Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions.

BACKGROUND: Hemostatic powder (HP) in gastrointestinal bleeding (GIB) is mainly used as rescue therapy after failure of conventional hemostatic procedures (CHP). AIM: To define the best field of application and the efficacy of HP as first choice monotherapy or rescue therapy. METHODS: We compared the efficacy of HP monotherapy, HP rescue therapy, and CHP in the management of active GIB due to neoplastic and non-neoplastic lesions. RESULTS: A total of 108 patients, 43 treated with HP as either first choice or rescue therapy and 65 with CHP, were included in the study. The most frequent sources of bleeding were peptic ulcer and malignancy. Immediate hemostasis rates were: HP monotherapy = 100% in peptic ulcer and 100% in malignancy; HP rescue therapy = 93.2% in peptic ulcer and 85.7% in malignancy; CHP = 77.9% in peptic ulcer and 41.7 in malignancy. Definitive hemostasis rates were: HP monotherapy = 50% in peptic ulcer and 45.5% in malignancy; HP rescue therapy = 73.3% in peptic ulcer and 85.7% in malignancy; CHP = 69.1% in peptic ulcer and 33.3% in malignancy. No difference was found in terms of additional intervention between the three groups. CONCLUSIONS: HP is highly effective as monotherapy and rescue therapy in GIB. GIB related to malignancy may be the best field of application of HP, but confirmatory studies are necessary.

Surgical treatment of isolated lung and adrenal metastasis from colorectal cancer. Case report.

INTRODUCTION: Up to 30% of stage I and II colorectal cancers (CRCs) treated with surgical resection alone show disease recurrence, indicating that lymph node (LN) involvement was probably underestimated. Lung is a common site of CRC metastasis, whereas adrenal glands are rarely involved. CASE REPORT: On July 2004 a 56-year old woman underwent left hemicolectomy for a stage I sigmoid cancer. Four years later a lobectomy was performed for an isolated lung metastasis; thirteen months thereafter she underwent left adrenalectomy for adrenal metastasis. No lymph node involvement has ever been demonstrated either histopathologically or radiologically. At present, the patient is alive and apparently disease-free. DISCUSSION: The presence of LN occult metastasis, that might explain recurrence in stage I and II CRCs, has recently been investigated by means of immunohistochemistry and polymerase chain reaction; evidence of LN metastasis obtained with the latter technique is associated to a worse outcome. There have been very few cases that resemble our patient's neoplastic progression and they were either stage III neoplasms or rectal cancers. Our patient's primitive localization in the sigmoid colon makes it difficult to imagine why the liver has not been a site of metastasis. Finally, surgery has an important role in treating isolated metastasis in both lungs and adrenal glands. KEYWORDS: Colorectal cancer, Lung metastasis, Solitary adrenal metastasis.