ABSTRACT
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
ABSTRACT
Objectives: To observe the frequency of QTc [corrected QT] interval prolongation in patients with chronic liver disease in our population
Study design: A cross-sectional analytical study
Place and duration: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi from May 2009 to October 2009
Methodology: A non- probability, purposive sampling is used in already diagnosed cirrhotic patients. Patients between 25-70 years were included. These patients were divided into three groups according to their Child-Pugh [C.P.] classification [class A, class B and class C]. An electrocardiogram [ECG] of all patients was obtained and QT intervals corrected for heart rate [QTc] were calculated. Analysis of data was done by SPSS 17
Results: 121 cirrhotic patients were inducted in this study. 10 patients belonged to C.P. class A, 49 to C.P. class B, and 62 to C.P. class C. Prolonged QTc interval was observed in 48 [39.7%] patients while in 73 [60.3%] patients QTc interval was normal. Occurrence of prolonged QTc interval was greater in C.P. class-C [50%] followed by C.P. class-B [30.6%], p value 0.045 and 0.016 respectively
Conclusion: Significant number of cirrhotic patients had prolonged QTc interval and this prolongation of QTc interval was directly associated with more advanced liver disease
ABSTRACT
To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care center in Karachi. Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Cross sectional descriptive study. Department of Gastroenterology, Liaquat National Hospital, Karachi. May 2008-October 2008. All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinal bleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two each from antrum and body and one from fundus were taken for histology. A total of 123 dyspeptic patients were included in the study. 76 [61.8%] patients were males and 47 [38.2%] were females. H pylori was detected in mucosa of 49 [39.8%] patients. The mean age of the patients was 41.41 +/- 13.15 Years [95%CI; 39.06 to 43.75]. Rate of H.pylori infection was not found statistical significant with age, gender, duration of symptoms and BMI. The prevalence of H pylori infection in dyspeptic patients was lower than reported in previous studies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pylori in our setup
ABSTRACT
N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation [CPR] was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest
ABSTRACT
Portal Hypertensive Gastropathy [PHG] is a rare cause of upper gastrointestinal bleeding in patients with Chronic Liver Disease [CLD]. This is the case report of a 46-year-old female known case of Hepatitis C Virus [HCV] CLD, who presented with melena and coffee ground vomitings for 6 months. Esophagogastroduodenoscopy [EGD] showed PHG while an ultrasound revealed chronic liver disease. The patient had a history of repeated blood transfusions over the last 6 months. She was given propanolol but no benefit occurred. She was referred for transjugular intrahepatic portosystemic stenting [TIPSS] to an interventional radiologist, which was followed by a reduction in PHG and the need for transfusion