Introduction

In 2023, a total of 7,244 new cancer cases were recorded within the Mongolian population. Among these, stomach cancer represented 17.4%, while esophageal cancer accounted for 4.9%. Of all the cancer cases registered in 2023, 34.6% were diagnosed at an early stage, whereas 65.4% were identified at a late stage.The primary objective of endoscopy is to diagnose cancer at an early stage or at the point of cellular abnormalities. However, esophagogastroduodenoscopy (EGD) can cause significant discomfort for patients. In recent years, the use of sedated endoscopy has become increasingly common, which has had a notable impact on diagnostic outcomes.

Results & Findings

Method: The study was conducted retrospectively, involving 91 patients out of 218 who underwent cytology tests, selected from a total of 9,373 patients who visited the endoscopy department of Brilliant Hospital between January 2023 and December 2023. Among these, 91 individuals diagnosed with cellular abnormalities through tissue analysis underwent both sedated and non-sedated esophagoscopy. The cohort consisted of 50 women and 41 men. Regarding age distribution, one individual was aged 30-40 years, eight individuals were aged 41-50 years, 20 individuals were aged 51-60 years, 39 individuals were aged 61-70 years, and 23 individuals were aged 71 years or older.
Result: A total of 218 individuals underwent tissue analysis, of whom 91 were diagnosed with cellular abnormalities. Among these, 56 individuals were identified with sleep apnea, representing 61.5% (n=56) of the total cohort diagnosed with cellular abnormalities.

Summary & Discussion

The findings indicate that sedated endoscopy enhances diagnostic accuracy by improving patient comfort and enabling better tissue sampling. This is particularly important in Mongolia, where a high proportion of cancer cases are diagnosed at later stages, emphasizing the need for improved early detection. However, the study's retrospective design and single-center nature limit the generalizability of these findings. Further large-scale, prospective studies are necessary to confirm these results and investigate the role of sleep apnea in cytological abnormalities.

Conclusion

In conclusion, sedated endoscopy shows promise in improving diagnostic outcomes, and its use could be beneficial for early cancer detection.
This study demonstrates that sedation during esophageal and gastric endoscopy may significantly enhance the detection of cytological abnormalities. The association between sleep apnea and cellular changes also warrants further investigation. Given the high rate of late-stage cancer diagnosis in Mongolia, the implementation of sedated endoscopy could play a critical role in promoting early detection and improving clinical outcomes. Future multicenter, prospective studies are needed to validate these findings and guide policy on sedation practices in endoscopic procedures.

References

Endoscopy with sedation has been shown to increase the detection rate of early-stage cancer and benign abnormalities. A multi-center study involving 432,202 patients found that while the detection of benign upper gastrointestinal changes was similar between sedated and non-sedated groups, the detection rate of high-grade intraepithelial neoplasia (HGIN) and early cancers was higher in the sedated group. (pubmed.ncbi.nlm.nih.gov)
Endoscopy with sedation was more effective in detecting small-sized cancers. A study showed that the group receiving sedated esophagogastroduodenoscopy (EGD) had a 3-fold higher detection rate for small-sized cancers. (pubmed.ncbi.nlm.nih.gov)
Propofol-based sedation in endoscopy has been found to have higher diagnostic accuracy in detecting early-stage gastric cancers and benign abnormalities. A study in China demonstrated that endoscopy with propofol sedation had a significantly higher diagnostic accuracy in detecting early-stage gastric cancers and benign changes. (link.springer.com)

Introduction

Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic gastrointestinal disorder characterized by relapsing inflammation and significant psychological burden [1]. Patients with IBD often experience depression, anxiety, and reduced quality of life [2]. However, emerging research highlights posttraumatic growth (PTG)—positive psychological transformation following trauma—as a potential outcome in chronic illness [3].
PTG arises from cognitive restructuring after traumatic events, with rumination playing a key role [4]. Rumination includes intrusive rumination (unwanted, distressing thoughts) and deliberate rumination (purposeful reflection). While deliberate rumination typically fosters PTG, findings on intrusive rumination are inconsistent, with some studies reporting negative, positive, or null effects [5].

Results & Findings

A cross-sectional survey of 237 Chinese IBD patients. Intrusive rumination was negatively associated with PTG (β = -0.33; 95% CI: -0.61, -0.04), with education level impacting this effect (P for interaction < 0.05). Deliberate rumination showed a positive linear relationship with PTG (β = 0.87; 95% CI: 0.57, 1.17). Above a threshold of 17, intrusive rumination had a stronger negative impact (β = -1.01; 95% CI: -1.73, -0.30).

Summary & Discussion

This finding aligns with cognitive theories of trauma processing, which suggest that excessive intrusive thoughts may overwhelm an individual's cognitive and emotional resources, impeding adaptive meaning-making [6]. Below this threshold, intrusive rumination may serve as an initial, albeit distressing, step in cognitive processing, whereas higher levels may entrench negative thought patterns[9].This non-linear association helps reconcile conflicting findings in the literature [7]. Future research should explore whether interventions (e.g., mindfulness, cognitive restructuring) facilitate a transition toward deliberate rumination and subsequent PTG.
In contrast to intrusive rumination, deliberate rumination demonstrated a robust positive association with PTG across all models[8]. For IBD patients, who often experience fluctuating symptoms and emotional distress, facilitating deliberate cognitive processing may help them reframe their illness narrative, enhancing resilience and adaptive coping.
Individuals with lower education levels may lack the cognitive resources and flexibility needed to transform intrusive rumination into constructive meaning-making, making them more susceptible to negative emotional cycles that hinder PTG [9].

Conclusion

In conclusion, a nonlinear relationship between intrusive rumination and PTG in patients with IBD was found. When intrusive rumination exceeded a threshold of 17, it was negatively correlated with PTG. Additionally, deliberate rumination was positively associated with PTG, highlighting its potential as a facilitator of psychological growth.

References

1. Barberio B, Zamani M, Black CJ, et al. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370.
2. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.
3. Joseph S, Murphy D, Regel S. An affective-cognitive processing model of post-traumatic growth. Clin Psychol Psychother. 2012;19(4):316-325.
4. Allen N, Hevey D, Cogley C, et al. A meta-analysis of the association between event-related rumination and posttraumatic growth: the event-related rumination inventory and the posttraumatic growth inventory. J Trauma Stress. 2022;35(6):1575-1585. https://doi.org/10.1002/jts.22875
5. Jones SR, Fernyhough C. Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model. Behav Res Ther. 2009;47(1):54-59.
6. Hill EM, Watkins K. Women with ovarian cancer: Examining the role of social support and rumination in posttraumatic growth, psychological distress, and psychological well-being. J Clin Psychol Med Settings. 2017;24(1):47-58
7. Tedeschi RG, Shakespeare-Finch J, Taku K, et al. Posttraumatic growth: Theory, research, and applications. Routledge. 2018.
8. Niemeyer H, Bieda A, Michalak J, et al. Education and mental health: Do psychosocial resources matter? SSM Popul Health. 2019;7:100392.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.