Clinical characteristics and endoscopic diagnosis and treatment for colorectal mucosa associated lymphoid tissue lymphoma / 中华消化内镜杂志

Clinical and endoscopic data of 6 patients with colorectal mucosa associated lymphoid tissue (MALT) lymphoma who were diagnosed by endoscopy in the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2015 to June 2021 were retrospectively analyzed. There were 2 males and 4 females with aged from 62 to 87 years. The lesions were located in rectum in 3 cases, transverse colon in 1 case, sigmoid colon in 1 case, and sigmoid colon and rectum in 1 case. There were 1 case of polyposis type, 2 cases of inflammation type, and 3 cases of submucosal tumor type. The "tree-like appearance (TLA)" found in 5 cases. Endoscopic resection, surgery combined with chemotherapy, Helicobacter pylori eradication and follow-up were performed on 2, 1, 1 and 2 cases, respectively. Five cases had a good prognosis after 21-73 months follow-up, and 1 case had lost to follow-up. No recurrence was found in endoscopic and imaging review. Colorectal MALT lymphoma should be considered when colonoscopy detects a submucosal lesion with TLA sign on the left colon. Endoscopic resection has the potential to be a first-line treatment in the context of early diagnosis.

Clinical value and significance of the Kyoto classification score of gastritis for the endoscopic prediction of Helicobacter pylori infection / 中华消化杂志

Objective:To verify the accuracy of the Kyoto classification score of gastritis for the endoscopic prediction of the Helicobacter pylori( H. pylori)infection in Chinese population. Methods:From June 2020 to January 2021, at the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University, the clinical data of 489 patients who underwent gastroscopy examination were collected and the gastric mucosal manifestations under white light endoscopy (including atrophy, intestinal metaplasia, widening of gastric fold, nodularity, diffuse redness, white sticky mucus, etc.) were recorded according to the Kyoto classification of gastritis. H. pylori infection of the patients was determined according to 13C-urea breath test, histopathological examination and anti- H. pylori antibody test. The Kyoto classification score of gastritis of each patient was calculated. The sensitivity, specificity and odds ratio( OR)(95% confidence interval(95% CI)) of various endoscopic appearances in prediction of H. pylori infection were analyzed. Chi-square test was used for statistical analysis. Results:Among the 489 patients, 246 patients had H. pylori infection and 243 patients did not have H. pylori infection. There were 242 patients with Kyoto gastritis score ≥ 2, among them 215 cases had H. pylori infection and 27 cases did not have H. pylori infection. The accuracy of Kyoto classification score of gastritis in predition of H. pylori infection was 88.14% (431/489). Among the five indexes of the Kyoto classification score of gastritis, there was no significant difference in the incidence of intestinal metaplasia between patients with H. pylori infection and patients without H. pylori infection ( P>0.05). The incidence rates of atrophy, widening of gastric fold, nodularity and diffuse redness were higher in patients with H. pylori infection than those in patients without H. pylori infection (68.3%, 140/205 vs. 31.7%, 65/205; 95.2%, 99/104 vs.4.8%, 5/104; 89.7%, 35/39, vs.10.3%, 4/39; 85.0%, 227/267 vs.15.0%, 40/267), and the differences were statistically significant ( χ2=45.68, 106.46, 26.37 and 283.48, all P<0.01). The sensitivity, specificity and OR (95% CI) of atrophy, widening of gastric fold, nodularity and diffuse redness in prediction of H. pylori infection were 56.91%, 73.25%, and 3.62 (2.47 to 5.29); 40.24%, 97.94% and 32.06 (12.76 to 80.57); 14.23%, 98.35%, 9.91 (3.47 to 28.35); and 92.28%, 83.54% and 60.63 (34.02 to 108.08), respectively. The sensitivity and specificity of atrophy in prediction of H. pylori infection were low, and the diagnostic efficacy was general. The incidence rates of white sticky mucus and spotty redness of the gastric fundus and body were higher in patients with H. pylori infection than those in patients without H. pylori infection (86.5%, 32/37 vs. 13.5%, 5/37; 86.9%, 146/168, vs. 13.1%, 22/168), and the differences were statistically significant ( χ2=20.96 and 137.12, both P<0.01). The sensitivity, specificity, and OR (95% CI) of the two indicators in prediction of H. pylori infection were 13.01%, 97.94% and 7.12 (2.72 to 18.60), and 59.35%, 90.95%and 14.67(8.84 to 24.34), respectively, and the diagnostic efficacy was ideal. Conclusions:The Kyoto classification score of gastritis used for the endoscopic prediction of H. pylori infection is suitable for Chinese population. However, from the perspective of individual indicator, the diagnostic efficiency of atrophy and intestinal metaplasia is unsatisfactory. At the same time, attention should be paid to whether there is sticky mucus or spotty redness of the gastric fundus and body.

Colonoscopic findings in patients younger than 40 years

ABSTRACT Objective: To analyze the main endoscopic findings in patients under 40 years of age and the main indications for colonoscopy in these patients. Methods: A retrospective study with 362 reports of patients under 40 years of age who underwent colonoscopy from January 2014 to June 2017 at the colonoscopy service of the General Hospital Roberto Santos. Colon preparation was performed with mannitol and the patients underwent sedation as the anesthetist criteria. Results: Of the 362 patients analyzed, 192 (53%) were female. The mean age was 25 years (25.58 ± 11.95). The most frequent indications were inflammatory bowel disease in 24.3% (88) of the patients, bleeding in the lower digestive tract in 24% (87), and chronic diarrhea in 20.2% (73). The main colonoscopic findings were polyposis in 21.3% (77) of the patients and inflammatory alterations in 20.7% (75). Conclusion: With the analysis of the data provided by the colonoscopies, it was possible to conclude that, when the investigation is adequate and the examination is well indicated, even under the age of 40, colonoscopy can help in the diagnostic and treatment of several pathologies, including those that may increase the risk of colorectal cancer.

RESUMO Objetivo: Analisar os principais achados endoscópicos nos pacientes com idade inferior a 40 anos e as principais indicações para realização das colonoscopias. Métodos: Estudo retrospectivo, com análise de 362 laudos de pacientes com idade inferior a 40 anos submetidos à colonoscopia, no período de Janeiro de 2014 até Junho de 2017 no serviço de coloproctologia do Hospital Geral Roberto Santos. Foi realizado preparo de cólon com manitol e os pacientes foram submetidos à sedação á critério do anestesista. Resultados: Dos 362 pacientes analisados, 192 (53%) eram do sexo feminino. Em relação à idade: média de 25 anos (25,58 ± 11,95). As indicações mais frequentes foram doença inflamatória intestinal em 24,3% (88) dos pacientes, sangramento digestivo baixo em 24% (87); e diarreia crônica 20,2% (73). Os principais achados colonoscópios foram polipose em 21,3 (77) dos pacientes e alterações inflamatórias em 20,7% (75). Conclusão: Com análise dos dados fornecidos pelos exames colonoscópios e suas indicações foi possível concluir que quando a investigação é adequada e o exame é bem indicado, mesmo abaixo dos 40 anos, a colonoscopia pode auxiliar no diagnóstico e tratamento de diversas patologias, inclusive as que podem aumentar o risco de câncer colorretal.

Accuracy of Endoscopic Diagnosis for Mild Atrophic Gastritis Infected with Helicobacter pylori

BACKGROUND/AIMS: This study examined the accuracy of endoscopic evaluation for determining the Helicobacter pylori infection status in patients with mild atrophy who might not exhibit characteristic endoscopic findings. METHODS: Forty endoscopists determined the H. pylori infection status of 50 randomly presented H. pylori-positive and H. pylori-negative cases on the basis of a list of established findings. RESULTS: The median clinical endoscopy experience was 7 years (range, 1–35 years), including 22 board-certified endoscopists (55%) of the Japan Gastroenterological Endoscopy Society. The mean accuracy rate of endoscopic diagnosis was 67% and was unrelated to experience status (experienced vs. trainee: 69% vs. 65%, p=0.089) and total years of experience (R 2 =0.022). The most frequently selected endoscopic findings were regular arrangement of collecting venules (59%), atrophy (45%), and red streak (22%), which had fair accuracy rates of 67%, 65%, and 73%, respectively. By contrast, the accuracy rates of nodularity (89%) and mucosal swelling (77%) were highest. The 20 endoscopists who more frequently identified these findings diagnosed H. pylori infection significantly more accurately than did the other endoscopists (71% vs. 64%, p=0.008). CONCLUSIONS: Careful attention to nodularity and mucosal swelling in patients with mild atrophy may enhance diagnosis, enable prompt treatment, and avoid possible long-term carcinogenesis.

Training Effect on the Inter-observer Agreement in Endoscopic Diagnosis and Grading of Atrophic Gastritis according to Level of Endoscopic Experience

BACKGROUND: Endoscopic diagnosis of atrophic gastritis can contribute to risk stratification and thereby tailored screening for gastric cancer. We aimed to evaluate the effect of training on inter-observer agreement in diagnosis and grading of endoscopic atrophic gastritis (EAG) according to the level of endoscopists' experience. METHODS: Twelve endoscopists (six less-experienced and six experienced) participated in this prospective study. The training session consisted of 1) four interventions with two-week intervals, and 2) a follow-up period (two follow-up assessments without feedback). EAG was categorized as C1 to O3 according to the Kimura-Takemoto classification. Kappa statistics were used to calculate inter-observer agreement. RESULTS: At baseline, kappa indexes were 0.18 in the less-experienced group and 0.32 in the experienced group, respectively. After four interventions with feedback, the kappa index improved in both groups and was sustained during the follow-up period. Overall diagnostic yields of EAG were 43.1% ± 10.7% in pre-intervention and 46.8% ± 5.9% in post-intervention. Variability in the rate of diagnosis of EAG significantly decreased in the less-experienced group (r = 0.04, P = 0.003). CONCLUSION: Irrespective of experience level, inter-observer agreement for diagnosis and grading of EAG improved after training and remained stable after intervention.

Clinical application of ultra-fine nasal endoscopy in digestive tract stenosis / 实用肿瘤学杂志

Objective The aim of this study was to investigate the application and clinical value of ultra-fine nasal endos-copy in the diagnosis and treatment of digestive tract stenosis. Methods A retrospectively investigation of 160 cases of nasogastricos-copy in esophageal,gastroduodenal and colorectal stenosis lesions,the detection rate of lesions under the stenosis and endoscopic treat-ment were analyzed from January 1,2016 to December 31,2017. Results In 102 cases of diagnostic examination,the passing rates of nasogastricoscopy in esophageal,gastroduodenum and colorectal stenosis were 76. 92% ,50. 00% and 88. 00% ,respectively. In the ca-ses which the endoscope could successfully pass the stenotic lesions, the detection rates of new lesions below the stenosis were 8. 89% ,0 and 27. 78% ,respectively,in esophageal,gastroduodenum and colorectal stenosis. A total of 58 cases of digestive tract ste-nosis were treated with endoscopic gastroscopy. Among them,46 cases had stenosis and the pass rate was 79. 31% . Conclusion Ultra-fine nasal endoscopy can significantly improve the completeness and accuracy of endoscopic diagnosis in patients with digestive tract stenosis that cannot be passed by standard gastrointestinal endoscopy. It can also be used for endoscopic treatment of digestive tract stenosis.

Current Status of Endoscopic Screening and Diagnosis of Early Gastric Cancer in Japan / 胃肠病学

Gastric cancer is a leading cause of cancer death worldwide. It is well known that Japan is the world leader in endoscopic diagnosis and treatment of early gastric cancer (EGC),thus the current status and executive standard in this area in Japan is worthy of studying. This paper reviewed numerous researches,reviews and epidemiological data, summarized the basic principles,standardized protocols,and the diagnostic algorithm and criteria and progress on endoscopic screening and diagnosis of EGC in Japan. Finally,the differences in endoscopic strategies for EGC existed between Japan and China were compared.

Infección por Helicobacter pylori en el municipio de Palma Soriano durante el período 2008-2014 / Helicobacter pylori infection in Palma Soriano during 2008-2014

Se realizó un estudio descriptivo y retrospectivo de 989 pacientes con diagnóstico endoscópico de gastritis crónica, cuyas biopsias habían sido procesadas en el Departamento de Anatomía Patológica del municipio de Palma Soriano, en Santiago de Cuba, durante el período 2008-2014, con el objetivo de determinar la incidencia de la infección por Helicobacter pylori, para lo cual además se consideraron las variables: edad, sexo, tipos de gastritis, presencia del microorganismo y su asociación con neoplasias malignas. En la serie predominaron el grupo etario de 40-49 años (26,7 %) y el sexo femenino (69,0 %); asimismo, resultó más frecuente la gastritis superficial (57,8 %) y se halló la bacteria en 70,5 % de la muestra, donde solo 0,5 se asoció a neoplasias malignas

A descriptive and retrospective study of 989 patients with endoscopic diagnosis of chronic gastritis whose biopsies had been processed in the Pathology Department of Palma Soriano in Santiago de Cuba, was carried out during 2008-2014, aimed at determining the incidence of the infection due to Helicobacter pylori, for which the variables: age, sex, gastritis types, presence of the organism and its association with malignancies were also considered. In the series the 40-49 years age group (26,7 %) and female sex (69,0 %) prevailed; also, the superficial gastritis was more frequent (57,8 %) and the bacteria was found in 70,5 % of the sample, where only 0,5 was associated to malignancies

Mucosa gástrica heterotópica en esófago cervical: presentación de un caso de compromiso circunferencial con estenosis franqueable / A Case Report of Circumferential Presentation with Stricture of Heterotopic Gastric Mucosa in the Cervical Esophagus

La mucosa gástrica heterotópica en esófago cervical (MGHEC) es una condición probablemente subdiagnosticada. La gran mayoría de los pacientes son asintomáticos y su detección es un hallazgo incidental. En los pacientes sintomáticos, las manifestaciones se asocian con cambios no neoplásicos o neoplásicos, que permiten categorizarlos en cinco tipos. A la categoría tipo III corresponde el caso presentado del paciente, con disfagia y globus faríngeo por MGHEC de compromiso circunferencial con estenosis franqueable. Al momento de esta publicación, solo se encontraron siete casos similares en la literatura mundial. La detección de MGHEC (apoyada en nuevas tecnologías de imagen como la cromoendoscopia) puede ser un indicador de calidad en el desempeño endoscópico, similar a la detección de adenomas en colonoscopia.

Heterotopic gastric mucosa in the cervical esophagus is a condition that is probably underdiagnosed. The vast majority of patients are asymptomatic, and detection is an incidental finding. In symptomatic patients, manifestations are associated with non-neoplastic or neoplastic changes that allow categorization into five types. The case presented here is a patient who had Type III with dysphagia and pharyngeal globus due to heterotopic gastric mucosa in the cervical esophagus with circumferential presentation with stenosis. At the time of publication, only seven similar cases could be found in the literature. Detection, supported by new imaging technologies such as chromoendoscopy, may be an indicator of the quality of endoscopic performance in a manner that is similar to detection of adenomas in colonoscopy.

Recent advances in endoscopic diagnosis and treatment of gastric cancer

Recently, several new endoscopic imaging techniques have been developed, including endoscopic ultrasonography, narrow band imaging, autofluorescence imaging, and confocal laser endomicroscopy. Preliminary studies have reported promising results in diagnosing gastric cancer with these new endoscopic imaging techniques. For wider clinical application, however, more evidence is required to show the clinical efficacy of these advanced endoscopic techniques in the diagnosis of gastric cancer. For the treatment of early gastric cancer, endoscopic submucosal dissection methods have recently been developed. Endoscopic submucosal dissection enables en bloc resection of large lesions and lesions with accompanying ulcerations, as the lesion is directly dissected along the submucosal layer using a high-frequency electrosurgical knife. With the development of the endoscopic submucosal dissection technique and the accumulation of long-term outcome data, the applications for endoscopic resection for early gastric cancer are expanding.

Recent advances in endoscopic diagnosis and treatment of gastric cancer

Recently, several new endoscopic imaging techniques have been developed, including endoscopic ultrasonography, narrow band imaging, autofluorescence imaging, and confocal laser endomicroscopy. Preliminary studies have reported promising results in diagnosing gastric cancer with these new endoscopic imaging techniques. For wider clinical application, however, more evidence is required to show the clinical efficacy of these advanced endoscopic techniques in the diagnosis of gastric cancer. For the treatment of early gastric cancer, endoscopic submucosal dissection methods have recently been developed. Endoscopic submucosal dissection enables en bloc resection of large lesions and lesions with accompanying ulcerations, as the lesion is directly dissected along the submucosal layer using a high-frequency electrosurgical knife. With the development of the endoscopic submucosal dissection technique and the accumulation of long-term outcome data, the applications for endoscopic resection for early gastric cancer are expanding.

cagE as a biomarker of the pathogenicity of Helicobacter pylori

Introduction Helicobacter pylori infection is associated with gastro-duodenal diseases. Genes related to pathogenicity have been described for H. pylori and some of them appear to be associated with more severe clinical outcomes of the infection. The present study investigates the role of cagE as a pathogenicity biomarker of H. pylori compare it to cagA, vacA, iceA and babA2 genes and correlate with endoscopic diagnoses. Methods Were collected biopsy samples of 144 dyspeptic patients at the Hospital of the Federal University of Rio Grande, Rio Grande do Sul, Brazil. After collection, the samples were sent for histological examination, DNA extraction and detection of all putative pathogenicity genes by PCR. Results Of the 144 patients undergoing endoscopy, 57 (39.6%) presented H. pylori by histological examination and PCR by detection of the ureA gene. Based on the endoscopic diagnoses, 45.6% (26/57) of the patients had erosive gastritis, while 54.4% (31/57) had enanthematous gastritis. The genes cagA, cagE, vacAs1/m1, vacAs1/m2 and iceA1 were related to erosive gastritis, while the genes vacAs2/m2, iceA2 and babA2 were associated to enanthematous gastritis. We found a statistically significant association between the presence of cagE and the endoscopic diagnosis. However, we detect no statistically significant association between the endoscopic diagnosis and the presence of cagA, vacA, iceA and babA2, although a biological association has been suggested. Conclusions Thus, cagE could be a risk biomarker for gastric lesions and may contribute to a better evaluation of the H. pylori pathogenic potential and to the prognosis of infection evolution in the gastric mucosa. .

Endoscopic diagnosis and treatment of primary gastrointestinal malignant lymphoma / 中国综合临床

Objective To summarize the endoscopic characteristics of Primary Gastrointestinal Malignant Lymphoma (PGIML) and increase the diagnostic accuracy of this method to aid the clinical treatment.Methods The clinical data of 67cases with PGIML from 2004 to 2009 were studied retrospectively.ResultsPGIML lacked specific clinical symptoms.The main clinical symptoms were abdominal pain, melena and abdominal mass.In our study, most PGIML(37/67,55.8％)were detected in stomach.Nodular appearance of mucosal surface was the most common endoscopic finding.The positive rate of endoscopic biopsy for the diagnosis of PGIML was 68.7 ％ (46/67 biopsy cases).All cases had Non-Hogkin Lymphoma (NHL).The most common immunophenotype was B-cell majority (50/67).Thirty cases had MALT.ConclusionIt is hard to diagnose PGIML at early stage,combination of various diagnosis tests should be considered to solve this problem.The effectiveness of surgery on PGIML should be further confirmed by prospective randomized clinical trials.

Recent update of endoscopic diagnosis of hilar cholangiocarcinoma / 대한내과학회지

The diagnosis of hilar cholangiocarcinoma (CCA) is usually accomplished through a combination of imaging modalities and endoscopic examination including tissue sampling. Although high quality cross-sectional imagings provide evidences for hilar obstruction and a malignancy arising from the bile duct, a definitive diagnosis and staging often obtained through the use of endoscopic procedures. It can provide complementary information for accurate tumor extension and tissue acquisition for histologic confirmation. These informations are important in determining therapeutic options. However, despite the various available techniques, the diagnosis and accurate staging of hilar CCA is often still challenging. Newly developed adjunctive diagnostic endoscopic techniques including intraductal ultrasound and cholangioscopy improve the accuracy of endoscopic diagnosis of this lesion. Multiple endoscopic modalities can be tried to obtain accurate assessment of the tumor. Therefore, endoscopy will continue to occupy an important position in assessment of the hilar CCA.

Barrett's Esophagus-With Emphasis on Endoscopic Disgnosis / 대한소화기내시경학회지

Barrett's esophagus is a metaplastic change of the esophageal mucosa, such that the normal squamous epithelium is replaced by specialized columnar epithelium. During the last decades, there has been a significant change in the definition, endoscopic diagnosis, pathologic diagnosis, surveillance and management of Barrett's esophagus. Because of the rising prevalence of gastroesophgeal reflux disease in Korea, problems related to Barrett's esophagus are expected to be much more common in the near future. In this review, methods of endoscopic diagnosis of Barrett's esophagus are discussed in detail. Management strategies in the context of Korean epidemiology are also suggested.

Diagnosis and Therapy of Primary Gastrointrestinal Lymphoma / 医学研究杂志

Objective To study the clinical and pathologic features,and endoscopic diagnosis as well as therapy and prognosis of the primary gastrointrestinal lymphoma(PGIL), and to improve its diagnosis and therapy efficiency. Methods The clinical data in 29 cases of PGIL were retrospectively reviewed. Results In these cases, the tumor was mainly located at stomach (n=21), colon(n=6) and small intestine(n=2). The type of pathology was mucosa associated lymphoid tissue lymphoma(n=8), diffuse large B-cell lymphoma(n=18), T-cell lymphoma(n=3). The commom manifestation include abdominal pain, anaemia, abdominal distention, melena or hemafecia, loss of weigh etc. The tumor appeared infilitrative in 11 cases, ulcerative in 10 cases, protruding in 6 cases, 9 cases were diagnosed by firstly routine biopsy endoscopiccally. 10 cases were treated by operation and chemotherapy, 19 cases were treated by chemotherapy. Up to now, 6 cases survival in operation group, 13 cases survival in chemotherapy group, the difference was not statistically significant . Conclusions PGIL was mainly located at stomach, which was not specific clinical manifestation; The type of pathology was mainly diffuse large B-cell lymphoma; the diagnositic rate of routine endoscopic biopsy was low. chemotherapy was the first treatment of PGIL.

Acute Phlegmonous Gastritis Diagnosed Early Endoscopically and Treated Successfully with Antibiotics / 대한소화기내시경학회지

Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone.

468 cases esophagogastroduodenoscopy performed by family physicians

BACKGROUND: Although family physicians are performing an increasing number of esophagogastroduodenoscopie(EGDs), there is little research conducted in Korea. Thus, the purpose of this research is to assess the ability of family physicians in performing EGD. METHODS: All EGDs performed by family physicians in the department of family medicine of one general hospital from January 1995 to December 1996 were reviewed retrospectively through medical records. Ten including physicians a family physician and nine family residents, performed EGDs five tirnes per week. RESULTS: 4,468 EGDs were performed on 4,313 persons during the two years. No major complications were noted and all of the procedures were completely investigated to the second portion of the duodenum Normal findings were 1,268 cases(28.4%) and abnormal findings were 3,200 cases(71.6%). Among the abnormal findings, gastritis was the most common finding(73.7%). The most common pathologic diagnosis was peptic ulcer 37.7%(177/470cases). Positive rate of CLO test was 89.4%. Family physicians, endoscopic diagnosis agreed with pathologic reports in 86.6%. The number of EGDs performed by each family physicians ranged from 2 to 1,503 cases. Data of six physicians who performed more than 200 EGDs for their diagnostic were comparatively analyzed ability. Diagnosis of normal, gastritis or gastric ulcer was significantly different(p0.05). There was little difference among physicians in the biopsy rate. The agreement ratio between endoscopic diagnoses and pathologic reports among those physicians who performed more than 200 procedures were 79.7- 93.3% and were not statistically different(p>0.05). CONCLUSIONS: This study is the first report of EGDs performed by family physician in Korea. Some family physicians performed more than 4,000 EGDs without major cornplications in primary care. These data confirm the ability of some family physicians to perform EGD. Biopsy analysis indicates the diagnostic accuracy is high. Further study on performance of EGD by family physicians and its standardization concerning description of endoscopic findings are needed.

Rectal Endometriosis: A Case Report of with a Clinical Analysis of Other Cases Reported in Related Korean Literature / 대한소화기내시경학회지

Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Involvement of the gastrointestinal tract is seen in 3~34% of patients affected by this condition. Although the commonest sites involved are the sigmoid colon and rectum, only 4 cases have been reported in Korea. The most frequent symptoms are lower abdominal and pelvic pain typically worsening at the time of menstruation. Bleeding per rectum is uncommon since the mucosa is rarely involved. Endoscopy has not been thought to be helpful in the evaluation of patients with suspected colonic endometriosis. However, endoscopy is often used as the first test in patients with rectal bleeding, excluding malignancy or other sources of bleeding. There are few reports of endoscopic documentation of colorectal endometriosis. A 26 year-old woman having a history of endometriosis with cyclic hematochezia and lower abdominal pain is herein reported. A flexible sigmoidoscopy revealed a protrusion of hyperemic mucosa with a surrounding fold formation on the rectum 8 cm above the anal verge. The subsequent biopsy of the lesion gave rise to a diagnosis of endometriosis.

A Study for The Changing Subsite Distribution of Colorectal Cancer with Age and Sex / 대한소화기내시경학회지

BACKGROUND/AIMS: Changes in subsite distribution of colorectal cancer have been shown in recent years. The carcinoma tend to shift to more proximal colon and this proximal shift is influenced by age and sex. This study was designed to delineate the relationship of age to subsite incidence of colorectal cancer and to define the role of gender in this difference. METHOD: We have analyzed the data by patients with colorectal cancer from 1985 to 1995 for elucidate the relationships between age, sex and prinmry location of colorectal cancer. 749 patients(male 454, female 295) were diagnosed of colorectal cancer performed by colonoscopy and/or sigmoidoeopy were divided into three groups by their location of cancer (Right colon: appendix, ascending colon, hepatic flexure, T-colon proximal 2/3 Left colon: T-colon distal 1/3, splenic flexure, descending colon, sigmoid colon Rectum: rectum). RESULTS: 1) The mean age of all patients was 53.84 +/- 13.11(yr). Mean ages of Right colon, Left colon, and Rectal cancer group were 55.54 +/- 14.12, 55.32 +/- 12.51, 52.22 +/- 13.09(yr), respectively. The mean age of Right colon and Left colon cancer group is significantly older than that of Rectal cancer group (p=0.0040, p=0.0042). 2) Infemale age group over 56, mean age of Right colon cancer group is shown to be 3.35 and 4.82 years older than Left colon cancer group and Rectal cancer group, respectively (p=0.0062, p=0.0053) and Colon cancer tend to develop on more right side according to increase in age. 3) Above correlation was not observed below 55 of both sexes and male age group over 56. 4) No significant differences in histological differentiation and tumor stage were observed among the three groups. 5) The study was conducted to evaluate the difference in the location of colorectal cancer between two following groups; The first group diagnosed from 1985 to 1990 and the second group from 1991 to 1995, yet significant statistical difference was not observed. CONCLUSION: Age increase seems to show correlation with right shifting of colon cancer, and this correlation was most significant in old women age group. This finding suggests unknown factor strongly linked to age and sex might play important role in carcinogenesis of colorectal cancer.