed at a training hospital in Korea between 2007 and 2013, and 552 healthy controls matched 2:1 for age, sex, and date of diagnosis. Risk factors for cholangiocarcinoma and possible synergism between those factors were evaluated using conditional logistic regression and synergism index, respectively.RESULTS:There was an association between cholangiocarcinoma and hepatitis B virus(HBV) infection, diabetes mellitus(DM), cholecystolithiasis, choledocholithiasis, and hepatolithiasis, with the adjusted odds ratios(AORs) of 4.1, 2.6, 1.7, 12.4, and 39.9, respectively. Synergistic interaction on the additive model was investigated between HBV infection and DM(AOR = 12.2; 95%CI: 1.9-80.1). In the subgroup analyses, cholecystolithiasis, choledocholithiasis, hepatolithiasis, and DM were significant risk factors for ECC(AOR = 2.0, 18.1, 14.9, and 2.0, respectively), whereas choledocholithiasis, hepatolithiasis, HBV infection, and DM were risk factors for ICC(AOR = 8.6, 157.4, 5.3 and 4.9, respectively). Synergistic interaction was also observed between HBV infection and DM(OR = 22.7; 95%CI: 2.4-214.1). However, there was no synergistic interaction between other significant risk factors for cholangiocarcinoma.CONCLUSION: In this Korean study, HBV infection and DM were found to exert independent and synergistic effects on the risk for cholangiocarcinoma, including ICC. Exploring the underlying mechanismsfor such synergy may lead to the development of cholangiocarcinoma prevention strategies in high-risk individuals.

Comparing upper gastrointestinal X-ray and endoscopy for gastric cancer diagnosis in Korea

AIM:To compare the cost and accuracy of upper gastrointestinal(GI)X-ray and upper endoscopy for diagnosis of gastric cancer using data from the 2002-2004 Korean National Cancer Screening Program(NCSP). METHODS:The study population included 1 503 646 participants in the 2002-2004 stomach cancer screening program who underwent upper GI X-ray or endoscopy.The accuracy of screening was defined as the probability of detecting gastric cancer.We calculated the probability by merging data from the NCSP and the Korea Central Cancer Registry.We estimated the direct costs of the medical examination and the tests for up- per GI X-ray,upper endoscopy,and biopsy. RESULTS:The probability of detecting gastric cancervia upper endoscopy was 2.9-fold higher than via upper GI X-ray.The unit costs of screening using upper GI X-ray and upper endoscopy were$32.67 and$34.89, respectively.In 2008,the estimated cost of identifying one case of gastric cancer was$53094.64 using upper GI X-ray and$16 900.43 using upper endoscopy.The cost to detect one case of gastric cancer was the same for upper GI X-ray and upper endoscopy at a cost ratio of 1:3.7. CONCLUSION:Upper endoscopy is slightly more costly to perform,but the cost to detect one case of gastric cancer is lower.

Assessment of participant satisfaction with upper gastrointestinal endoscopy in South Korea

AIM:To measure the perceived satisfaction with gastric cancer screening as part of the National Cancer Screening Program (NCSP) in South Korea.METHODS:Data were derived from the participantsin a satisfaction survey of the Quality Evaluation of National Cancer Screening in 2009.This is a populationbased nationwide telephone survey of participants who were screened by the NCSP between May and October 2009.This study included 4412 participants who provided full sets of data and who had upper endoscopies for the purpose of gastric cancer screening.RESULTS:The negative appraisal percentages for each of the seven questions were as follows:explanation in preparation for the upper endoscopy,12.3%;explanation about the process and procedure of the upper endoscopy,13.8%;explanation about any pain or discomfort related to the upper endoscopy,27.5%;level of pain during the procedure,30.3%;physical environment,16.2%;manner of the staff,11.2%,and privacy protection,8.8%.CONCLUSION:The critical issues identified by the Pareto analysis include the adequacy of the explanation about any pain or discomfort associated with the upper endoscopy and the level of pain experienced during the procedure.