Upper gastrointestinal endoscopy findings at Riyadh Armed Forces Hospital

To analyze the results of upper gastrointestinal endoscopic findings performed at Riyadh Armed Forces Hospital over a period of 15 years in 18,829 patients who were entered in the computer at the endoscopy unit. A retrospective study based on data of 18,829 patients who underwent upper gastrointestinal endoscopy. The data was entered into a computer with special codes for symptoms and endoscopic findings. Eighteen thousand eight hundred and twenty nine upper gastrointestinal endoscopy results were analyzed. Oesophagitis was found in 16.45%, Hiatus Hernia in 10%, Oesophageal varices in 7%, Oesophageal Cancer in 1.14%, Gastritis in 22%, Gastric erosions in 13.6%, Benign gastric ulcer in 3.29%, Gastric malignancy in 1.22%, Duodenal Ulcer in 14%, Duodenal erosions in 3.7% and Duodenitis in 12.7%. Only in 5.15% endoscopic findings were normal. In our analysis only 5.15% had normal upper gastrointestinal endoscopy findings while majority of patients had abnormal findings

Comparison of helicobacter serum

The objective of the study is to compare the helicobacter pylori high molecular weight cell associated protein, IgG enzyme immunoassay [HM.CAP, IgG EIA] with the campylobacter-like organism preformed urease campylobacter-like-organism [CLO test] as an indication of the presence of H.pylori among patients with dyspepsia. One hundred and six Saudi patients with dyspepsia or abdominal pain who had gastroscopy between July and September 1993, at the Gastroenterology Department of the Riyadh Armed Forces Hospital, were included in the study Antral biopsy was collected from each patient for CLO test, while a serum sample was obtained for H.pylori immunoassay test using the HM.CAP immunoassay kit from Enteric Products Inc. Specimens were sent to the microbiology laboratory blind without indicating the clinical findings or the result of the CLO test performed in the Gastroenterology Department. In 60 of these patients [56.6%] both tests were positive and in 12 cases both tests were negative. The concordance of the two tests was 68%. The most common abnormal gastroscopic findings were gastritis or gastric erosion in 24 patients and in 12 [50%] of them, both the CLO test and serology were positive. Both tests were found useful for screening for the presence of H.pylori. A screening strategy based on serology could play an important role in reducing endoscopy workload and for follow-up of patients with H.pylori infection

Albendazole in hydatid disease: results in 22 patients

A prospective study to evaluate the effect of albendazole in the treatment of echinococcus granulosus was conducted at the Gastroenterology Unit, Armed Forces Hospital, Riyadh since April 1985 to present involving 22 patients mainly with liver hydatid disease. Of these patients, 30% had a previous history of surgery for recurrence of previously operated hydatid cysts. The duration treatment and follow up period ranged from two months to three years. The only side effect was hair loss in two patients which was fully reversible on the termination of treatment. The following results were achieved: Radiological disappearance of the liver cysts were achieved in eight patients. Four of eight patients were treated only with albendazole and the other four patients with ruptured liver cysts to the biliary tree were treated with a combination of non-surgical endoscopic method, hypertonic saline irrigation and albendazole. In the remaining 14 patients, 5 [22.72%] had a 30% to 60% reduction in cyst size. Intracystic change was noted in five patients [22.72%], in two patients the cyst ruptured and there was no change in the cyst size in two patients [9.9%]. This study demonstrates that albendazole is a promising drug for the treatment of hydatid disease

Endoscopic biliary drainage of postoperative biliary fistulae and leak

Five consecutive patients with postoperative biliary fistulae or leak were diagnosed and treated successfully by endoscopic intervention The development of the fistulae were related to distal common bile duct obstruction by stones in four patients and in one patient by hydatid daughter cysts. Endoscopic sphincterotomy with stone or cyst extractions achieved decompression of the biliary system and initiated closure of the fistulae. In two patients, nasobiliary tube was used and endoscopic endoprosthesis was needed to close the fistula in another patient. In such cases, endoscopic management seems to be superior to surgical re-intervention for repair of fistulae or leak

Endoscopic choledochoduodenostomy [ECDT]: a practical approach to management of impacted papillary gallstones and ampullary tumors

We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy [ECDT] at Riyadh Armed Forces Hospital [RAFH]. The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy [ECDT]. This approach provides an access to the common bile duct thus allowing appropriate therapeutic procedures on the biliary system to be performed

Endoscopic management of bile duct stones at Riyadh Military Hospital: an eight-year experience

Over a period of eight years, 161 Saudi patients with biliary stones underwent 200 endoscopic retrograde cholangiopancreatographic studies at the Armed Forces Hospital, Riyadh, Saudi Arabia. Endoscopic sphincterotomy was performed in 93.2% of these patients and not attempted in the remainder who were referred for surgery because of biliary stones in both the common bile duct and gallbladder. All patients were symptomatic and the most common presenting symptom was biliary colic, seen in 42.2% of these patients. Either acute gallstone pancreatitis or cholangitis was seen in 14.2%, and this resolved completely following gallstone extraction. Endoscopic extraction of common bile duct stones was successful in 138 [85.7%] patients. Failure of stone extraction occurred in nine patients, three of whom received extracorporeal shockwave lithotripsy, which was successful in only one. Complications from endoscopic sphincterotomy and stone extractions occurred in 12 patients, of which bleeding was the most common

Incidence of colorectal cancer and colonic polyps in Saudi patients

Of 1600 Saudi patients who underwent lower gastrointestinal tract endoscopy at the Riyadh Armed Forces Hospital, 40 [2.50%] had adenomatous polyps, 12 [0.75%] had colorectal cancer, 149 [9.31%] had Schistosoma mansoni, and 5 [0.31%] had schistosomal polyps but with no associated malignancy. Despite the high incidence of S. mansoni, there was no increase in the incidence of colorectal cancer in these patients. Of 1846 Saudi patients seen at the oncology department, 346 [18.74%] had gasterointestinal malignancy [307 in the upper gastrointestinal and 39 in the lower gastrointestinal tract]. This distroibution of neoplasms in the alimentary tract is almost the reverse of the seen in the West. There is a low incidence of adenomatous polyps and colorectal cancer in Saudi patients compared to the Western population. This might be due to genetic, dietary, and environmental factors. The present study also confirms previous studies from Egypt that S. mansoni infestation dose no play a role in or predispose to large lowel malignancy

Endoscopic dilatation in the management of benign and malignant esophageal strictures: results of 203 consecutive dilatations

Eighty-three patients with benign or malignant strctures underwent 203 endoscopic esophageal dilatations using different type of dilators. Of these, 36 patients [78.2%] with benign strictures become free of symptoms after one to three dilatations, during a mean follow-up period of 8.5 months. Thirty-seven patients had malignant strictures; in 14 dysphagia abated after the initial dilatations without the need to insert feeding or Atkinson tubes. Seventeen patients [20.5%] had dysphagia following esophageal surgery and their condition improved followed following endoscopic dilatations. Dilatation failed in four patients and esophageal perforation occurred in one patient with malignant stricture. There was no mortality among our patients that was directly related to endoscopic dilatations

Trans-papillary endoscopic naso-biliary drainage of a hepatic abscess - presumably hydatid in origin

This is a report on a 60-year-old diabetic female with hepatic abscess and obstructive jaundice with cholangitis which was treated endoscopically with sphincterotomy and naso-biliary drainage resulting in complete resolution of cholangitis and substantial decrease in the size of the abscess cavity. We presume that the pathology of the cavity was a ruptured hydatid cyst with secondary obstruction and infection. To our knowledge this is the first case reported from Saudi Arabia

Sclerotherapy for bleeding esophageal varices in schistosomiasis

A prospective study to evaluate the role of sclerotherapy in bleeding oesophageal varices secondary to different aetiological factors in 96 patients was conducted at the Gastroenterology Unit, Armed Forces Hospital, Riyadh, between December 1980 and March 1986. Fifty of these patients had proven schistosomal liver disease, 62% of which were in Group A Child's Classification. Sclerotherapy has a special place in schistosomal liver disease as liver function is usually well preserved. Oesophageal varices have been eradicated in 25[50%] during the mean follow-up period of 38 months [range 3-64 months]. Six patients were referred for surgery because of bleeding gastric varices, three of whom died following operation. Forty-three patients had no recurrence of bleeding following sclerotherapy. Surgical procedures for oesophageal varices carry the risk of peri-operative and post-operative morbidity and mortality, while in our study complications following sclerotherapy were minor. We believe that sclerotherapy is the treatment of choice for bleeding Oesophageal varices in schistosomiasis

Lower gastrointestinal tract pathology in Saudis: results of endoscopic biopsy findings in 1,600 patients

Between 1979 and 1985, 1, 775 patients had sigmoidoscopy or colonoscopy in the Gastroenterology Unit of Riyadh Armed Forces Hospital, because of different gastrointestinal tract problems. Sixteen hundred of these patents were Saudi. This study shows the incidence of lower gastrointestinal tract pathology in Saudi patients, based on the histological findings from endoscopic biopsies of the colon. The most common pathological finding was infective causes [18.6%], of which Schistosoma mansoni infestation accounts for 9.31%. One hundred eleven Saudi patients [6.94%] had nonspecific colitis, 10 [0.6%] had tuberculosis, and 3 [0.19%] had amoebic colitis. Ulcerative colitis was diagnosed in 281 [1.75%], Croh's disease in 3 [0.19%], and diverticular disease in 16 patients. There was a low incidence of adenomatous polyps [2.69%] and colorectal cancer [0.78%] compared to Western and Far Eastern countries, but similar to Middle Eastern countries

Comparative evaluation: duodenal aspirate and stool examination in diagnosing giardia lamblia in Saudi patients

Five hundred and sixteen consecutive patients have undergone upper gastrointestinal endoscopy for various reasons at the Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia. As giardiasis is thought to be common in Saudi Arabia, a prospective study on these patients was carried out to evaluate duodenal aspirate and stool examination methods in the diagnosis of Giardia lamblia. Duodenal aspirate was obtained from 495 patients, but only two [0.4%] were positive for Giardia lamblia trophozoites when examined in both wet preparation and acridine orange staining methods. Seven hundred and thirty-four stool samples from 300 patients were examined by the formalin-ether concentration method. Eight stools [1%] from six patients [2%] were positive for Giardia lamblia. Stool examination also revealed the presence of 141 other parasites in these patients