Primary Gastric Small Cell Carcinoma: A Case Identified as a Large Subepithelial Tumor from Invisible State in 6 Months

Primary gastric small cell carcinoma (GSCC) is one of the gastroenteropancreatic neuroendocrine tumors. It is a rare cancer with a very aggressive behavior and a poor prognosis because of the high rate of metastases. It is usually found in far advanced stage. We experienced a case of GSCC which had developed into a large subepithelial tumor (SET) from invisible state in a short period. A 65-year-old man consulted our hospital because of early gastric cancer. He underwent endoscopic submucosal dissection for the early gastric cancer at high body posterior wall. After 6 months, the follow-up endoscopy showed a large newly developed SET-like lesion with central ulceration at the gastric cardia. Endoscopic biopsy revealed GSCC. Total gastrectomy was performed. One out of the 26 perigastric lymph nodes had a metastasis. He received 6 cycles of adjuvant chemotherapy with etoposide and cisplatin. He is still in good health 12 months after operation.

Usefulness and Cost-effectiveness of Colorectal Stent Followed by Curative Resection for Left-sided Malignant Colorectal Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: We aimed to evaluate the cost-effectiveness of preoperative stent insertion for treating left-sided malignant colorectal obstruction. METHODS: Patients with left-sided malignant colorectal obstruction were included in this study. The stent group (ST, n=24) included those patients who were treated with preoperative stent insertion followed by curative surgical resection. The clinical course and management cost of the ST group was compared to those of the emergency operation group (EO, n=22). RESULTS: The patients' age (60.6+/-3.1 yrs vs. 62.1+/-3.2 yrs, p=0.74) and the male to female ratio (12:12 vs. 15:7, p=0.25) were not different between the ST and EO groups. The distribution of the postoperative pathologic stages was also not different. All the patients in the ST group underwent only one surgical operation, while 6 patients (27.3%) in the EO group underwent 2 or more surgeries (p<0.01). The mean hospital stay in the ST group was 22.0+/-0.8 days compared to 26.3+/-2.4 days in the EO group (p=0.09). Postoperative care in the intensive care unit was necessary for one patient (4.2%) in the ST group, while 7 patients (31.8%) in EO group needed postoperative care (p=0.02). Postoperative complications developed in one patient in the ST group, while 6 patients in the EO experienced postoperative complications (p=0.04). The mean total cost per patient was 7,974,236 won for the ST group while this was 9,271,630 won for the EO group (p=0.06). CONCLUSIONS: Preopreative stent insertion for treating left-sided malignant colorectal obstruction is more cost-effective than an emergency operation.

Sulfate free polyethylene glycol versus standard polyethylene glycol for colonoscopy preparation: a prospective, randomized, investigator-blinded comparison / 대한내과학회지

BACKGROUND/AIMS: Although polyethylene glycol (PEG) solution is safe and effective for bowel preparation for colonoscopy, its salty taste as well as the required large volume limits its use. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the SF-PEG solution with the standard PEG solution in regard to the quality of bowel preparation, the degree of patients' satisfaction and the side effects in Korean patients. METHODS: From July through September in 2006, 100 patients who underwent colonoscopic polypectomy were prospectively enrolled. They were randomly assigned to receive either PEG or SF-PEG solution. The quality of bowel preparation was assessed by one colonoscopist who was blinded with regard to the type of preparation used. Detailed questionnaires were used to assess the patients' tolerance and satisfaction. The serum biochemical parameters were measured before and after bowel cleansing. RESULTS: The numbers of patients whose quality of bowel preparation was excellent, good, fair and poor were 2, 43, 5 and 0 in PEG group, while this was 0, 41, 9 and 0 in SF-PEG group, respectively (p=0.118). The side effects were not different between the groups. The visual analog scale score of the patients' satisfaction was 6.4+/-2.4 in the PEG group and 5.8+/-2.8 in the SF-PEG group (p=0.237). The changes of serum biochemical parameters were also not different. CONCLUSIONS: The SF-PEG solution shows similar effectiveness and safety for bowel preparation for colonoscopy when compared to the standard PEG solution. The SF-PEG solution is a good solution to use for colonoscopy preparation.