Berry, P.A.; McNeil, N.I.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA72
Academic Journal
The number of endoscopic oesophageal dilatations performed for benign stricture was observed to have decreased in our unit over the past decade, making it hard for trainees to gain experience. This trend was investigated, and compared to the rise in the use of proton pump inhibitors (PPIs). Comparison was also made with the number of duodenal ulcers diagnosed each year. The number oF dilatations performed and new duodenal ulcers identified per year was obtained from records kept in the endoscopy unit for the years 1994 to 2001. As dilatations had been performed on several patients a number of times in quick succession, the number of different patients treated per year was used. Detailed information concerning the quarterly expenditure on all PPIs by the local health authority (Ealing, Hounslow and Hammersmith) was also obtained. Annual expenditure on PPIs rose steadily during the decade, from 1 630 000 in 1994 to 3 200 000 in 2001. The total number of endoscopic procedures remained broadly constant. The number of patients requiring dilatation fell. Only 4 patients presented in 2001, compared to 20 in 1994. The incidence of duodenal ulcer also fell, the trend being most marked in the latter part of the study period (96 in 1997, 59 in 2000). There was strong negative correlation between the amount spent by the health authority on PPIs and the number of dilatations performed (r = 0.68, p < 0.05). Between expenditure on PPIs and number of DUs identified there was less strong negative correlation (r = -0.50, p < 0.05). The reduction in the number of patients requiring dilatation over the past 10 years appears dramatic and sustained. This may be due to the rise in the prescription of powerful acid suppressants. Dilatation of benign oesophageal stricture may become increasingly rare, and trainee endoscopists may lack adequate practise in the technique.


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