Rescue bowel preparation: same day 2 L polyethylene glycol addition, not superior to bisacodyl addition 7 days later.

BACKGROUND: The optimal colon-cleansing method after failure of bowel preparation (BP) for colonoscopy has not been established. AIMS: We aimed to compare BP rescue methods after failed initial BP and to identify risk factors for rescue BP failure. METHODS: Eighty-five patients with BP failure after 4 L polyethylene glycol (PEG) ingestion were prospectively enrolled from March 2008 to March 2012. A second colonoscopy was performed either on the same day after ingestion of another 2 L PEG (group A) or 1 week later after ingestion of 4 L PEG plus 20 mg oral bisacodyl (group B). Differences between groups in terms of BP quality and risk factors for a poor BP on the second colonoscopy were investigated. RESULTS: Median patient age was 59 years, 45 were male (52.9 %), and 17 (20 %) had poor BP on the second colonoscopy. For group B, the multivariable-adjusted odds ratio (OR) for poor BP on the second colonoscopy relative to group A was 0.68 (95 % confidence interval [CI], 0.16-2.95). Adequately ingested PEG during the initial colonoscopy was associated with poor BP on the second colonoscopy (OR 4.05; 95 % CI 1.04-15.75). The two groups had similar patient discomfort rates during the second BP. CONCLUSIONS: The two groups did not differ in rescue BP failure rate. Initial BP failure after adequate consumption of 4 L PEG may be a risk factor for rescue BP failure. A stricter BP regimen should be considered for these patients.

Clinical outcomes of colonic mucosal cancers with histologically positive or uncertain resection margin after endoscopic resection.

BACKGROUND/AIMS: Although incomplete endoscopic resection of colonic neoplasms can lead to the development of interval invasive cancer, few studies have assessed clinical outcomes after histologically incomplete resection of colonic mucosal cancer. We aimed to evaluate the clinical outcomes of patients with histologically positive or uncertain resection margins after endoscopically complete resection of colonic mucosal cancer. METHODOLOGY: We analyzed the clinical course of 38 patients (median 62 years, male:female = 27:11) who underwent endoscopically complete resection of colonic mucosal cancer, but who showed histologically positive or uncertain resection margins. RESULTS: The median size of the 38 colonic mucosal cancers was 14 mm (range, 5-50 mm). Of these, 20 were resected by a piecemeal resection, and had uncertain histological resection margins. The remaining 18 patients underwent en-bloc resection; of these, 16 had uncertain resection margins and 2 had positive margins. Patients underwent a median of 2.3 follow-up endoscopies (range, 1-7) during a median follow-up time of 18.3 months (range, 3-75 months). No local or distant recurrence was detected. CONCLUSIONS: Cautious followup without immediate additional treatment can be considered for patients who undergo endoscopically complete resection of colonic mucosal cancers, even when histological examination shows uncertain or positive resection margins.

The outcome of fluoroscopically guided balloon dilation of pyloric stricture in Crohn disease.

PURPOSE: To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation for pyloric stricture associated with Crohn disease (CD) while monitoring the outcome. MATERIALS AND METHODS: Five patients (age range 15-34 y) were diagnosed with symptomatic pyloric stricture associated with CD between November 2006 and August 2009. All five patients underwent fluoroscopically guided balloon dilation one or more times. RESULTS: The initial balloon dilations were technically successful in all patients. Two patients showed improvement of symptoms without further need of dilation, two patients had one more session of dilation, and one patient underwent two more sessions of repeated dilation. There were no procedure-related complications. Overall technical and clinical success rates were 100%. After the last dilation, all patients remained healthy, with no case of relapse of obstructive symptoms during the median follow-up of 16 months (range 6-22 mo). CONCLUSIONS: Fluoroscopically guided balloon dilation seems to be a useful tool for management of symptomatic pyloric stricture in CD and may be a viable alternative to open surgery.

[Two cases of multiple adenomas in the ileal pouch after total proctocolectomy in patients with familial adenomatous polyposis].

Familial adenomatous polyposis (FAP) is an inherited disease characterized by the development of hundreds of colorectal adenomas, leading to a 100% lifetime risk of colorectal cancer. A prophylactic colectomy is recommended for patients with FAP to prevent colorectal cancer. Four surgical strategies are available for patients with FAP: proctocolectomy with permanent ileostomy, colectomy with ileorectal anastomosis, proctocolectomy with Kochs pouch continent ileostomy (Koch), and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Koch and IPAA, which make ileal pouch, have theoretical advantage of the elimination of the risk of colorectal cancer and adenomas and good functional outcome of reduced defecation frequency. However, recent reports have shown frequent development of adenomas and carcinomas in the ileal pouch after Koch or IPAA. We experienced 2 cases of multiple pouch adenomas after pouch surgery in FAP patients. Both patients were treated with endoscopic mucosal resection without complications. We report these 2 cases with a review of literatures.

Clinicopathologic characteristics of T-cell non-Hodgkin's lymphoma: a single institution experience.

BACKGROUND/AIMS: Although the incidence of T-cell non-Hodgkin's lymphoma (NHL) is higher in Far East Asia than in Western countries, its incidence and clinical course in Korea are not well-defined. Therefore, we assessed the relative frequency and clinical features of T-cell NHL in Korea. METHODS: We performed a retrospetcive analysis of 586 patients with NHL. RESULTS: 101 (17.2%) had T-cell NHL. The most frequent subtypes of T-cell NHL were extranodal NK/T-cell lymphoma, nasal type (NASAL), peripheral T-cell lymphoma, unspecified type (PTCL-U), and anaplastic large cell lymphoma, T/null cell, primary systemic type (ALCL). The seven pathological subtypes could be classified into three prognostic subgroups. When patients with the three most frequent subtypes were grouped together, their survival was reflected in the International Prognostic Index (IPI) scores. Univariate analysis of IPI elements and other clinical features showed that clinical stage and extranodal sites were significant predictors of survival. Cox multivariate analysis showed that the number of extranodal sites was the only independent prognostic indicator. CONCLUSIONS: The relative frequency of T-cell NHL seems to be decreasing in Korea, although NASAL remains frequent. Korean patients with ALCL appear to have an unfavorable prognosis. Large-scale studies are warranted for Korean patients with T-cell NHL.

Autologous stem cell transplantation for diffuse large B-cell lymphoma with residual extranodal involvement.

BACKGROUND/AIMS: Diffuse large B-cell lymphoma (DLBCL) in Koreans is frequently accompanied by extranodal (EN) disease at the time of autologous stem cell transplantation (ASCT). We sought to determine whether high EN involvement affected survival following ASCT in Koreans. METHODS: We reviewed 27 patients who had DLBCL with residual disease at ASCT: 13 with residual disease at nodal site(s) only and 14 with nodal and EN disease. RESULTS: Univariate analysis showed that disease status, lactate dehydrogenase (LDH), and performance status at ASCT were predictors of survival following ASCT. The number of EN sites, as categorized by the International Prognostic Index system, had no prognostic significance. When EN involvement at ASCT was classified as negative or positive, the 2-year overall survival for the negative group was 64%, significantly better than the 14% for the positive group (p=0.021), and the event-free survival for the negative group was 62%, significantly better than the 14% for the positive group (p=0.02). CONCLUSIONS: Patients who had DLBCL with residual EN involvement at ASCT showed worse outcomes following ASCT compared to those without EN disease.

Prospective randomized comparative observation of single- versus split-dose lenograstim to enhance engraftment after autologous stem cell transplantation in patients with multiple myeloma or non-Hodgkin's lymphoma.

BACKGROUND: Granulocyte-colony-stimulating factor (G-CSF) is used to enhance hematopoietic recovery after autologous stem cell transplantation (ASCT). Recommendations for administration of G-CSF during the engraftment phase of ASCT have recently changed. This study sought to compare the early engraftment profile between groups receiving single-dose versus split-dose lenograstim to enhance engraftment after ASCT. STUDY DESIGN AND METHODS: A prospective, randomized study was performed with 40 patients (14 with non-Hodgkin's lymphoma, 26 with multiple myeloma) undergoing ASCT. Patients were randomly assigned to receive 5 microg per kg lenograstim once daily (single dose) or 2.5 microg per kg lenograstim twice daily (split dose) starting 1 day after transplantation (Day +1). A minimum of 3 x 10(6) per kg CD34+ cells per kg was required for the autograft. RESULTS: The median time to neutrophil engraftment was 10 days for both groups. Platelet (PLT) engraftment was achieved in 11 days for the single-dose group and 14 days for the split-dose group. Episodes of clinically documented infection were low and similar in both groups (18 during 392 patient-days in the single-dose group and 22 during 556 patient-days in the split-dose group). There were no significant differences in requirements for red blood cell or PLT transfusion between the two groups. The duration of hospitalization after stem cell infusion was 18 days for the single-dose group and 22 days for the split-dose group. CONCLUSION: Administration of split doses of lenograstim is not associated with superior clinical efficacy compared with conventional daily single-dose administration for immediate hematopoietic recovery after ASCT.

Double autologous stem cell transplantation for multiple myeloma: a Korean single center study.

BACKGROUND: Although high dose chemotherapy coupled with an autologous stem cell transplantation (ASCT) is widely accepted as effective therapy for multiple myeloma (MM), few reports are available in Korea, especially in the area of double ASCT. We present the results of an institutional retrospective study of 12 patients with MM treated by double ASCT. METHODS: Eligible patients received induction therapy using vincristine, adriamycin, dexamethasone (VAD), and mobilization was performed using cyclophosphamide plus lenograstim. High-dose melphalan (total 200 mg/m2) was used to condition the ASCT. RESULTS: The median interval from diagnosis to ASCT was 6 months (range, 1.8-15.3 months). The median interval between the 1st and 2nd ASCT was 4.4 months (range 2.1-48.7 months). The median follow up was 18.3 months (range 8.1-50.5 months) for the nine surviving patients. No therapy-related mortality occurred. Following induction chemotherapy, two patients experienced CR. Following double ASCT, eight patients experienced CR. The 5 year OS was 59%. The median duration of event free survival was 2.13 years (95% CI, 0.84-3.42). CONCLUSION: Although the results of study did not demonstrate the advantage of double ASCT, this is the first report to outline the outcome of double ASCT for Korean MM patients.