Gastric polyps and polypoid lesions: Retrospective analysis of 36650 endoscopic procedures in 29940 patients.

BACKGROUND/AIMS: The frequency of gastric polyps increases with the widespread use of endoscopy for diagnosis and treatment. As gastric polyps can be malignant or premalignant, histopathological evaluation is needed. The aim of this study is to determine the prevalence and characteristics of gastric polyps in patients undergoing endoscopy. MATERIALS AND METHODS: This study consisted of a retrospective analysis of 36650 consecutive endoscopy and associated pathology reports of 29940 patients between December 2005 and February 2012 in a tertiary-referral center. RESULTS: Gastric polypoid lesions were detected in 666 (2.22%) patients. Hyperplastic polyps were the most common type of polyps (36.2%), followed by fundic gland polyps (8.3%), inflammatory fibroid polyps (2.4%) and adenomatous polyps (1.9%). Foveolar hyperplasia, neuroendocrine tumor, xanthoma, gastrointestinal stromal tumor, adenocarcinoma and lymphoma were less commonly seen. Malignant transformation was seen in 0.42% of hyperplastic polyps and in 23.1% of adenomatous polyps. CONCLUSION: Endoscopic appearance of gastric polyps can be variable, distinguishing macroscopically can be misleading. Because of their malignant potential histopathological evaluation is mandatory and polypectomy should be performed whenever possible.

A succesfully managed inflammatory pseudotumour of liver without surgery: report of a case.

The inflammatory pseudotumor (IPT) of the liver is an extremely rare focal lesion of the parenchyma with unknown aetiology. It has the appearance of a malignant tumor but has a benign histology and clinical course. Herein, we report a case of IPT in a 55 year-old woman. She had complained of right upper quadrant pain and subfebrile fever. Imaging studies revealed a heterogeneous, solitary mass in right lobe of liver which was 90 x 81 mm in size. Histopathological examination of ultrasonography-guided true-cut biopsy demonstrated IPT. After the initiation of the antibiotic and nonsteroidal anti-inflammatory drugs (NSAID), the size of hepatic pseudotumor decreased (20 x 20 mm) and then completely disappeared. To rule out a malignancy and to reach the diagnosis of IPT, biopsy from the mass is mandatory. After the diagnosis, IPT gave an excellent response to short course of antibiotic and NSAID therapy. To prevent unnecessary resective liver surgery, IPT should be kept in mind in the differential diagnosis of liver mass which can be successfully managed medically.

Colonoscopy without sedation.

BACKGROUND/AIMS: In Turkey, colonoscopy is a procedure generally performed with intravenous sedation and analgesia. Most of the complications of colonoscopy are related to sedation. The aims of this study were to determine the percentage of patients who could successfully undergo nonsedated colonoscopy without sedation and to assess patient tolerance and acceptance. METHODS: The study included 120 consecutive patients undergoing colonoscopy by two endoscopists in our endoscopy unit. The procedure routinely began without sedation, which was later given (midazolam and hyoscine butylbromide) only if significant discomfort occurred. Parameters of blood pressure, oxygen saturation and heart rate were measured before and during colonoscopy. After the procedure patients were asked to rate their pain on a four point scale 1=no pain, 2=slight, 3=moderate, 4=severe and they were also asked if they would be willing to undergo colonoscopy again without sedation. RESULTS: Eighty eight percent of all colonoscopies were completed without sedation. Mean PaO2 was 96.46 in nonsedated patients and 93.90 (significant p<0.05) in sedated patients. No difference was found between blood pressure and pulse rate of nonsedated and sedated patients. The mean pain score was 2.0 for the nonsedated patients and 3.8 (significant p<0.05) for the sedated patients. Eighty eight percent of patients stated that they would be willing to undergo colonoscopy without sedation again. CONCLUSIONS: In experienced hands, colonoscopy without sedation can be completed successfully in most patients, without any complications and use of extra instrumentation.