W. Melki

Variceal band ligation in the prevention of variceal bleeding: a multicenter trial.

Background/Aim: Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. The study has been aimed at investigating the effectiveness of endoscopic band ligation in preventing upper gastrointestinal bleeding in patients with portal hypertension and to establish the clinical outcome of patients. Patients and Methods: We analyzed in a multicenter trial, the efficacy and side effects of endoscopic band ligation for the primary and secondary prophylaxis of esophageal variceal bleeding. We assigned 603 patients with portal hypertension who were hospitalized to receive treatment with endoscopic ligation. Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The primary end point was recurrent bleeding. Results: The median follow-up period was 32 months. A total of 126 patients had recurrent bleeding. All episodes were related to portal hypertension and 79 to recurrent variceal bleeding. There were major complications in 51 patients (30 had bleeding esophageal ulcers). Seventy-eight patients died, 26 deaths were related to variceal bleeding and 1 to bleeding esophageal ulcers. Conclusions: A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.

Upper gastrointestinal bleeding in elderly patients in a Tunisian hospital: A retrospective study

BACKGROUND AND STUDY AIMS The older age group presents a major problem in the management of acute gastrointestinal bleeding with a relatively high mortality. The study aims to describe the background characteristics, causes and outcome of acute upper gastrointestinal bleeding in the elderly in Tunisia. PATIENTS AND METHODS We retrospectively reviewed data of 401 patients aged≥60 years presenting with upper gastrointestinal bleeding. Information collected included history, physical examination findings, laboratory data, endoscopic findings and length of hospital stay. Patients were divided into two groups: group A (65-79 years) and group B (>79 years). RESULTS Group A included 315 patients and group B 86 patients. There was a male preponderance in both groups. Co-morbidity (p<0.01) and use of non-steroidal anti-inflammatory drugs (NSAIDs) or anti-platelet drugs (p<0.01) were more common in group B. Oesophagitis was the cause of bleeding in 38.37% in group B, as compared with 19% in group A. The main cause of bleeding in group A was peptic ulcer. Rebleeding (6/86) and emergency surgery (1/86) were rare in group B and not different from those in group A. However, the bleeding-related mortality in the very elderly group was higher (13.9% vs. 4.76%; p=0.02). In multivariate analysis, only shock on admission was independently related to mortality (p=0.02). CONCLUSION Oesophagitis is the major cause of upper gastrointestinal haemorrhage in the very elderly patients. While rebleeding and emergency surgery rates are relatively low, the bleeding-related mortality was higher in the very elderly group.

Épidémiologie des hémorragies digestives hautes en Tunisie

RésuméL’hémorragie digestive haute demeure une cause fréquente d’hospitalisation, de morbidité et de mortalité. Les études épidémiologiques sont limitées dans notre pays.ButDéterminer les causes et l’évolution des patients ayant une hémorragie digestive haute, colligés au CHU deMonastir.Matériels et méthodesLes dossiers de 874 patients qui ont subi une endoscopie digestive haute pour hémorragie digestive pendant une durée de dix ans (1997–2007) ont été rétrospectivement analysés.RésultatsLes hémorragies digestives hautes ont représenté 5,3 % de l’ensemble des endoscopies digestives hautes. On avait noté une nette prédominance masculine (63,1 %), avec un âge moyen de 54 ± 12 ans. L’origine de saignement a été détectée dans 90 % des cas. La précision diagnostique était plus grande quand l’endoscopie est pratiquée dans les 24 premières heures suivant l’apparition de l’hémorragie, et en présence de l’hématémèse. L’ulcère gastroduodénal est la cause la plus fréquente de l’hémorragie digestive haute (50,5 %), suivi des gastroduodénites hémorragiques (24 %). La prévalence de l’hémorragie digestive par rupture des varices oesogastriques était de 9,49 %. Le traitement endoscopique a été utilisé dans 103 cas (11,7 %). Une intervention chirurgicale a été effectuée chez 51 patients (5,83 %), incluant 9,9 % des patients ayant un ulcère hémorragique. Trente-six patients étaient décédés (4,1 %).ConclusionL’ulcère hémorragique est la cause la plus fréquente d’hémorragie digestive dans notre pays. La mortalité était élevée dans le groupe des patients ayant saigné par rupture des varices oesogastriques. La plupart des cas d’hémorragie digestive haute peuvent être traités par hémostase endoscopique, quand l’endoscopie diagnostique établit la source.AbstractBackgroundAcute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. Epidemiological studies are still limited in our country.Aim and objectivesThe aim of this study is to determine the causes and outcome of patients with UGIB presenting at the teaching hospital of Monastir.Materials and methodsThe study was carried out at the teaching hospital of Monastir. The records of 874 patients who underwent endoscopy for UGIB over a period of 10 years (1997–2007) were retrospectively analysed.ResultsThe acute UGIB represented 5.3% of all high digestive endoscopy. Male predominance (63.1%) was noted with an average age of 54 ± 12 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset and in the presence of hematemesis. Peptic ulcer was the main cause of UGIB (50.5%) followed by erosive mucosal disease (24%). The prevalence of variceal bleeding was 9.49%. Endoscopic treatment was used in 103 cases (11.7%). Operations were performed in 51 cases (9.9%), including 9.9% of ulcers. There were 36 deaths (4.1%).ConclusionPeptic ulcer was the most common cause of gastrointestinal bleeding in our country. Mortalitywas raised in variceal group. Most cases of UGIB can be treated with endoscopic hemostasis, when diagnostic endoscopy establishes the source.

Préparation intestinale avant coloscopie

Colonoscopy is a routinely performed procedure in adults. Completion of the procedure and proper visualization of the intestinal mucosa are highly dependent on the quality of the bowel preparation. The ideal bowel preparation should be safe, well-tolerated and effective. No bowel preparation method meets the ideal criteria for bowel-cleansing prior to colonoscopy. However, polyethylene glycol-electrolyte lavage solution and sodium phosphate are the most commonly used bowel preparations before colonoscopy and colon surgery. NaP preparations appear more effective and better tolerated than standard PEG solutions but should be administered with caution in patients with preexisting or at an increased risk for electrolyte disturbances. Timing and dose are important considerations regardless of the method used. The last generation of preparations improves safety and acceptability by reducing volume of liquid ingested.

Abrikossof tumor of the esophagus: report of a new case

Granular cell tumors or Abrikossoff tumors are rare and usually benign tumors. The esophageal involvement was rarely described (2% of cases). Diagnosis is histological and treatment controversial. From a new observation of granular cell tumor of the esophagus, we discuss clinical, endoscopic, histologic and therapeutic characteristics of this rare entity through a literature review. The Observation reported was of a 65-year-old man in whom and through exploration of dysphagia, we discovered a granular cell tumor of the third lower esophagus. In the absence of criteria of malignancy, the therapeutic approach was conservative with a simple endoscopic and echo endoscopic monitoring.

Tumeur d’Abrikossoff à localisation œsophagienne : à propos d’un nouveau cas

Granular cell tumors or Abrikossoff tumors are rare and usually benign tumors. The esophageal involvement was rarely described (2% of cases). Diagnosis is histological and treatment controversial. From a new observation of granular cell tumor of the esophagus, we discuss clinical, endoscopic, histologic and therapeutic characteristics of this rare entity through a literature review. The Observation reported was of a 65-year-old man in whom and through exploration of dysphagia, we discovered a granular cell tumor of the third lower esophagus. In the absence of criteria of malignancy, the therapeutic approach was conservative with a simple endoscopic and echo endoscopic monitoring.

Tumeur d’Abrikossoff à localisation œsophagienne : à propos d’un nouveau cas@@@Abrikossof tumor of the esophagus: report of a new case

Granular cell tumors or Abrikossoff tumors are rare and usually benign tumors. The esophageal involvement was rarely described (2% of cases). Diagnosis is histological and treatment controversial. From a new observation of granular cell tumor of the esophagus, we discuss clinical, endoscopic, histologic and therapeutic characteristics of this rare entity through a literature review. The Observation reported was of a 65-year-old man in whom and through exploration of dysphagia, we discovered a granular cell tumor of the third lower esophagus. In the absence of criteria of malignancy, the therapeutic approach was conservative with a simple endoscopic and echo endoscopic monitoring.

P.57 - Jeûne du Ramadan et perforation de l’ulcère duodénal avant et après l’ère d’ Helicobacter pylori : étude rétrospective comparative de 224 cas

Introduction Le jeune diurne au cours du mois de Ramadan s’accompagne d’une augmentation de la secretion gastrique acide. Il est donc attendu que cette hypersecretion soit responsable d’une recrudescence des poussees de la maladie ulcereuse et de ses complications, en particulier la perforation. Par ailleurs, et depuis plus d’une dizaine d’annee, l’eradication d’Helicobacter pylori est devenue systematique et devrait changer l’histoire naturelle de cette complication. Le but de notre etude est de comparer la frequence de la perforation de l’ulcere duodenal au cours du Ramadan par rapport au reste de l’annee, et d’etudier indirectement l’impact de l’eradication d’Helicobacter pylori sur la survenue de cette complication. Patients et Methodes Etude retrospective des perforations d’ulcere duodenal survenues dans 2 periodes de 5 annees successives incluant le mois de Ramadan de chaque annee. La premiere periode est etalee de 1986 a 1990 et la deuxieme de 2000 a 2004. Ces 2 periodes sont separees de 10 ans pendant lesquels tout ulcere duodenal diagnostique a beneficie d’une tritherapie anti-Helicobacter pylori. Pour chaque periode, nous avons calcule la frequence moyenne de la perforation au mois de Ramadan et la moyenne par mois du reste de l’annee. Resultats Il s’agissait de 224 cas de perforations repartis en 103 au cours de la periode 1, et 121 au cours de la periode 2. Les patients des 2 periodes etaient separes en mois de Ramadan (R) et non mois de Ramadan (NR). Full-size table Conclusion La perforation de l’ulcere duodenal est au moins 4 fois plus frequente au cours du mois de Ramadan qu’au cours du reste des mois de l’annee. Ces rapports sont restes les memes avant et apres l’ere d’Helicobacter pylori soutenant que le jeune prolonge reste probablement un facteur de risque important et independant pour la perforation de l’ulcere duodenal.