Solitary rectal ulcer syndrome. aTunisian monocentric survey

Solitary rectal ulcer syndrome is an uncommon and benign defecation disorder. Occidental series are scarce and to our knowledge, Tunisian data are not available. The aim of this study was to evaluate the clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome. All the patients diagnosed with solitary rectal ulcer syndrome from January 2001 to 2012 were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic, histological and therapeutic findings. A total of 15 patients were evaluated: 7 males; mean age 42.6 years. Bleeding per rectum was present in 66% and dyschezia in 73%. Endoscopically, solitary lesion was present in 66% patients. The most frequent dynamic abnormalities shown by defecography were of rectal intussusception [53%]. Anorectal manometry was performed in seven cases disclosing dyssynergia in 2 cases. Thirty patients underwent surgery, always after failure of medical treatment and one patient was treated with biofeedback. Rectopexy was the most utilized technic. After a mean follow-up of 29 months, total regression of symptoms was noted in 50% of patients who underwent surgery. In this cohort, diagnostic and therapeutic spectrum of solitary rectal ulcer syndrome was comparable to occidental features. Nevertheless, accesses to manometry and defecography as well as biofeedback were limited

Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma

Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas. A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment. Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment [hepatic resection] was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively [p=0,04]. The disease free survival were not significantly different. Our results showed the efficacy and safety of percutaneous ablation treatments [radiofrequency ablation and ethanol injection] in patients with small hepatocellular carcinoma

Quality indicators for colonoscopy in a Tunisian endoscopy unit

Colonoscopy is a powerful tool for prevention and early diagnosis of colorectal cancer. However, the effectiveness of colonoscopy is dependent on the quality of the procedure, which is assessed by a number of key quality indicators. Among them, cecal intubation and adenoma detection rate are historically the most commonly used indicators of quality of colonoscopy. The aim of our study was to evaluate these two indicators of quality of colonoscopy in a Tunisian endoscopy center. We conducted a retrospective study from January 2009 to March 2013. Data were collected from colonoscopies reports. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The quality of bowel preparation was subjectively classified at the time of the examination by each endoscopist as good, fair, or poor. Procedure related quality indicators considered for analysis were: cecal intubation rate [CIR] and polyp detection rate. During the period of the study, 859 colonoscopies were performed without sedation. The average age was 54.76 +/- 17.5 years. Males represented the majority of our population [50.2%]. Colic preparation was judged good, fair and poor in respectively 24 %, 61% and 15% of cases. The cecal intubation rate was 61.1 %. Causes of incomplete colonoscopy were especially poor preparation [47.3%] and poor tolerance [34.4%]. Univariate analysis disclosed 3 predictive factors of CIR: the quality of bowel preparation [good vs fair or poor[[67.2 % vs 31.3%, p = 0.0001,OR: 4.5, 95% CI: 3.3-6], the screening indication [72.9% vs 60.1%, p = 0.03, OR: 1.7, 95% CI: 1-3] and the presence of alarming signs [55% vs 43%, p=0.04; OR: 1.1, 95% CI:0.9-2.5]. By multivariate analysis, the factors influencing independently the CIR were the quality of bowel preparation [p=10-3, OR=2.23, 95% CI: 1.47-3.3] and the screening indication [p=0.02, OR: 1.9, 95% CI: 1.1-3.4]. The polyp detection rate was 21% and was correlated, in univariate analysis with: age over 47 years [p=10-3, OR:3.2, 95 % CI:2-4.9], male gender [25.1% vs 16.8%, p=0.001, OR:2.36, 95% CI: 1.4-4], the quality of the preparation [26.5% vs 19.1%, p=0.03 OR:1.4, 95% CI:0.9 -2], the presence of colorectal cancer [50.9% vs 18.2%, p=0.0001, OR:4.6, 95% CI: 2.6-8] and the screening indication [35.7% vs 19%, p=0.001 OR: 2.36, 95% CI: 1.4-4]. By multivariate analysis, 3 independent factors associated with polyp detection rate were identified: age over 47 years [p=10-3, OR: 3.5 95% CI:2-5.9], bowel preparation [p=10-3 OR=5, 95% IC:2.7-9.6] and the screening indication[p=0.01, OR 2.5, 95% IC 1.4-4.7]. In our cohort, the quality of bowel preparation, tolerance of the procedure, age and the indication of colonoscopy were significantly associated with the indicators of quality. Bowel preparation and tolerance are targets on which we should act to improve performance