Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis

Background: Endoscopic sphincterotomy [EST] combined with balloon catheters and/or baskets are the routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large common bile duct [CBD] stones are treated conventionally with mechanical lithotripsy, large balloon papillary dilation after endoscopic sphincterotomy [ELPBD] represents the onset of an era in large CBD stone extraction and the management of [impaction]. That is because it seems effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones

Methods: Randomized prospective comparative study was conducted on seventy four patients with CBD stone[s], subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD[s]

The enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in the great majority of patients

Results: Complete extraction CBD stones among the patients of groupl; EPLBD was effective for clearance of [92.5%] of CBD stones in patients with the stone sized < 1cm and in [83%] of patients with stone size > 1cm, [overall clearance rate=87%]

Overall adverse effects of patients of groupl was [29%] as mild self-limiting post ERCP pain occurred in [9.6%] and mild intra- procedure bleeding occurred in [9.6%], whereas more serious complication as melena which occurred in [3.2%], and mild pancreatitis occurred in [6.4%]. Whereas complete CBD stones clearance among the patients of group 2; EST was effective in [96%] of patients with the stone sized < 1 cm, while stone clearance occurred in [56%] in patient with stone size> 1cm, [overall clearance rate=79%]. Overall adverse effects of patients of group 2 was [18.5%] as mild self-limiting post ERCP pain occurred in [7%] and mild intra-procedure bleeding occurred in [4.6%], whereas more serious complications as mild pancreatitis developed in [4.6%], and post ERCP cholangitis in [2.3%] The comparison between the two groups regarding the extraction of CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients whose the CBD stone size < 1 cm. Whereas the clearance rate of CBD stones in the patients with stone size > 1cm among the group 1 was [83%] which better than among the group 2 which was [56%] with nearly statistical difference [P value=0.07]

Conclusion: Conventional EST is an effective method for removal of common bile duct stones < 1 cm in diameter whereas the use of large papillary balloon dilation after endoscopic sphincterotomy improve the clearance rate of bile duct stones> 1cm which is difficult to be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones

Comparative study between percutaneous acetic acid injections and percutaneous ethanol injection in the management of hepatocellular carcinoma

This study was conducted on 30 patients with hepatocellular carcinoma [Hcc-3-6 cm in the largest diameter].They were divided into two equal groups: The first group was treated by a single or multiple sessions of percutaneous ethanol injection, while the second group was treated by a single or multiple sessions of percutaneous acetic acid injection. All patients were subjected to full history takings clinical examination, and routine laboratory investigations including alpha feto-protein. Radiological assessment was carried out using abdominal ultrasonography and triphsic computed tomography. The patients were clinically followed up and assessed at one, and three months after therapy by abdominal triphasic computed tomography, ultrasound and alpha feto-protein [AFP]. There was no significant difference between the studied groups as regard age and sex distribution or the clinical features. Hepatomegaly was detected in 4 [26.7%] in groups I and II. Splenomegaly was detected in 10 [66.7%] in group I and 11[73.3%] in group II. No ascites was detected by shifting dullness in all patients of both groups. Regarding the ultrasonographic criteria, 24 [80%] patients had their focal lesions in the right lobe. Most of the focal lesions were from 3-4 cm in diameter 24 [80%], mostly hypoechoic [85%]. Also, the diameter of focal lesions increased in 10 [66%] patients of group I in comparison to 12 [80%] patients of group II. Spiral CT one month after the procedure showed complete ablation was achieved in 10 patients [66.7%] of group I and in 13 patients [86.7%] of group II. Although percutaneous acetic acid injections showed higher rate with complete ablation, the difference was not statistically significant in comparison with the other group

Early prediction of neuropathic wrist arthropathy in Egyptian leprotic patients

Leprosy is a chronic dermatologic and neurologic condition caused by the organism, an obligate intracellular acid fast bacillus with a predilection for dermal and neural cells [John, 2006]. We investigated the early prediction of the neuropathic wrist arthropathy in Egyptian leprotic patients. Thirty six leprotic patients [26 males and 10 females] their ages ranged from 15-60 years with mean [44.83+16.75] and the disease duration ranged from 1-35 years with mean [15.70+4.70] in addition to thirty control subjects[22 males and 8 females] their age ranged from 12-58 years with mean [32.03+11.99] were included in the study. Careful history examination with a special attention to family history, Neurological examination and Rheumatological and Radiological examination of both wrists joints, ESR, CBC, RF, urine and stool analysis and kidney and liver functions. The wrist joints are highly significantly involved in the patients group than in the control group with a higher predilection to the sensory impaired patients than the motor impaired patients. We can conclude that the radio carpal joints may be affected by neuropathic arthropathy in leprotic patients with sensory impairment