Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study.

AIM: To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS: A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) were randomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method, and early (< 12 h) and late bleeding complications (12 h-30 d) were observed. RESULTS: A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall, bleeding complications occurred in 7.6% (37/486) of the patients, including 4.9% (12/244) in the epinephrine group, and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients, respectively, including 4.5% (11/244), 0.4% (1/244) in the epinephrine group, and 8.7% (21/242), 1.7% (4/242) in the saline group. No significant differences in the rates of overall, early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB. CONCLUSION: The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.

Clinical significance of small colorectal adenoma less than 10 mm: the KASID study.

BACKGROUND/AIMS: Polypectomy is the current modality of choice to prevent benign colorectal adenoma from progressing to an invasive cancer. However, in cases of small colorectal adenoma, it remains unclear as to whether polypectomy is actually an effective treatment modality. We evaluated the clinical significance of polypectomy in cases of small colorectal adenomas, measuring less than 10 mm. METHODOLOGY: All colonoscopies were performed at 11 Korean tertiary medical centers, between July 2003 and March 2004. A total of 5996 colorectal adenomas were detected and divided into 5 groups according to their size (Group 1; 1-5 mm, Group 2; 6-7 mm, Group 3; 8-9 mm, Group 4; 10-19 mm, Group 5; more than 20 mm). The term 'advanced adenoma' refers here to tubular adenomas with diameters of at least 10 mm, or to tubulovillous, villous, or high-grade dysplasia, irrespective of size. 'Cancer' here is defined as the invasion of malignant cells beyond the muscularis mucosa. RESULTS: As the sizes of the adenomas increased, the prevalence of advanced adenoma was also observed to increase. In Groups 2 and 3, the prevalence of tubulovillous or villous adenoma were higher than was expected (5.2% and 6.6%, p < 0.001). Interestingly enough, in Group 2, the prevalence of cancer was at least as high as in Group 4 (0.7% vs. 0.5%, p < 0.001). CONCLUSIONS: In cases of small colorectal adenomas, measuring between 6 and 9 mm, the prevalence of cancer was at least as high as that seen in the cases of colorectal adenomas measuring between 10 and 19 mm. Therefore, small colorectal adenomas measuring between 6 and 9 mm should not be ignored, in order to decrease the prevalence of colorectal cancer.

Analysis of factors associated with the workers' health status using periodic health examination data by size of enterprises.

This study was conducted to determine whether the size of an enterprise can make a difference to workers' health and to examine those factors, which influence workers' health. The subjects of this study included 26,324 workers employed in manufacturing industry who received medical examinations at the Industrial Health Center at Yonsei University in 1995, 1996 and 1997. Medical examination data were used as a measure of health. Each enterprise was classified by size into three categories: Small scale enterprises (SSE) that employ no more than 50 regular employees; middle scale enterprise (MSE) that employ from 50 to 300 regular employees; and large scale enterprise (LSE) that employ more than 300 regular employees. Health conditions, according to the size of the enterprise, were determined by comparing prevalence rates, and direct standardization methods were used based upon the Korean population, as a standard population, in order to adjust for differences in population structure. 1. The findings of the medical examinations showed that, the prevalence rate in SSEs was higher than in MSEs or LSEs, but that this relationship was reversed after standardizing for sex and age. 2. Logistic regression analysis showed that, although subjects of advanced age, prolonged work history, and male gender had higher risks of disease, the size of the enterprise had no significant effect upon these risks.

Colorectal Neoplasm in Asymptomatic Average-risk Koreans: The KASID Prospective Multicenter Colonoscopy Survey.

BACKGROUND/AIMS: The incidence of colorectal cancer is increasing in Korea, but the epidemiology of colorectal neoplasm is not clearly defined. We aimed to elucidate the prevalence of colorectal neoplasm in average-risk Koreans and explore the underlying risk factors. METHODS: A large-scale, multicenter, prospective study was conducted. Of the 19,460 subjects who underwent colonoscopy at 11 university hospitals, we analyzed 3,951 consecutive asymptomatic adults with no risk factors for colorectal cancer. RESULTS: The subjects were aged 52.1+/-11.6 years (mean+/-SD) and 60.1% of them were men. The prevalences of colorectal neoplasm and advanced neoplasm were 33.3% and 2.2%, respectively. The prevalence of a neoplasm increased with age (trend: p<0.001) and was higher in males (p<0.001). The prevalence of a proximal neoplasm was higher in subjects with a distal neoplasm than in those without a distal neoplasm (11.9% vs. 5.4%, p<0.001). However, 150 (52.1%) of the 288 subjects with a proximal neoplasm had no distal neoplasm. CONCLUSIONS: The overall prevalence of colorectal neoplasm in asymptomatic average-risk Koreans is comparable with that in Western countries. Being male and older are associated with a higher risk of colorectal neoplasm. Over half of proximal neoplasms are not associated with any distal sentinel lesions.

Clinical significance of distal colon polyps for the prediction of an advanced proximal neoplasm: the KASID prospective multicenter study.

BACKGROUND/AIMS: The possibility of proximal lesion without distal polyps is a weak point of sigmoidoscopic colon cancer screening, but the clinical significance of distal findings for advanced proximal neoplasm (APN) is uncertain. The aim of this study was to assess the significance of a distal finding as a predictor of APN. MATERIALS AND METHODS: Asymptomatic patients > or =50 years old were enrolled from among patients who underwent polypectomy at 11 tertiary medical centers during the Korean Association for the Study of Intestinal Disease prospective study conducted between July 2003 and March 2004. Polyps located distal to the splenic flexure were defined as distal polyps. An advanced neoplasm was defined as a polyp of > or =10 mm in size, and/or with villous features, and/or with high-grade dysplasia, or invasive cancer. Age, gender, and distal polyp size, appearance, and histology were analyzed as risk factors of APN. The sensitivity and positive predictive value of distal polyps for APN were calculated. RESULTS: Data from 826 patients were analyzed. Mean patient age was 60.1 years (range 50-86), and 71.3% were men. APN was found in 98 patients, and 45 (45.9%) patients had no distal polyps. Risk factors of APN were a male gender, distal polyp size, and an advanced distal neoplasm. Sensitivities of a distal polyp of > or =10 mm and of an advanced distal neoplasm for APN were both 38.8% with positive predictive values of 13.3 and 14.4%, respectively. CONCLUSIONS: Although distal colon findings were found to be helpful for predicting APN in asymptomatic patients aged > or =50 years, APN without distal polyps requires careful consideration.

Comparison of the efficacy of rabeprazole 10 mg and omeprazole 20 mg for the healing rapidity of peptic ulcer diseases.

AIM: Rabeprazole has been known to inhibit H(+)/K(+)-ATPase more rapidly than omeprazole, the prototype proton pump inhibitor (PPI). The aim of this study was to demonstrate equivalence between low-dose rabeprazole 10 mg and omeprazole 20 mg for the healing rapidity of active peptic ulcer and for improvement of symptoms. Also, the effect of CYP2C19 genotypes on ulcer healing rapidity was investigated. METHODS: A total of 112 patients with active peptic ulcer were randomized to receive either rabeprazole 10 mg q.d. or omeprazole 20 mg q.d. for 6 weeks. The remaining ratios (%) and complete healing of the ulcer were determined by endoscopy at 1 week and 6 weeks of treatment. The severity of ulcer pain was also investigated during treatment. CYP2C19 genotype was determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: The remaining ratio of peptic ulcers after 1 week and the complete healing rate after 6 weeks in the rabeprazole versus omeprazole group were 45.5% versus 50.3% (P = 0.475) and 80.6% versus 87.0% (P = 0.423), respectively. CYP2C19 genotypes had no effect on the remaining ratio of peptic ulcers after 1 week and the healing rate of peptic ulcers after 6 weeks in both groups. The proportions of patients with symptom improvement or resolution were comparable between the two groups. CONCLUSION: Low-dose rabeprazole 10 mg has a similar efficacy for the healing rapidity of active peptic ulcer disease and symptom improvement compared with standard-dose omeprazole 20 mg.