The incidence and prevalence of upper gastrointestinal neuroendocrine tumors (NETs), including gastric NETs (GNETs) and duodenal NETs (DNETs), have been gradually increasing. These trends may be associated with the increased use of health checkups, which includes upper endoscopy, in conjunction with better disease recognition. However, the clinical factors associated with GNETs and DNETs remain unknown; previous studies revealed discrepancies. Recently, metabolic disorders have been indicated as potential factors that are associated with GNETs and DNETs. This review summarizes the results of previous studies and briefly introduces the results of a recent Korean multicenter study on the factors associated with GNETs and DNETs.

Background/Aims: Regular surveillance colonoscopy after colon cancer resection is recommended for detecting metachronous adenoma and cancer. However, risk factors for metachronous neoplasms have not been fully evaluated. We aimed to assess risk factors for advanced metachronous neoplasms during surveillance colonoscopy after colon cancer resection. Methods: Patients who underwent curative colectomy for nonmetastatic colon cancer between January 2002 and December 2012 were evaluated and followed up to December 2017. Results: A total of 293 patients were enrolled in this study. Among these, 179 (61.1%) were male, and the mean age was 63.2 ± 10.4 years. On perioperative clearing colonoscopy, synchronous high-risk adenomas (number ≥ 3, size ≥ 10 mm, high-grade dysplasia, villous histology, and serrated adenoma ≥ 10 mm) were detected in 95 patients (32.4%), and they were significantly associated with male sex, old age (≥ 65 years), current alcohol consumption, and current smoking (p < 0.05). During the follow-up period (mean 74.4 ± 36.4 months), advanced metachronous neoplasms were found in 45 patients (15.4%), including metachronous cancer in four (1.4%). In multivariate analysis, distal colon cancer (distal-to-splenic flexure; odds ratio [OR], 4.402; 95% confidence interval [CI], 1.658 to 11.689; p = 0.003), synchronous highrisk adenomas (OR, 3.225; 95% CI, 1.503 to 6.918; p = 0.003), and hypertension (OR, 2.270; 95% CI, 1.058 to 4.874; p = 0.035) were significant risk factors for advanced metachronous neoplasms. Conclusions During surveillance after curative colon cancer resection, patients with distal colon cancer, synchronous high-risk adenomas, and hypertension may need meticulous follow-up to improve overall outcomes.

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis.

No abstract available.
Humans ; Irritable Bowel Syndrome

Constipation is a common functional problem of the digestive system and may occur secondary to diet, drugs, endocrine diseases, metabolic diseases, neurological diseases, psychiatric disorders, or gastrointestinal obstruction. When there is no secondary cause, constipation is diagnosed as functional constipation. The first steps that should be taken to relieve symptoms are diet and lifestyle modifications, and if unsuccessful, laxative therapy should be initiated. If a patient does not respond to laxative therapy, diagnostic anorectal physiological tests are performed, though they are not routinely recommended. However, these tests may be considered earlier in patients strongly suspected to have a defecatory disorder. The revised guideline on the diagnosis and treatment of chronic constipation will undoubtedly aid the individualized management of chronic constipation in clinical practice.
Biofeedback, Psychology ; Constipation ; Diagnosis ; Diet ; Digestive System ; Digital Rectal Examination ; Endocrine System Diseases ; Humans ; Laxatives ; Life Style ; Metabolic Diseases

No abstract available.
Bulimia* ; Gastric Dilatation* ; Ischemia* ; Portal Vein*

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis.