Sh Kim

Differences in the prevalence of colorectal polyps in patients undergoing endoscopic removal of gastric adenoma or early gastric cancer and in healthy individuals

BACKGROUND AND AIMSnWe compared the prevalence of adenomatous and cancerous colon polyps in patients who underwent endoscopic removal of gastric neoplasms and in healthy controls.nnnMATERIALS AND METHODSnThis retrospective study reviewed the medical records of 186 patients with gastric neoplasms and 186 healthy subjects from January 2002 to October 2008. The gastric neoplasm group was comprised of patients undergoing endoscopic removal of gastric adenomas or early gastric cancers and serial fiberoptic colonoscopy (FCS) for checkups. The control group was comprised of subjects undergoing fiberoptic esophagogastroduodenoscopy (FEGD) and FCS for general checkup and was matched for age and sex with the gastric neoplasm group. Advanced colonic neoplasm was defined by any of the following: (1) the presence of three or more polyps; (2) polyp size at least 1.0 cm; (3) high-grade dysplasia or adenocarcinoma confirmed by histopathologic examination.nnnRESULTSnOf the 372 persons, colorectal polyps were detected in 124 (33.3 %), advanced colonic neoplasms in 44 (11.8 %), and adenocarcinomas in 10 (2.7 %). The overall prevalence of adenomatous or cancerous polyps (all polyps) and the prevalence of advanced colonic neoplasms were significantly higher in the gastric neoplasm group than in the control group (all polyps: 40.9 % in the gastric neoplasm group vs. 25.8 % in the control group, P = 0.002; advanced colonic neoplasms: 15.6 % vs. 8.1 %, P = 0.025). The risk factors for all polyps were age, male sex, diabetes mellitus, and being assigned to the gastric neoplasm group, and those for advanced colonic neoplasms were age and being assigned to the gastric neoplasm group. Confining the analysis to the gastric neoplasm group, the risk factors for all polyps were identical with those for the total group; however, those for advanced colonic neoplasm were different (age vs. diabetes and hypertriglyceridemia).nnnCONCLUSIONnEndoscopists should consider performing routine FCS in patients undergoing endoscopic removal of gastric neoplasms.

A rare case of disseminated intravascular coagulation after endoscopic submucosal dissection for early gastric cancer

cancer (EGC) is currently standard practice in Korea and Japan [1]. Although there are many causes of disseminated intravascular coagulation (DIC), it occurs mostly after sepsis, wide tissue damage, and obstetric complications [2]. The authors report a case of DIC after endoscopic submucosal dissection (ESD), which has never been reported before. A 75-year-old female patient had been diagnosed with EGC. The patient had no specific medical history and blood tests were normal. ESD was performed on the second day of hospitalization (l Fig. 1). At 4 hours after ESD, the patient showed hematemesis. Endoscopic bleeding was immediately controlled using hemoclips (l Fig. 2). The following day, blood test results showed a decrease in platelet number (60 000/ L) and the international normalized ratio was increased to 1.8. Other results were fibrinogen 140 mg/dL and fibrin degradation product 32 g/mL. Schistocytosis was observed on a peripheral blood smear (l Fig. 3). The patient was diagnosed with DIC based on test results and clinical evidence. There was no additional bleeding and DIC improved under observation. ESD has the advantage over surgery of less tissue damage. DIC is generally known to occur after serious tissue injuries. A combination of mechanisms, including release of fat and phospholipids from tissue into circulation, hemolysis, and endothelial damages, may promote the systemic activation of coagulation [2]. The interesting fact in this case is that DIC occurred after ESD, which is a procedure that causes relatively little tissue damage. Until now there has been no report of DIC after ESD. Another cause for DIC could be cancer itself; about 10% – 15% of patients with metastasized tumors have evidence of DIC [2]. However, there have been no reports of DIC in EGC A rare case of disseminated intravascular coagulation after endoscopic submucosal dissection for early gastric cancer