Long term efficacy and safety of N-butylcyanoacrylate in endoscopic treatment of gastric varices.

Introduction: Endoscopic glue (N-butyl-2-cyanoacrylate) injection has emerged as promising therapy for bleeding gastric varices (GV). We evaluated safety and long term efficacy of this technique in patients with portal hypertension and large bleeding GV. Patient and Methods: 170 patients (mean age 40.9±14y; 132 male; 142 had cirrhosis, 40 Child A, 62 Child B, 40 Child C) underwent glue injection into GV (F3 140, F2 30; fundal 114) as emergency procedure for active bleeding in 62 and electively for prevention of rebleeding in 108. Glue was injected intra-variceally under endoscopic vision, 0.5-4ml/aliquot, repeated at 3 weeks till varices were eradicated/solidified. The efficacy was assessed by hemostasis at 48 h, primary, secondary, definitive success and treatment failure. Results: The overall hemostasis rate at 48h was 82.3% (51/62). Follow up was available in 158 patients for mean of 30.7 + 17.2 months. Repeat injections were performed in 76. The mean number of injections were 1.9±1.0 (1-4); total volume was 2.5±1.7 ml / patient. The status of GVs at last follow up was : disappeared in 32 (22.6%); F1 solidified in 46 (32.3%); F2 solidified in 64 (45.0%). Bleeding recurred in 14.5% (23/158); 60% within 2 weeks of injection. The primary, secondary and definitive success rates were 85.4% (135/158), 4.4% (7/158) and 89.9% (142/158) respectively and treatment failure rate was 10% (16/158). No significant complications were noticed except for injection site ulceration in 32. Twenty patients died on follow up (9 died of uncontrolled bleeding, 11 died of liver failure) Conclusion: Endoscopic glue injection into bleeding GVs was effective in achieving hemostasis in 82% with a definitive success rate of 90% and had a good safety profile on long term follow up.

Acute buried bumper syndrome: An endoscopic buried bumper syndrome:approach.

Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement.

Melioidosis and pulmonary tuberculosis co-infection in a diabetic

Burkholderia pseudomallei is the causative agent of melioidosis. It is endemic in South East Asian countries and North Australia. Sporadic cases of melioidosis have been reported from several parts of South India. Melioidosis may manifest as chronic pneumonia mimicking tuberculosis and generally be seen as a single entity. We report the first case of melioidosis and pulmonary tuberculosis co-infection in a diabetic patient. The causative agents were identified using standard methods and the patient recovered after completion of the recommended antibiotic therapy. Melioidosis is an emerging infectious disease in India. Though melioidosis and tuberculosis present with similar clinical picture, co-infections are rare. Hence, increased awareness among clinicians and microbiologists can help in diagnosing the disease even when there is no clinical suspicion

Gastric adenocarcinoma presenting with intestinal pseudoobstruction, successfully treated with octreotide.

Intestinal pseudoobstruction has been reported as a paraneoplastic manifestation of several cancers, including those of gastrointestinal tract. Octreotide, a somatostatin analogue, has been used successfully in the treatment of idiopathic and scleroderma-associated intestinal pseudoobstruction. We report a 65-year-old man with carcinoma stomach presenting with intestinal pseudoobstruction, which responded to octreotide.