Clinicopathological features of colorectal polyps in 2002 and 2012

BACKGROUND/AIMS: There are few comparative studies on the historical changes in the clinicopathologic characteristics of colorectal polyps in Korea. This retrospective study compared the clinicopathologic characteristics of colorectal polyps treated at our institution in 2002 and 2012. METHODS: The medical records of 1,816 patients who underwent colonoscopy and were found to have colorectal polyps in 2002 (n = 597) or 2012 (n = 1,219) were reviewed retrospectively. Patient characteristics and polyp sizes, gross morphologies, locations, and pathologic results were analyzed and compared. RESULTS: Mean age was older in the 2002 group than in the 2012 group (67.3 ± 11.1 years vs. 55.4 ± 10.8 years, p < 0.001). The 1,816 study subjects had a total of 3,723 colorectal polyps, with a mean of 2.05 polyps per patient. Mean polyp size was larger in the 2002 group than in the 2012 group (0.6 ± 0.4 cm vs. 0.4 ± 0.3 cm, p < 0.001). The most common histology was tubular adenoma and they were more common in the right colon in both study groups. Although the distribution of total adenoma was not significantly different between groups, the location of advanced adenoma differed significantly and was more common in the right colon in the 2012 group (30.4% vs. 63.2%, p = 0.01). CONCLUSIONS: No significant change in total polyps and adenoma distribution was found between 2002 and 2012. However, advanced adenoma was more common in the right colon in 2012, which cautiously suggests a locational shift from the left to right colon. These findings indicate that right colon polyps require more attention.

Risk Factors of Advanced Adenoma in Small and Diminutive Colorectal Polyp

The aims of this study were to review the clinicopathological characteristics of diminutive (≤ 5 mm) and small polyps (> 5 mm but 65 years), a male gender, and a polyp size of > 5 mm were risk factors of advanced adenoma. The incidence of advanced adenoma in polyps of 65 years are independent risk factors of advanced adenoma.

A Case of Multiple Primary Cancer with Follicular Lymphoma

The incidence of multiple primary cancer (MPC) is low but has been reported occasionally. Although follicular lymphoma is rare in Korea, the incidence is reported to be gradually increasing. We report a case of synchronous and metachronous MPC consisting of esophagus (squamous cell carcinoma), stomach (adenocarcinoma), and ampulla of Vater (extranodal follicular lymphoma grade 1) in a patient diagnosed as follicular lymphoma (grade 3a) six years ago. In a complicated case like ours, concurrent therapeutic control of synchronous MPC and metachronous hematological malignancy is challenging; meticulous examination and prioritized target therapy are essential for patients' survival.

Multiple Rectal Neuroendocrine Tumors: Report of Five Cases / 대한소화기학회지

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.

A Case of Plummer-Vinson Syndrome Associated with Crohn's Disease / 대한소화기학회지

Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn's disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn's disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn's disease patient, which caused malnutrition and constipation.

Trends in the Eradication Rates of Helicobacter pylori Infection in Daegu and Gyeongsangbuk-do, Korea: Multicenter Study over 13 Years / 대한소화기학회지

BACKGROUND/AIMS: The eradication rates of Helicobacter pylori infection have been reported to have decreased over the years due to antibiotics resistance. The aim of this study is to investigate the trend of eradication rates of first-line triple therapy for H. pylori over the past 13 year period, and to evaluate factors affecting H. pylori eradication in Daegu and Gyeongsangbuk-do, Korea. METHODS: A total of 2,982 patients with H. pylori infection who were treated with either 1 week or 2 weeks first-line therapy (proton pump inhibitor [PPI], amoxicillin, and clarithromycin) from January 1999 through December 2011 were included in this study. Data were collected by retrospectively reviewing the medical records. RESULTS: The overall H. pylori eradication rate was 87.2%. The eradication rates from 1999 to 2011 fluctuated between 78.0% and 95.7%, but no definite evidence of a decreasing tendency was seen over the 13 year period (p=0.113). Furthermore, there was no significant difference in the eradication rate according to the duration of therapy (p=0.592). However, there was a significant difference in the eradication rate among various PPIs (p<0.01). CONCLUSIONS: There was no decreasing trend in the H. pylori eradication rate over the past 13 years in Daegu and Gyeongsangbuk-do, Korea. There also was no difference in the eradication rates depending on duration of therapy. However, a significant difference was noted among various PPIs.

Clinical Features and Risk Factors of Gastric Subepithelial Tumor Needed Surgery in Clinical Practice: A Single-center Retrospective Study

BACKGROUND/AIMS: Gastric subepithelial tumor (SET) is often noted incidentally during esophagogastroduodenoscopy (EGD). The prevalence of SET is increasing in accordance with the increase of EGD and endosonographies. SET can range from benign lesions to tumors with malignant behavior or potential such as gastrointestinal stromal tumor (GIST) and carcinoid tumor. The aim of this study was to evaluate clinical features and risk factors of gastric SET that needed surgery in a single center. MATERIALS AND METHODS: We retrospectively analyzed medical records of 90 patients who underwent operations due to SET during the period from January 2006 to December 2010. RESULTS: Of the 90 patients, those who were diagnosed with GIST, ectopic pancreas, leiomyoma, schwannoma, carcinoid tumor, and inflammatory fibroid polyp after surgery were 43 (47.8%), 14 (15.6%), 13 (14.4%), 8 (8.9%), 3 (3.3%), and 2 (2.2%), respectively. Most patients who received operation due to SET were asymptomatic (52.2%). Patients were divided into non-GIST and GIST groups, non-malignant and malignant groups, respectively. Baseline characteristics between both groups were significantly different in age, and size (P<0.05). Age was an independent risk factor of malignant gastric SET (OR, 1.045; 95% CI, 1.008~1.084; P=0.016). In addition, age and size were independent risk factors of gastric SET with potential of GIST (OR, 1.049; 95% CI, 1.011~1.089; P=0.011, OR, 1.026; 95% CI, 1.002~1.050; P=0.031). CONCLUSIONS: We demonstrated that an independent risk factor of malignant gastric SET that needed surgery was age, and independent risk factors of GIST were age and size of the tumor.

Clinical Features and Risk Factors of Gastric Subepithelial Tumor Needed Surgery in Clinical Practice: A Single-center Retrospective Study

BACKGROUND/AIMS: Gastric subepithelial tumor (SET) is often noted incidentally during esophagogastroduodenoscopy (EGD). The prevalence of SET is increasing in accordance with the increase of EGD and endosonographies. SET can range from benign lesions to tumors with malignant behavior or potential such as gastrointestinal stromal tumor (GIST) and carcinoid tumor. The aim of this study was to evaluate clinical features and risk factors of gastric SET that needed surgery in a single center. MATERIALS AND METHODS: We retrospectively analyzed medical records of 90 patients who underwent operations due to SET during the period from January 2006 to December 2010. RESULTS: Of the 90 patients, those who were diagnosed with GIST, ectopic pancreas, leiomyoma, schwannoma, carcinoid tumor, and inflammatory fibroid polyp after surgery were 43 (47.8%), 14 (15.6%), 13 (14.4%), 8 (8.9%), 3 (3.3%), and 2 (2.2%), respectively. Most patients who received operation due to SET were asymptomatic (52.2%). Patients were divided into non-GIST and GIST groups, non-malignant and malignant groups, respectively. Baseline characteristics between both groups were significantly different in age, and size (P<0.05). Age was an independent risk factor of malignant gastric SET (OR, 1.045; 95% CI, 1.008~1.084; P=0.016). In addition, age and size were independent risk factors of gastric SET with potential of GIST (OR, 1.049; 95% CI, 1.011~1.089; P=0.011, OR, 1.026; 95% CI, 1.002~1.050; P=0.031). CONCLUSIONS: We demonstrated that an independent risk factor of malignant gastric SET that needed surgery was age, and independent risk factors of GIST were age and size of the tumor.

A Case of Hyperplastic Gastric Polyp Presenting with Massive Gastrointestinal Bleeding

Hyperplastic polyps are the most common histological findings among benign gastric polyps. The characteristics of gastric hyperplastic polyps are usually subclinical, small, sessile form, and solitary lesions occurring in the antrum. With increasing size, they can present with dyspepsia, nausea, melena or iron deficiency anemia due to chronic blood loss. Especially polyps with size exceeding 2 cm is defined as a giant gastric polyp and comprises 2% of gastric hyperplastic polyps. However, massive upper gastrointestinal bleeding caused by gastric hyperplastic polyps is rare. Here, we report a case of a 64-year-old male patient with massive bleeding caused by a giant gastric polyp which needed urgent endoscopic hemostasis and was confirmed as a hyperplastic polyp. According to our experience, physicians should be aware that gastric hyperplastic polyp might result in massive upper gastrointestinal bleeding.

A Case of Hyperplastic Gastric Polyp Presenting with Massive Gastrointestinal Bleeding

Hyperplastic polyps are the most common histological findings among benign gastric polyps. The characteristics of gastric hyperplastic polyps are usually subclinical, small, sessile form, and solitary lesions occurring in the antrum. With increasing size, they can present with dyspepsia, nausea, melena or iron deficiency anemia due to chronic blood loss. Especially polyps with size exceeding 2 cm is defined as a giant gastric polyp and comprises 2% of gastric hyperplastic polyps. However, massive upper gastrointestinal bleeding caused by gastric hyperplastic polyps is rare. Here, we report a case of a 64-year-old male patient with massive bleeding caused by a giant gastric polyp which needed urgent endoscopic hemostasis and was confirmed as a hyperplastic polyp. According to our experience, physicians should be aware that gastric hyperplastic polyp might result in massive upper gastrointestinal bleeding.