AIM To evaluate the usefulness of total colonoscopy(TCS) for patients undergoing gastric endoscopic submucosal dissection(ESD) and to assess risk factors for colorectal neoplasms.METHODS Of the 263 patients who underw...AIM To evaluate the usefulness of total colonoscopy(TCS) for patients undergoing gastric endoscopic submucosal dissection(ESD) and to assess risk factors for colorectal neoplasms.METHODS Of the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test(FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.RESULTS TCS revealed adenoma less than 10 mm in 53 patients(33.6%), advanced adenoma in 17(10.8%), early colorectal cancer in 5(3.2%), and advanced colorectalcancer in 4(2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FITpositive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women(P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus(P = 0.019).CONCLUSION In patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.展开更多
Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithel...Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection.If patients with IPNB who are treated only with endoscopic procedures are noted,clinical profiles and alternative therapies other than resection may be recommended.We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB.Radical resection could not be recommended because of the age of the patient,therefore,endoscopic sphincterotomy was performed.Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis,the patient has done well during follow-up.Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.展开更多
文摘AIM To evaluate the usefulness of total colonoscopy(TCS) for patients undergoing gastric endoscopic submucosal dissection(ESD) and to assess risk factors for colorectal neoplasms.METHODS Of the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test(FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.RESULTS TCS revealed adenoma less than 10 mm in 53 patients(33.6%), advanced adenoma in 17(10.8%), early colorectal cancer in 5(3.2%), and advanced colorectalcancer in 4(2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FITpositive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women(P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus(P = 0.019).CONCLUSION In patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.
文摘Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection.If patients with IPNB who are treated only with endoscopic procedures are noted,clinical profiles and alternative therapies other than resection may be recommended.We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB.Radical resection could not be recommended because of the age of the patient,therefore,endoscopic sphincterotomy was performed.Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis,the patient has done well during follow-up.Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.
