Gastric Xanthomas and Fundic Gland Polyps as Endoscopic Risk Indicators of Gastric Cancer

BACKGROUND/AIMS: Fundic gland polyps (FGPs), hyperplastic polyps (HPs), and xanthomas (XTs) are common benign gastric lesions that can be diagnosed by endoscopic appearance alone in most cases. The aim of this study was to evaluate associations between gastric cancer and these benign lesions. METHODS: Two expert endoscopists reviewed a series of gastroscopy images. FGPs, HPs, and XTs were diagnosed by endoscopic appearance, whereas all gastric cancers were confirmed pathologically. RESULTS: Of the 1,227 patients reviewed, 114 (9.3%) had a concurrent or past history of gastric cancer. The overall prevalences of FGPs, HPs and XTs were 9.4%, 6.3% and 14.2%, respectively. HPs and XTs coexisted in 1.6% of patients, whereas other combinations were rarer. XTs were observed in 39.3% and 11.5% of patients with and without gastric cancer, respectively (p<0.001). In contrast, no gastric cancer patients had FGPs, whereas 10.4% of patients without cancer had FGPs (p<0.001). The prevalence of HPs was similar between the two groups (8.8% and 6.0% of patients with and without cancer, respectively, p=0.29). Multivariate and Mantel-Haenszel analyses demonstrated that XTs were positively associated and FGPs were negatively associated with gastric cancer. CONCLUSIONS: XTs and FGPs might be useful as endoscopic risk indicators for monitoring gastric cancer.

Successful management of cancer related pruritus by using mirtazapine: a case report

<b>Introduction</b>: It is difficult to manage that pruritus complicated with jaundice, for invalidity of almost all antihistamines. Recently, effects of paroxetine for pruritus are reported, but the report to invalid cases of paroxetine is rare. We report a case treated effectively with mirtazapine for pruritus of the paroxetine invalid. <b>Case report</b>: A 56-years old woman was diagnosed cancer of head of pancreas and peritoneal dissemination.After stenting by a plastic stent for obstructive jaundice in previous hospital, she came to our hospital. But, her total bilirubin (T-bil) were very high (9.9 mg/d<i>l</i>), and she was suffering from systemic pruritus. The NRS (numerical rating scale) score for pruritus was 9-10. Though she was prescribed an antihistamine in previous hospital, it was invalid. We had changed it to paroxetine, but pruritus were protraction two weeks later. After changing it to mirtazapine, the pruritus became NRS 1 on the next day, and recurrence was not seen subsequently. <b>Conclusion</b>: For pruritus of the paroxetine invalid, mirtazapine is important as one of the choices.