Gastric adenocarcinoma presenting as a submucosal tumor (SMT) accounts to only 0.1% to 0.63%. A 56-year-old Filipino male presenting with new onset melena underwent magnifying endoscopy, narrow-band imaging, endoscopic ultrasound, and computed tomography revealing a 2.5 cm x 2.0 cm polypoid SMT-like lesion at the fundus. Total gastrectomy with lymph node dissection and esophagojejunostomy was performed with histopathology showing adenocarcinoma. This suggests the need for different modalities to ensure the accuracy of diagnosis and the need for subsequent invasive treatments.

OBJECTIVE: To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) in improving minimal hepatic encephalopathy in adult patients with liver cirrhosis.

METHODS: A search in PubMed, Cochrane Library, Google Scholar, and Medline was made obtaining four qualified randomized controlled trials. Studies included adult cirrhotic patients with minimal hepatic encephalopathy measured by the number connection test (NCT-A, B), figure connection test (FCT-A, B), picture completion, block design test, and critical flicker frequency (CFF) testing with a cut-off score of

RESULTS: Of the 29 studies identified, 4 fulfilled the inclusion criteria, which entailed analysis of 238 participants (LOLA: 116, Control: 122). Three out of the four studies were used in meta-analysis and one study was analyzed separately due to a difference in the neuropsychometric measure. The meta-analysis favored the experimental group (LOLA), with a mean difference of 2.29 (95% CI 0.72 - 3.86), p-value = 0.004, and an I2 of 18%.

CONCLUSION: LOLA provided great potential in managing encephalopathy since treating earlier related to better survival and prevention of disease progression. The results of our study supported such evidence and its use may be encouraged.

Human ; Fibrosis ; Hepatic Encephalopathy