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Background/Aims In recent years, the incidence of diabetes mellitus (DM) and colorectal cancer have been increasing in Korea. The aim of this study is to evaluate the factors affecting on the incidence of advanced colorectal adenoma known as precancerous lesion in diabetic patients. Methods We retrospectively analyzed the data of the patients who have type 2 DM and had a colonoscopy from August 2008 to August 2016 in Kangwon National University Hospital. After having a colonoscopy, the patients were divided into two groups with or without advanced colorectal adenoma (size ≥ 1 cm or high grade dysplasia or villous adenoma or cancer) by pathologic findings and then the data from the both groups were analyzed by multivariate logistic regression analysis. Results Four hundred sixty-three patients were excluded in 990 enrolled patents from the study by exclusion criteria and the advanced adenomas were found in 65 patents (12%). Conclusions The incidence of colorectal adenoma was higher in the male diabetic patients. The users of metformin showed lower tendency to have advanced colorectal adenoma but there was not statistical significance in multivariate analysis. Further study with more patients will be needed to know the factors affecting on the characteristics of advanced colorectal adenoma in diabetic mellitus. [ABSTRACT FROM AUTHOR]

Results Seventy-year-old female was referred to our hospital for endoscopic removal of colon polyps found in routine colonoscopy. She had never taken colonoscopy before, and the findings from recent colonoscopy showed 2 cm sized laterally spreading tumor in ascending colon that was biopsy proven to be tubulovillous adenoma with low grade dysplasia, and diffuse irregular nodular mucosa that was encircling the entire rectum with biopsy result of tubular adenoma with low grade dysplasia. Endoscopic submucosal dissection was done for 2 cm sized LST in ascending colon and the histopathology showed well differentiated adenocarcinoma with submucosa invasion up to 1 mm, with clear deep and lateral resection margins, no lymphovascular invasion, and no perineural invasion. Rectum showed diffuse nodular mucosa encircling the entire rectum. Despite its benign appearance, the patient was referred to surgical department and received laparoscopic ultra low anterior resection as the lesion involved entire rectum. Pathology of resected rectum revealed well differentiated intramucosal adenocarcinoma (Tis) confined to mucosa without lymphovascular invasion. However, histopathology of regional lymph node showed that one perirectal lymph node had definite metastatic focus of adenocarcinoma. PET-CT was done to determine other metastasis, but no abnormal hypermetabolic lesions suggesting metastasis were found. After discussing the case with oncologist, the patient received concurrent chemotherapy and RT for stage IIIa rectal cancer. Conclusions This case is of interest because Tis carcinoma had involvement of lymph node metastasis. It is well understood that carcinoma confined to mucosa in colon is unlikely to metastasize as lymphatic channels are not present in mucosa. Current TNM staging limits Tis tumors to stage 0 with no involvement of lymph node or distant metastasis (N0M0). However, findings from our study suggest that further classification of Tis tumors may be needed and clinicians must consider possibility of metastasis even in Tis tumors. Although some studies have reported cases of local recurrence or distant metastasis during follow up, to our knowledge this is the first case that reported identification of lymph node metastasis of Tis tumor at the same time as surgical resection. [ABSTRACT FROM AUTHOR]

Background/Aims International guidelines for the management of acute pancreatitis (AP) are against the routine use of antibiotics. However, it is not clear whether antibiotics is helpful for the management of febrile AP. We performed this study to evaluate the effect of antibiotics administration for mild to moderately severe non-biliary AP with fever. Methods From July 2018 to August 2019, patients admitted with non-biliary AP were reviewed retrospectively, and those with fever within 1 week of hospitalization were included. Severe AP was excluded. Duration of hospitalization and mortality rate were compared according to antibiotics use. Results A total of 41 patients were included. Alcoholic pancreatitis was most common (56.1%), and hypertriglyceridemia was the second common cause (26.8%). Moderately severe AP accounted for half of the patients. Antibiotics were used for 20 patients (48.8%). Duration of hospitalization was 8 days for antibiotics group, and it was comparable to non-antibiotics group (6 days, p=0.36). Mortality case was not present in both groups. Conclusions In mild to moderately severe AP with non-biliary etiology and fever, routine use of antibiotics did not reduce the duration of hospitalization and mortality. [ABSTRACT FROM AUTHOR]