Incidence and clinical characteristics of gastroenteropancreatic neuroendocrine tumor in Korea: a single-center experience.

BACKGROUND/AIMS: Neuroendocrine tumors (NETs) may originate from heterogeneous neuroendocrine cells. The incidence is increasing worldwide, and World Health Organization (WHO) updated its classification in 2010. We investigated clinical characteristics of gastroenteropancreatic NETs in a single center. METHODS: Clinicopathologic characteristics of patients with pathologically confirmed gastroenteropancreatic NET in Seoul St. Mary Hospital from March 2009 to August 2011 were retrospectively analyzed. The grade and stage were determined according to WHO 2010 classification and TNM Staging System for Neuroendocrine Tumors (7th ed., 2010) of American Joint Committee on Cancer. RESULTS: One hundred and twenty-five patients (median age, 50; male, 61.3%) were analyzed. Among 100,000 patients who visited the hospital, incidence was 24.1. Only two patients (1.6%) had a functional NET. The rectum (n = 99, 79.8%) was most common primary site and found in early stage. The prevalence by stages was 84.7% stage I, 8.9% stage IV, 4.8% stage II, and 1.6% stage III. The pathology grading was 74.5% grade 1, 12.7% grade 2, and 12.7% grade 3. Tumor stage correlated positively with pathologic grade (Spearman's rank correlation coefficient, 0.644). CONCLUSIONS: Wide range of clinicopathological features of Korean gastroenteropancreatic NETs were demonstrated using WHO 2010 classification. Rectal NET was most frequent and found in early stage.

Premedication with erythromycin improves endoscopic visualization of the gastric mucosa in patients with subtotal gastrectomy: a prospective, randomized, controlled trial.

BACKGROUND: Food residue in the remnant stomach after subtotal gastrectomy (STG) interferes with endoscopic observation. We investigated whether intravenous erythromycin improves gastric mucosa visualization in patients with STG. METHODS: This study was conducted from April 2012 to October 2012 as a double-blinded, placebo-controlled, randomized trial. Patients who received STG with complete resection (stage T1-2N0M0) were included. Exclusion criteria were diabetes mellitus, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing gastrointestinal motility and severe comorbidity. Patients were instructed to consume a soft diet for dinner between 1800 and 2000 h, and endoscopies were performed between 0900 and 1200 h. Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc) or placebo saline. The endoscopy was performed 15 min after infusion. Grade of residual food was rated as follows: G0, no residual food; G1, a small amount of residual food; G2, a moderate amount of residual food; G3, a moderate amount of residual food that hinders observation of the entire surface, even with body rolling; G4, a great amount of residual food such that endoscopic observation is impossible. RESULTS: When good visibility was defined as G0+G1, visibility was significantly better in the erythromycin group (61 + 19 %) than in the placebo group (38 + 12 %, p < 0.001). However, this effect was not seen in patients within 6 months after gastrectomy. The risk factor for food stasis in the placebo group (n = 58) was food stasis at last endoscopy. The only factor predicting erythromycin response in the erythromycin group (n = 56) was elapsed time since surgery. Adverse effects included nausea [11 (19.7 %)] and vomiting [1 (1.8 %)] in the erythromycin group and vomiting [3 (5.2 %)] in the placebo group. However, they were transient and tolerable. CONCLUSIONS: Premedication with erythromycin improves mucosal visualization during endoscopy in patients with STG. ( CLINICAL TRIALS REGISTRATION NUMBER: NCT01659619).

Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy.

BACKGROUND: The introducer method of percutaneous endoscopic gastrostomy (PEG) minimizes procedure-related peristomal infection. Ultrathin transnasal endoscopy (UTE) allows comfortable endoscopic examination of patients with fewer adverse effects and passage of the endoscope through a narrow esophagus or oropharynx. This study aimed to investigate the clinical outcomes for the introducer method of PEG with UTE. METHODS: Patients who underwent the introducer method of PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the patients within 180 days after gastrostomy placement were investigated. RESULT: During the study period, 92 patients (31.9 % male; age, 67.7 ± 16.6 years) underwent the introducer method of PEG with UTE. The major indications for PEG insertion were stroke (40.4 %), esophageal cancer or head and neck cancer (27.1 %), and neurologic disorder (14.9 %). Esophageal stenosis was identified by endoscopy or imaging in 14 patients before PEG. In all the patients, UTE was successfully introduced through the nasal cavity. In 90 (97.8 %) of the 92 patients, PEG was successfully inserted. Insertion of the endoscope into the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper esophagus. No procedure-related peristomal infection, gastric contents leakage, or bleeding occurred within 30 days after gastrostomy placement. In eight patients (8.7 %), catheter displacement occurred within 30 days. Catheter displacement in 44 patients (47.8 %) and gastric contents leakage in eight patients (9 %) occurred within 30-180 days after gastrostomy placement. CONCLUSION: Introducer PEG with UTE is a useful method for gastrostomy placement with a high success rate. This technique allows procedure-related complications to be avoided and permits the use of endoscopy in patients with narrow esophagi or oropharynges. However, the long-term durability of the balloon-type catheter is questionable.

Detection of neoplastic gastric lesions using capsule endoscopy: pilot study.

Objectives. Capsule endoscopy is relatively noninvasive method and its use extends from the small bowel to the esophagus and colon. The aim of this study was to evaluate the feasibility and acceptability of capsule endoscopy for neoplastic gastric lesions. Methods. Capsule endoscopy (Pillcam ESO) was performed within 48 hours of esophagogastroduodenoscopy for eight patients who were diagnosed with gastric cancers, the size of which were less than 4 cm and who presented written consent. Patients changed position in a specified designed sequence every 30 seconds after capsule ingestion. Position change was repeated with ingestion of an effervescent agent. The rate of detection of intragastric lesions, observation of normal gastric anatomy and patient satisfaction between capsule endoscopy and esophagogastroduodenoscopy were compared. Results. Capsule endoscopy found four out of eight gastric lesions. The gastroesophageal junction was observed in seven of the eight cases, pyloric ring in five of the eight cases, and gastric angle in four of the eight cases. The patient satisfaction assessment questionnaire rated capsule endoscopy significantly higher than upper endoscopy in all categories. Conclusions. Capsule endoscopy was less effective than esophagogastroduodenoscopy and showed limited value in this feasibility study.

Expression of girdin in human colorectal cancer and its association with tumor progression.

BACKGROUND: Girdin is crucial for cellular motility in cancer cell lines and for metastasis in a mouse model. Its expression has been demonstrated in a range of cancers by a few studies and was a prognostic factor in a subset of patients. OBJECTIVE: The aim of this study was to investigate the relationship of Girdin expression to clinicopathologic factors in terms of the progression of colorectal cancers and patient survival. DESIGN: This study is a retrospective review of immunohistochemical and clinicopathologic data. SETTING: This study was conducted at a tertiary care hospital/referral center in South Korea. PATIENTS: Tissue microarrays were made from surgical biopsies of 298 patients with colorectal cancer diagnosed between November 1996 and August 2007. Patients were included in the study if their survival time was known and if well-preserved surgical biopsy specimens were available. MAIN OUTCOME MEASURES: The primary outcomes measured were Girdin expression and its association in tumor progression and patient survival. RESULTS: Positive staining for Girdin was observed in samples from 66 of 242 patients (27.3%). Expression of Girdin was significantly associated with tumor-node-metastasis stage (p = 0.036), liver metastasis (p = 0.025), and metastases involving the liver and other organs (p = 0.009). However, Girdin expression did not correlate significantly with the overall survival of patients and was not a significant negative prognostic factor for survival by univariate or multivariate analyses. LIMITATIONS: The number of investigated patients and the number of cases with positive staining for Girdin were rather small for the multivariate analysis. The inclusion time frame is long and includes other surgical and medical improvements, which influence a patient's survival. CONCLUSION: The expression of Girdin is related to tumor metastasis but not to survival in human colorectal cancers.

Pneumopericardium as a complication of pericardiocentesis.

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.