Safety of endoscopic n-butyl-2 cyanoacrylate injection for the treatment of bleeding gastric varices in children

Objective: To determine the safety and efficacy of N-butyl 2-cyanoacrylate in bleeding gastric varices in children

Methods: This retrospective observational study was conducted in the Department of Gastroenterology and Pediatric Surgery in Liaquat National Hospital Karachi between January 2010 and January 2017. Gastric fundal varices were obliterated in pediatric population with single shot of N-butyl-2 Cyanoacrylate 0.50ml diluted with 0.50ml of Lipoidal with use of forward-viewing video endoscope with 22-gauge needle. The primary outcome was primary hemostasis, Secondary outcome was complications, re-bleeding and mortality

Results: Thirty patients was included in the study, 18[60%] were male with mean age of 7.12 +/- 2.9 years. Non cirrhotic portal hypertension was the most common etiology in 15[50%] patients, followed by liver cirrhosis secondary to hepatitis B and D co-infection in 6[20%] patients. Primary hemostasis was achieved in 29 [96.7%], while 3[10%] patients developed rebleeding after 48 hours, and hemostasis was achieved after second session of endoscopic obliteration. Abdominal pain and fever developed in 3[10%] patients which was managed conservatively. Mortality was observed in 1[3%] of cases due to sepsis after shunt surgery

Conclusion: Endoscopic fundal varix obliteration with N Butyl-2 cyanoacrylate was safe and effective in treatment of gastric variceal hemorrhage in children

Safety of trans-nasal percutaneous endoscopic gastrostomy placement

Objective: To evaluate the safety of trans-nasal percutaneous endoscopic gastrostomy [TPEG] placement for nutrition in patients where oral approach is not possible

Study Design: Case-series

Place and Duration of Study: April 2010 to April 2016 in the Department of Gastroenterology at Liaquat National Hospital, Karachi

Methodology: Patients underwent trans-nasal PEG placement and were included in this study. Inclusion criteria were either gender of any age and patients referred for PEG tube placement in whom oral PEG tube insertion was not possible. Ultrathin gastroscope [outer diameter of 5.9 mm] was passed through a nostril after assessment and lubrication, the pull technique was used for tube placement. Primary outcome variable of study was the safety of the procedure. The secondary outcome variables were procedure related complications during and 72 hours after the procedure

Results: TPEG placement was successful in all 46 cases. Thirty-one [67.4%] were males. The mean age was 56.63 +/- 12.62 years. Dysphagia was the main indication in all cases. Head and neck cancer was the most common indication present in 38 [82.6%] patients. In 36 [78.2%] cases, the procedure was performed under local anesthesia. PEG site infection occurred in one [2.1%] patient

Conclusion: TPEG is a safe procedure in patients with oro-pharyngeal obstruction, and it should be considered as an alternative approach

[Study of incidence of Giardia on sever malnutrition patients that have diarrhea]

This prospective study had been done on 100 patients with sever malutrition that admitted to Ataturk pediatric hospital in years 2008. The propose of this study is to reveal the incidence of Giardia on sever malnutrition patients that have diarrhea. This research revealed that the prevalence of Giardia was 24 cases from this case 14 was male and 10 was female. And due to seasons it shows more prevalence in the summer and spring. Due to quality of water the high prevalence was among the people who has drunk the well water and shows more incidence in 1-3years