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Radboud University, 17 november 2022, Promotor : Drenth, J.P.H. Co-promotores : Wahab, P.J., Groenen, M.J.M., Contains fulltext : 283436.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 218547.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 220092.pdf (Publisher’s version ) (Open Access), Background: The Dutch guidelines for esophageal and gastro-esophageal junction (GEJ) cancer recommend discussion of patients by a multidisciplinary tumor board (MDT). Despite this recommendation, one previous study in the Netherlands suggested that therapeutic guidance was missing for palliative care of patients with esophageal cancer. The aim of the current study was therefore to assess the impact of an MDT discussion on initial palliative treatment and outcome of patients with esophageal or GEJ cancer.Material and methods: The population-based Netherlands Cancer Registry was used to identify patients treated for esophageal or GEJ cancer with palliative intent between 2010 and 2017 in 7 hospitals. We compared patients discussed by the MDT with patients not discussed by the MDT in a multivariate analysis. Primary outcome was type of initial palliative treatment. Secondary outcome was overall survival.Results: A total of 389/948 (41%) patients with esophageal or GEJ cancer were discussed by the MDT before initial palliative treatment. MDT discussion compared to non-MDT discussion was associated with more patients treated with palliative intent external beam radiotherapy (38% vs. 21%, OR 2.7 [95% CI 1.8-3.9]) and systemic therapy (30% vs. 23%, OR 1.6 [95% CI 1.0-2.5]), and fewer patients treated with stent placement (4% vs. 12%, OR 0.3 [95% CI 0.1-0.6]) and best supportive care alone (12% vs. 33%, OR 0.2 [95% CI 0.1-0.3]). MDT discussion was also associated with improved survival (169 days vs. 107 days, HR 1.3 [95% CI 1.1-1.6]).Conclusion: Our study shows that MDT discussion of patients with esophageal or GEJ cancer resulted in more patients treated with initial palliative radiotherapy and chemotherapy compared with patients not discussed by the MDT. Moreover, MDT discussion may have a positive effect on survival, highlighting the importance of MDT meetings at all stages of treatment.

Radboud University, 10 mei 2019, Promotor : Drenth, J.P.H. Co-promotores : Berends, F.J., Groenen, M.J.M., Contains fulltext : 202625.pdf (publisher's version ) (Open Access)

Radboud University, 02 november 2018, Promotor : Drenth, J.P.H. Co-promotores : Wahab, P.J., Lochem, E.G. van, Groenen, M.J.M., Contains fulltext : 196844.pdf (publisher's version ) (Open Access)

Radboud University, 12 december 2017, Promotores : Drenth, J.P.H., Laarhoven, C.J.H.M. van Co-promotores : Barends, F.J., Groenen, M.J.M., Contains fulltext : 178929.pdf (publisher's version ) (Open Access)

Gastrointestinal endoscopy has developed rapidly in the last five decades. It started in the sixties, when the first commercial model of the then recently invented fully flexible fiberoptic gastroscope was developed. In the late sixties fiberoptic endoscopes changed to forward viewing, with an open channel for air insufflation, aspiration and a passage for accessories, especially biopsy instruments. In the seventies with the introduction of a new side-viewing endoscope it became possible to visualize the pancreatic duct and to perform endoscopic sphincterotomy, later accompanied by stone extraction. Enteroscopy was first established in the mid seventies and advanced into balloon-assisted enteroscopy, which enabled visualizing and treating the whole small intestine in the new millennium. Endoscopic ultrasound (EUS), developed in the 1980’s, has in recent years become tool for diagnosis and therapy of a range of esophageal, gastric, hepatobiliary, pancreatic and rectal disorders. Nowadays these innovative techniques have evolved into a routine investigation of the gastrointestinal tract. Patients with gastrointestinal complaints generally undergo an endoscopic examination. In the Netherlands yearly approximately 400,000 examinations of the gastrointestinal tract are performed. With these endoscopic studies abnormalities in esophagus, stomach, duodenum, colon, small intestines and bile ducts are diagnosed and therapeutic interventions are performed. The findings of these investigations have important implications for patient management, for example for the selection of medical therapy for a gastric ulcer or for the indication for a surgical intervention of a malignant process. The endoscopist generates a report of the performed examination for the referring physician. The reports range from short written or dictated reports to standardized computer reports.

Technological developments have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy and creating databases. The aim of this study was to develop a comprehensive WHO-approved code system for gastrointestinal endoscopic terminology. The International Classification of Diseases, 10th edition (ICD-10), and the ICD-10 clinical modification (ICD-10-CM) were expanded to allow description of every possible gastrointestinal endoscopic term under conditions defined by the WHO. Classifications of specific gastrointestinal disorders and endoscopic locations were added. A new chapter was developed for frequently used terminology that could not be classified in the existing ICD-10, such as descriptions of therapeutic procedures. The new extended code system was named Gastrointestinal Endoscopic Terminology Coding (GET-C). The GET-C is a complete ICD-10-related code system that can be used within every endoscopic database program for all specific endoscopic terms. The GET-C is available for free at http://www.trans-it.org/.

BACKGROUND: The widespread use of gastrointestinal endoscopy for diagnosis and treatment requires effective, standardised report systems. This need is further increased by the limited storage of images, and by the need for structured databases for surveillance and epidemiology. We therefore aimed for a report system which would be quick, easy to learn, and suitable for use in busy daily practice. METHODS: Endobase III is an endoscopy information system offering three different ways of report writing, i.e. standard reports, text blocks and Minimal Standard Terminology (MST). A working group of two university and four general hospitals worked as a reference group for the development of standard reports and text blocks. Guidelines from various gastrointestinal endoscopy societies were followed to compose the reports. RESULTS: Standard reports were based on a list of distinct diagnoses; text blocks were based on anatomic landmarks and individual procedures. As such, 316 standard reports were developed for upper and lower gastrointestinal endoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). In this way selecting one diagnosis produces a complete report. A total of 1571 different text blocks were additionally developed for each part of the gastrointestinal tract and for procedures during endoscopy. This module allowed generation of a full report on the combination of text blocks. Reports could be composed and printed within two minutes for 90% of cases. CONCLUSION: Standard reports and text blocks are a quick, user-friendly way of report writing accepted and used by a number of gastroenterologists in the Netherlands.