Gastro

Background and Aims: In 1999, the diagnostic criteria of Autoimmune Hepatitis (AIH) have been revised by an international panel. This revised scoring system had a high diagnostic accuracy but was limited by its complexity. Subsequently, a simplified score has been proposed recently to enhance clinical practicability. The goal of this study was to compare the performance parameters of the revised and the simplified scores in Tunisian patients satisfying conventional pretreatment criteria for the diagnosis of AIH and other chronic liver diseases. 

Methods: Diagnostic scores were calculated using the revised and simplified criteria in patients with AIH, viral, cholestatic and metabolic chronic liver disease. The sensitivity, specificity, and predictability of each scoring system for the pretreatment diagnosis of AIH were determined. 

Results: Sixty-three patients were included. Of these, 19 held a diagnosis of AIH, and 3 were identified with AIH primary biliary cirrhosis overlap syndrome. The remaining 41 patients had diagnoses of primary biliary cirrhosis (n=7), chronic hepatitis B (n=17), chronic hepatitis C (n=9), non-alcoholic steatohepatitis (n=5) or primary sclerosing cholangitis (n=3). The revised score had greater sensitivity for the diagnosis of AIH than the simplified score (100% versus 72.7%) as 5 patients diagnosed as AIH with the revised score were nondiagnostic by the simplified score. The simplified score had a higher specificity than the revised score (100% versus 94.8%) as 2 patients with non-alcoholic steatohepatitis were ascribed a false diagnostic of AIH with the revised score. score (100% versus 72.7%) as 5 patients diagnosed as AIH with the revised score were nondiagnostic by the simplified score. The simplified score had a higher specificity than the revised score (100% versus 94.8%) as 2 patients with non-alcoholic steatohepatitis were ascribed a false diagnostic of AIH with the revised score.

A 71-year-old woman was admitted to our hospital for treatment of cancer in the body and tail of the pancreas.  After admission, she had tarry stool and esophagogastroduodenoscopy (EGD) was performed.  EGD revealed enlarged tortuous, red color sign negative gastric varices between the cardiac orifice, fundus and the curvature ventriculi major of the gastric body. Computed tomography showed gastric varices due to splenic vein occlusion with advanced pancreatic cancer (left-sided portal hypertension).  endoscopic However, endoscopic observation was not sufficient to identify the bleeding site of the gastric varices.  Consecutively, endoscopic color Doppler ultrasonography (ECDUS) was performed to evaluate the gastric varices in detail.  ECDUS showed the velocity of gastric varices in the cardiac orifice and fundus to be 11.7 cm/sec, the thickness of the gastric wall to the submucosal gastric varices being 1.0 mm, and the gastric varices in the cardiac orifice and fundus were diagnosed as the likely bleeding site.  Subsequently, we performed obliterative therapy with 70% n-butyl-2 cyanoacrylate diluted with 5% Lipiodol at the possible bleeding site of these varices.  The patient experienced no further episodes of bleeding during the three months following treatment.

Keywords: Gastric Varices; Splenic Vein Occlusion; Endoscopic Ultrasonography; Color Doppler; Left-Sided Portal Hypertension 

Aims: To evaluate the utility of endoscopic obliterative therapy with n-butyl-2-cyanoacrylate (a tissue adhesive) for gastric varices and to assess the incidence of serious complications.  

Methods: Endoscopic obliterative therapy with n-butyl-2 cyanoacrylate was performed on two groups of patients with gastric varices. One group consisted of 129 patients from year 1992 through 2000, and the second of 92 from 2001 through 2014 (total=221).  Endoscopic therapy was performed under fluoroscopy using 70% cyanoacrylate diluted with 5% Lipiodol.  

Results: Endoscopic obliterative therapy with cyanoacrylate for gastric varices was successful in all 221 cases. The recurrence rate was 30/210 (14.3%) among patients wherre variceal eradication had been achieved. Additional treatment was successfully performed in all recurrent cases. The incidence of serious complications in the first group was 4/129 (3.1%), including two cases of splenic infarction, one of pulmonary embolism, and one of an inflammatory tumour of the pancreatic tail. In contrast, there were no serious complications was in the group treated later using smaller amounts of n-butyl-2cyanoacrylate.  

Conclusions: Endoscopic obliterative therapy with cyanoacrylate is a useful and relatively safe method for treatment of bleeding gastric varices.  Nonetheless, careful attention must be paid to the avoidance of potentially serious complications.  

Keywords: N-butyl-2-cyanoacrylate; Endoscopic Obliterative Therapy; Gastric Varices; Histoacryl® 

60 year old male patient was admitted with acute on chronic mesenteric ischeamia. He was found to have rare anatomical variant of common celiacomesenteric trunk which had atherosclerotic occlusive disease. Revascularisation by endovascular techniques can effectively treat this condition and avoid catastrophe of massive bowel gangrene in future. 

Keywords: Common Celiacomesenteric Trunk; Anatomical Variation; Endovascular Procedures