ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

A case of an inflammatory pseudotumor of the spleen is presented. A 43-year-old woman was hospitalized for a detailed examination due to pancytopenia, which was diagnosed during an examination related to left upper quadrant abdominal pain. Physical examination revealed a 2 to 3 cm splenomegaly. Reticulocyte count was 4% and erythrocyte sedimentation rate was 55 mm/h. No other important findings were noted, except for an evident increase in myeloid series and megakaryocytes (more evident in erythroid series) on bone marrow aspiration and biopsy. Computed tomography (CT) scan revealed splenomegaly and a centrally located hypodense lesion with a 92 X 86 mm axial diameter in the spleen. With a hematologic malignancy prediagnosis, a splenectomy was performed on the patient because of pancytopenia and splenomegaly. An intrasplenic, centrally located, well-limited, capsulated lesion (9.5 x 11 x 10 cm in diameter) was discovered on macroscopic examination of the material. A cellular infiltration area was seen on microscopic examination. The spleen capsule was mildly fibrotically thickened. The lesion that separated from the spleen tissue consisted of diffusely proliferated fusiform fibroblasts, heterogenous inflammatory cells consisting mainly of plasma cells, lymphocytes, sparse neutrophils and vascular elements. No granuloma or multinuclear giant cells were detected. Pancytopenia improved on follow-up. The patient followed up for two years, is now healthy and has no complaints.

Aim: To evaluate patient characteristics by reviewing colonoscopy procedures performed within an 8-year period in the endoscopy centre of a training and research hospital. Methods:Colonoscopy procedures that were performed for various indications between 2002 and 2009 in the endoscopy unit of our hospital were retrospectively evaluated. Of 3035 colonoscopy procedures, 2831 were included in the analysis. In addition to demographic characteristics of the patients, presence and localization of colorectal masses, presence of inflammatory bowel disease, frequency of presence of hemorrhoids, diverticula, polyps, and other diseases, as well as complications were recorded. Results:The mean age of the patients (male, 50.5%) was 54.36 ± 15.05 years (range, 16-93 years). While a pathological finding was determined in 1512 (53.4%) colonoscopy procedures, 1319 (46.6%) colonoscopy procedures were reported as normal. Concerning complications during examinations, perforation was encountered in two patients and major bleeding was not determined in any of the patients. The most common diagnoses were polyps (15.9%) and hemorrhoids (15.9%), followed by colorectal mass (12.9%), diverticula (6.8%), and inflammatory bowel disease (5.6%). Conclusion:The fact that colorectal masses ranked third among the colonoscopic diagnoses suggested that cancer screening programs should be handled nationally.

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BackgroundWe assessed the validity of using serum pepsinogen tests (sPGTs) to differentiate autoimmune atrophic gastritis (AAG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM), and sPGT results in patients with gastric atrophy.MethodsWe enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGIM staging systems.ResultsThe median (IQR) age of the patients (83 females (56.5%)) was 58 (46–67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) I and II levels, as well as a lower PGI/PGII ratio, compared with the EAG group (p<0.01, p<0.05 and p<0.01, respectively). The optimal PGI/PGII ratio for predicting AAG was ≤1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was ≤9.2 (47.5% sensitivity and 90.6% specificity). The OLGA/OLGIM stage was negatively correlated with the PGI level and PGI/PGII ratio. In the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGIM stage III–IV disease.ConclusionssPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.