Mazin Sayegh

Acute oesophageal necrosis: A case report and review of the literature

AIMS We discuss a case of acute oesophageal necrosis and undertook a literature review of this rare diagnosis. METHODS The literature review was performed using Medline and relevant references from the published literature. RESULTS One hundred and twelve cases were identified on reviewing the literature with upper gastrointestinal bleeding being the commonest presenting feature. The majority of cases were male and the mean age of presentation is 68.4 years. This review of the literature shows a mortality rate of 38%. CONCLUSION Acute necrotizing oesophagitis is a serious clinical condition and is more common than previously thought. It should be suspected in those with upper GI bleed and particularly the elderly with comorbid illness. Early diagnosis with endoscopy and active management will lead towards an improvement in patient outcome.

Laparoscopic Nissen fundoplication with or without short gastric vessel division: a meta-analysis.

ObjectiveThe aim of this work is to systematically analyse the prospective randomised controlled trials on laparoscopic Nissen fundoplication (LNF) with and without short gastric vessel division (SGVD) for management of gastro-oesophageal reflux disease (GORD).MethodsAfter an extensive literature search, all previous trials on laparoscopic Nissen fundoplication with and without SGVD for management of GORD were assessed. Those meeting study quality criteria were analysed to generate summative data expressed by standardised mean difference (SMD) and risk ratio (RR).ResultsFive randomised controlled trials on 388 patients qualified for the meta-analysis. There were 194 patients in the no-SGVD group and 194 patients in the SGVD group. No-SGVD was associated with shorter operative time and length of stay. In both fixed- and random-effects models, there were no statistically significant differences in laparoscopic to open conversion rate or complications between the two groups. Three trials presented data on 1-year follow-up, with 118 patients in the no-SGVD group and 112 patients in the SGVD group. There was no statistically significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups. Two trials presented data on 10-year follow-up, with 84 patients in the no-SGVD group and 86 patients in the SGVD group. There was no significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups either. There was no heterogeneity between trials.ConclusionsBased on this review, SGVD in LNF is associated with longer operative time and hospital stay. However, there is no difference in terms of functional outcomes for 1- and 10-year follow-up. Routine use of SGVD may therefore not be necessary in LNF.

Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM To critically appraise the published randomized, controlled trials on the prophylactic effectiveness of the non-steroidal anti-inflammatory drugs (NSAIDs), in reducing the risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS A systematic literature search (MEDLINE, Embase and the Cochrane Library, from inception of the databases until May 2015) was conducted to identify randomized, clinical trials investigating the role of NSAIDs in reducing the risk of post-ERCP pancreatitis. Random effects model of the meta-analysis was carried out, and results were presented as odds ratios (OR) with corresponding 95%CI. RESULTS Thirteen randomized controlled trials on 3378 patients were included in the final meta-analysis. There were 1718 patients in the NSAIDs group and 1660 patients in non-NSAIDs group undergoing ERCP. The use of NSAIDs (through rectal route or intramuscular route) was associated with the reduced risk of post-ERCP pancreatitis [OR, 0.52 (0.38-0.72), P = 0.0001]. The use of pre-procedure NSAIDs was effective in reducing approximately 48% incidence of post-ERCP pancreatitis, number needed to treat were 16 with absolute risk reduction of 0.05. But the risk of post-ERCP pancreattis was reduced by 55% if NSAIDs were administered after procedure. Similarly, diclofenac was more effective (55%) prophylactic agent compared to indomethacin (41%). CONCLUSION NSAIDs seem to have clinically proven advantage of reducing the risk of post-ERCP pancreatitis.

The use of holmium laser technology for the treatment of refractory common bile duct stones, with a short review of the relevant literature.

Background. The treatment of common bile duct (CBD) stones can vary in complexity and many methods exist to fragment them before removal. Although holmium laser is frequently used in urological surgery, it is rarely used to achieve this aim. Methods. The holmium laser was passed along a fiber introduced via a flexible scope through the cystic duct at the time of laparoscopic cholecystectomy. This energy modality was used to fragment the stones to a size that allowed easy removal. Results. The authors have used this technique once so far and achieved complete clearance of the CBD with no mucosal damage. Conclusion. Holmium laser provides an alternative and realistic treatment option for difficult CBD stones.

Technical Notes and Tips: Infacol to Reduce the Bubble Effect at Endoscopic Ultrasonography

Endoscopic ultrasonography is frequently used in the clinical setting. In order for the ultrasound to be as effective as possible, a good interface between the structure wall and the probe is required. If bubbles are present, they will produce artefact and decrease sensitivity. Yiengpruksawan et al.1 have described the use of simethicone to reduce the bubble effect. We have found that the infant colic remedy Infacol® provides an efficient and user-friendly method of dispensing simethicone. One dropper (0.5 ml equal to 20 mg) of Infacol is mixed with 50 ml of water and squirted down the endoscope to great effect. Figure 1 Infacol® is readily available.