- 1 Medical utilization by liver cancer patients under the National Health Insurance program in Taiwan A population-based cross-sectional study
Taiwan implemented a comprehensive and universal National Health Insurance
(NHI) program to cover all inhabitants. This study aimed to assess the medical utilization
by liver cancer patients under the NHI.
Methods: This retrospective cross-sectional study used a sampled NHI research database,
which contained 1 million beneficiaries. The claims of liver cancer patients in 2009 were
analyzed. The other beneficiaries without liver cancer who used medical services in 2009
served as the control patients.
Results: Among the 2335 identified liver cancer patients, 2178 (93.3%) patients used outpatient
services and 1193 (51.1%) patients used inpatient services. Liver cancer accounted for
1.8% of the NHI’s total cost. The cost per visit was United States dollars (US$)59.30 for outpatient
care and US$2070.30 for inpatient care. The annual cost per patient was US$4746.60;
US$1951.00 were for outpatient care and US$2795.60 for inpatient care. Patients who were female,
in their 60s, had a lower income, and lived in southern Taiwan had a higher cost per patient
(p < 0.0001). Fees for consultation, treatment, and medical supplies (57.3%) accounted
for the highest portion of outpatient costs, followed by drug fees (30.0%) and diagnosis fees
(11.2%). Ward fees accounted for the highest portion of inpatient costs (19.0%), followed by
drug fees (18.7%) and X-ray fees (14.9%). Private hospitals were visited more frequently than
public hospitals. The cost per visit and cost per patient with liver cancer were 206.0% and
666.8%, respectively, of the cost of the control patients.
- 2 Endoscopic ultrasound-guided fine-needle aspiration A safe bridge to accurate diagnosis
Endoscopic ultrasound (EUS) is a good adjunctive tool for
evaluating lesions of the gastrointestinal (GI) tract and
surrounding organs. Besides imaging assessment, EUS has
become a popular method for procuring diagnostic tissue by
fine-needle aspiration (FNA). EUSeFNA involves passing a
19- to 25-gauge (most commonly a 22-gauge) aspiration
needle through the working channel of a curvilinear
echoendoscope under real-time guidance into an EUSvisualized
lesion. Although EUSeFNA plays only a limited
role in submucosal tumor tissue acquisition with a modest
diagnostic yield of 70e84% [1], it can offer a highly sensitive
and specific cytological diagnosis at rates of 85% and
98% in pancreatic cancer patients, respectively, with estimates
suggesting corresponding rates of 90% and 100% in
most other patients [2,3].
- 3 Short-term outcomes of endoscopic submucosal dissection for colorectal neoplasms in a single medical center
Endoscopic submucosal dissection (ESD) is an emerging technique for
treating superficial neoplasms of the gastrointestinal tract. Clinical experience of ESD for superficial
colorectal neoplasms remains limited in Taiwan. The aim of this study was to assess
ESD performed in a series of patients at our hospital and report the results.
Materials and methods: Thirty-three patients who underwent ESD were retrospectively
analyzed for tumor size, rate of en bloc resection, complete resection, curative resection,
technical results, and complications.
Results: The tumors treated using ESD were situated in the cecum (n Z 6), ascending colon
(nZ2), transverse colon (nZ2), descending colon (nZ4), sigmoid colon (nZ9), and rectum
(n Z 10). The median size of the tumors was 30 mm (range, 10e55 mm). The en bloc resection
rate was 72.7%, and the complete resection rate was 66.7%. In patients with en bloc resection,
the curative resection rate was 87.5%. Histopathological analysis revealed adenoma with lowgrade
dysplasia (n Z 18), adenoma with high-grade dysplasia (n Z 7), and adenocarcinoma
(n Z 8). Five patients experienced perforation, and the overall complication rate was
15.2%. None of these five patients received surgical treatment.
- 4 The clinical efficacy and safety of EUS-FNA for diagnosis of mediastinal and abdominal solid tumors e A single center experience
4 The clinical efficacy and safety of EUS-FNA for diagnosis of mediastinal and abdominal solid tumors e A single center experience
- 5 Delayed healing of gastric ulcer is associated with downregulation of connexin 32 in the gastric mucosa
Most benign gastric ulcers are healed through suppression of
gastric acid by a proton pump inhibitor (PPI). Despite prolonged use of a PPI, some gastric ulcers
still do not heal. The primary goal of this study is to investigate the relationship between
the expression of connexin 32 (Cx32), a major gap junction protein expressed in the gastric mucosa,
and the healing response of gastric ulcers.
Methods: Patients with endoscopically verified gastric ulcer were treated with a standard dose
of PPI for 12 weeks. Histological studies were performed to exclude malignancy. In total, 10
patients having endoscopically verified gastric ulcers with delayed healing at the end of the
PPI course were included in this study. The control group consisted of 11 patients with gastric
ulcers that healed normally. The expression of Cx32 in the gastric mucosa of the ulcer margin
was analyzed by immunoblotting.
Results: Patients with gastric ulcer showing delayed healing had significantly reduced Cx32
expression in the gastric mucosa compared with the patients in whom the ulcers healed normally
(i.e., controls). Age, sex, presence of duodenal ulcers, location and size of gastric ulcer,
ulcer staging, Helicobacter pylori infection, use of nonsteroidal anti-inflammatory drugs
(NSAIDs) and aspirin, smoking, and alcohol consumption were similar in both the control and
delayed healing groups. H. pylori infection, use of NSAIDs, smoking, and alcohol consumption
all had no significant
- 6 Endoscopically diagnosed cavernous hemangioma in the deep small intestine A case report
We report a 27-year-old female with chronic iron deficiency anemia and unexplained
fecal occult blood. Abdominal ultrasonography and computed tomography disclosed
a possible endoluminal lesion in the small intestine. Single-balloon enteroscopy detected
the target lesion in the proximal ileum. The lesion was a 2.5-cm submucosal tumor that was
purple-red, soft, had a narrow base, and exhibited superficial telangiectasia. After endoscopic
marking, the tumor was resected with minimally invasive laparoscopy. It was histologically
confirmed as a cavernous hemangioma. In this report, we discuss the endoscopic characteristics,
surgical and pathological assessment, and management strategy of hemangiomas in the
small intestine.
Copyright ª 2015, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society
of Taiwan and Taiwan Association for the
- 7 An 86-year-old man with intermittent fever for 1 month
An 86-year-old man presented with intermittent fever for 1
month. He had dull abdominal pain in the right upper
quadrant for 2 weeks. The patient denied a productive
cough, chest pain, and dysuria. He had no recent travel
history and no body weight loss. He had no underlying
systemic disease, such as diabetes mellitus. Physical examinations
were not remarkable. Laboratory data revealed
leukocytosis (white blood cells: 21.34 103/mL, neutrophils:
83.6%). Aspartate and alanine aminotransferase
levels were 23 IU/L and 19 IU/L (normal range: < 31 IU/L),
respectively, and total bilirubin was 0.3 mg/dL (normal
range: 0.2e1.5 mg/dL). His alkaline phosphatase was
117 IU/L (normal range: 40e129 IU/L).
- 8 Analyzing Taiwan’s National Health Insurance Research Database to explicate the allocation of health-care resources
More than 99% of the residents in Taiwan have been covered
by National Health Insurance (NHI) since its implementation
in 1995, thanks to the single-payer, universal, and
compulsory policies [1]. To construct and maintain a publicly
available database for the purpose of academic
research, the government entrusts the Taiwan National
Health Research Institute (NHRI) to continuously and systemically
collect relevant registration and claim data
generated in the insurance system. Therefore, the National
Health Insurance Research Database (NHIRD) contains
comprehensive computerized NHI records of literally the
entire population of Taiwan for the past 2 decades. Under
the “least privilege” principle, qualified researchers are
entitled to access the database after their projects are
reviewed and approved by the NHRI [2]. As a reliable data
source, the NHIRD has facilitated academic research in
various scientific disciplines, and the rapidly increasing
number of research articles is proof of this [3].
