An Unusual Spectrum of Upper Gastrointestinal Tract Foreign Bodies: A 4-Year Prospective Endoscopic Study

Introduction: Ingestion of a foreign body (FB) is a commonoccurrence in day to day clinical practice; however, fewstudies have been reported from Northern India. The aimof this study was to study the spectrum and managementoutcome of patients with FBs in their gastro intestinal tracts(GIT) presenting to gastroenterology unit in a tertiary carereferral hospital.Material and methods: Data were collected from allconsecutive patients with history of FB ingestion admitted toour endoscopy centre from January 2015 to December 2018.The demographic data, clinical presentations, and endoscopicmanagement was reviewed and analyzed.Results: A total of 204patients with suspectedFBingestionunderwent endoscopic management. 211 FBs were found in204 patients with suspected FB.Scarf pin was most common(57.3%) followed by knitting needle in twenty-six (12.3%)cases. Most of theFBs were located in the stomach (72.6%). Themajorityof patients (95.2%) were successfully removed withflexibleendoscopy with the addition of suitable accessorieswithout any serious procedure-related complications.Conclusion: In this part of the world the pattern and types ofUpper gastrointestinal tract foreign bodies is unique not seenelsewhere across the globe. Endoscopic management wasfound to be highly safe and efficacious.

Ahlstrom's Syndrome with Type IV Choledochal Cyst.

Ahlstrom's syndrome is an autosomal recessive, single gene disorder with multisystem involvement with cone-rod retinal dystrophy leading to juvenile blindness, sensorineural hearing loss, obesity, insulin resistance and type 2 Diabetes mellitus. The other less common involvements may severely affect the prognosis and survival and include endocrine abnormalities, dilated cardiomyopathy(DCM) , pulmonary fibrosis and restrictive lung disease, progressive hepatic and renal failure.Apart from its typical, well known clinical features, hepatic & biliary involvement should be kept in mind. Though not known in literature, the biliary tract abnormalities might not be so uncommon. A routine MRCP in a child of AS with typical or atypical biliary tract involvement is thus advisable.

Correlation of hepatic venous pressure gradient with variceal bleeding, size of esophageal varices, etiology, ascites and degree of liver dysfunction in cirrhosis of liver.

An elevated hepatic venous pressure gradient (HVPG) has been associated with risk of variceal bleeding, and outcome and survival after variceal bleeding. In this pilot study, we measured HVPG in 40 patients with liver cirrhosis and studied its relationship with etiology of liver disease, esophageal variceal size, history of variceal bleeding or ascites, biochemical liver tests and Child-Pugh class. There was no procedurerelated complication. The mean (SD) HVPG was similar in patients who had history of variceal bleeding as compared to those who did not (15.4 [2.8] mmHg vs. 13.9 [2.7] mmHg, p=0.1); HVPG had no significant association with etiology of cirrhosis (p=0.4). HVPG levels were significantly higher in patients with larger esophageal varices (grade III/IV vs. I/II: 15.2 [2.7] mmHg vs.13.1 [2.8] mmHg, p=0.04), poorer Child- Pugh class (B or C versus A), and presence of ascites (p=0.04). Thus, HVPG correlated with variceal size, Child-Pugh class, and presence of ascites, but not with variceal bleeding status.