OBJECTIVE: Because of the high incidence of recurrent colorectal adenomas, regular surveillance by colonoscopy is recommended. However, there is still a shortage of information on the factors that influence the incidence of recurrent colorectal adenomas in patients with a history of these lesions. The aim of this study was to determine the association between the development of recurrent colorectal adenomas, metabolic syndrome and obesity. SUBJECTS AND METHODS: The hospital-based cohort was composed of 193 patients who had recurrent colorectal adenomas removed between January 2002 and December 2003. The Cox proportional hazard model was used to determine hazard ratio (HR) and 95% confidence interval (CI) between obesity, metabolic syndrome and other factors, and the incidence of recurrent adenomatous polyps. RESULTS: The mean follow-up period was 4.8 person-years. In all, 78 of the patients (40.4%) had recurrent colorectal adenomas. In the overall recurrent adenoma group, significant associations between metabolic syndrome (HR, 1.33; 95% CI, 1.02--1.73), waist circumference (WC) X90 cm (HR, 1.42; 95% CI, 1.06--1.90) and waist--hip ratio (WHR) X0.9 (HR, 2.03; 95% CI, 1.55--2.68) were found. Moreover, advanced adenomas were significantly associated with metabolic syndrome (HR, 2.81; 95% CI, 1.86--4.25), body mass index X25 kg m À2 (HR, 2.69; 95% CI, 1.64--4.42), WC (HR, 2.16; 95% CI, 1.31--3.54) and WHR (HR, 1.99; 95% CI, 1.28--3.11). In addition, current smoking (HR, 2.60; 95% CI, 1.09--6.25) and alcohol consumption (HR, 2.20; 95% CI, 1.10--4.39) were also significantly associated with recurrent advanced adenoma. CONCLUSION: Metabolic syndrome and obesity were significantly associated with the development of recurrent colorectal adenomas in Korean adult males. Furthermore, these associations were more strongly associated with advanced adenomas.

What abnormalities are shown on the computed tomography (CT) scan in Figure 1? The major abnormality is calcification in the lumen of the gallbladder. Dense calcification in the fundus probably reflects the presence of a calcified gallstone but calcification has also been shown in gallbladder 'sludge'. Other CT images showed calcified 'sludge' in a mildly dilated bile duct. The patient was an 86-year-old man who was admitted to hospital with abdominal pain, fever and jaundice. Endoscopic retrograde cholangiography confirmed mild dilatation of the bile duct and there was a vague filling-defect in the left hepatic duct. Endoscopic sphincterotomy was performed and a milky amorphous material was extracted from the bile duct using a balloon catheter (Fig. 2). Thereafter, his symptoms resolved and he was referred for laparoscopic cholecystectomy.Limy bile is a term that is used to describe calcified biliary sludge. The original reports were based on plain abdominal radiographs but similar changes can be found on ultrasound studies and CT scans. Reasons for the presence of high concentrations of precipitated calcium salts remain unclear but predisposing factors may include prolonged fasting and narrowing or obstruction of the cystic duct. However, in relation to cystic duct obstruction, case reports have described the presence of limy bile in the bile duct and the spontaneous clearance of limy bile from the gallbladder. Almost all patients with limy bile have coexisting gallbladder stones and chronic cholecystitis. At surgery, limy bile within the gallbladder has a white or off-white appearance with a consistency that varies from milk curd to a pasty mass. In the patient described above, limy bile was present in both the gallbladder and bile duct. Whether the presence of limy bile increases the risk of complications such as cholecystitis and cholangitis remains unclear.

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