Predictive factors for lymph node metastasis in early gastric cancer

AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.

How can colorectal neoplasms be treated during colonoscopy?

AIM: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to a large number of endoscopic diagnoses and treatment for colorectal neoplasms. The purpose of this investigation is to evaluate the efficacy and outcomes of endoscopic treatment for colorectal neoplastic lesions.METHODS: From September 1999 to May 2003, 11 447 consecutive colonoscopic examinations in 9 864 patients were gathered; totaling 5 502 endoscopic treatments for colorectal neoplasms. Macroscopic characteristics of the neoplasms were classified into protruded (n = 3 953), sessile (n = 1 402), lateral spreading tumor (n = 139) and depressed lesions (n = 8). Snare polypectomy was conducted in 3 984 lesions, hot forcep removal in 1 368 lesions, and endoscopic mucosal resection in 150 lesions.RESULTS: Histological diagnoses were 4 596 neoplastic lesions (4 376 adenomas and 220 adenocarcinomas) and 906 non-neoplastic lesions (891 hyperplastic and 15 inflammatory polyps). For the adenocarcinoma group, 31 instances involved submucosal invasion or resection margin, who received further operations, while 13 surgical specimens discovered no residual tumors. Three perforations and 96 bleedings were found following endoscopic treatment. No procedure-related mortality was found and no recurrent malignancy was found after 1456 mo follow-up.CONCLUSION: To lower the incidence and mortality of colorectal cancer, endoscopic treatment for colorectalneoplasms is a simple and safe procedure.

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

AIM:To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids.METHODS:A total of 759 consecutive patients (415 males and 344 females) were enrolled.Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients).All patients received EHL at outpatient clinics.Hemorrhoid severity was classified by Goligher's grading.The mean follow-up period was 55.4 mo (range,45-92 mo).RESULTS:The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients.Bleeding was controlled in 587 (98.0%) patients,while prolapse was reduced in 137 (82.5%) patients.After treatment,93 patients experienced anal pain and 48 patients had mild bleeding.Patient subjective satisfaction was 93.6%.Repeat treatment or surgery was performed if symptoms were not relieved in the first session.In the bleeding group,the recurrence rate was 3.7% (22 patients) at 1 year,and 6.6%and 13.0% at 2 and 5 years.In the prolapsed group,the recurrence rate was 3.0%,9.6% and 16.9% at 1,2 and 5 years,respectively.CONCLUSION:EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids,with good long-term results.