Epidemiology and survival analysis of gastrointestinal stromal tumors in lebanon: real-life study from a hospital tumor registry 2000-2015

Background: We report, to our knowledge, one of the largest studies concerning gastrointestinal stromal tumors [GIST] in the Middle East. We also present a survival analysis of GIST in our 15-year real-life experience

Methods: We studied demographic, epidemiologic and survival characteristics of 70 patients with confirmed GIST in a cross-sectional study between 2000 and 2015

Results: The .median age of our patients was 62 +/-12.8 years [range, 25-84] with a male to female ratio of 1.7. The gastric and the small intestine GIST were the most frequent primary sites. The majority of our patients had localized disease at diagnosis [81.4%]. Metastasis m limited to the abdominal cavity and lymph node spreadinc occurred in 14.3%. After a median follow up of 838 dap [range 48-4309 days] with only two patients reporte dead, two and five-year overall survival rates were 98% and 95% respectively. Median overall survival was not reached

Conclusion: In the light of our results, molecular profili of Lebanese patients with GIST would be of interest t detect the particularities responsible for the increase! overall survival and lymph node spreading

Treatment of achalasia by pneumatic dilatation [PD]: Local experience in treating 41 patients

L'achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter [LES] has abnormally high resting pressure and incomplete relaxation with swallowing. Pneumatic dilatation [PD] remains the first choice of treatment. Our aim was to report, in a retrospective way, our experience in treating with pneumatic dilatation 41 achalasia patients admitted to the gastroenterology unit at Hotel-Dieu de France [HDF] hospital between 1994 and 2004. A total of 46 dilatations were performed in 41 patients with achalasia [20 males and 21 females, the mean age was 46.8 years [range, 15-90]]. All patients underwent an initial dilatation by inflating a 35 mm balloon to 7 psi three times successively under fluoroscopic control. The need for subsequent dilatation with the same technique or for surgical treatment was based on symptom assessment. The mean follow-up period was 36.7 months [3 mo-7 years]. Among the patients whose follow-up information was available, a satisfactory result was achieved in 29 patients [805%] after only one or two sessions of pneumatic dilatation. Esophageal perforation as a short-term complication was observed in one patient [2.17%]. Seven patients were referred for surgery [one for esophageal perforation and six for persistent or recurrent symptoms]. In conclusion, performing balloon dilatation under fluoroscopic observation is simple, safe and efficacious for treating patients with achalasia. Referral to repeated PD or to surgical myotomy should be discussed in case of no response to a first session of PD

Factors predictive of clinical outcome in upper gastrointestinal bleeding

Upper gastrointestinal bleeding [UGIB] is a frequent life-threatening emergency resulting in a large number of hospital admissions. Upper endoscopy has a crucial role in the diagnosis and treatment of UGIB, however the characteristics of our patients and the impact of our practice in these cases are still limited. Our aim was to assess, in a prospective way, the predictive factors of mortality in patients admitted to the gastroenterology unit at Hotel-Dieu de France hospital during the years 2002-2003 and to establish predictive factors of prolongation of hospital stay and occurrence of complications. Our study included 96 consecutive patients. The sex ratio was equal to 1 with a mean age of 63.24 +/- 8.72 years. Most endoscopic exams[67.7%] were done after 24 hours of the onset of UGIB. Endoscopic accuracy was a high as 98.95% [95/96 cases] with the use of 2 endoscopic exams to localize the bleeding lesion in only 4 cases [4.2%]. Peptic ulcer was the main cause of UGIB [44.8%], followed by bleeding erosive gastritis or duodenitis [13.5%], variceal bleeding [10.4%], oesophagitis [10.4%], and Dieulafoy's lesions[6.3%]. Endoscopic treatment was performed in 33.3% of the patients. Permanent hemostasis was achieved in 81.3% of the patients. Permanent hemostasis was achieved in 81.3% of the patients at the first endoscopic intervention and in62.5% of the patients at the first endoscopic intervention and in 62.5% of the patients after rebleeding. Rebleeding and/or absence of hemostasis after endoscopic diagnosis were reported in 15.6% of patients. Emergency surgery was rarely necessary [6 cases]. The average number of blood units was 3.37 +/- 2.28 per patient. Coagulation disorders, chemotherapy treatment, shock at admission and absence of hemostasis were predictive of a transfusion higher than 2 blood units on multivariate analysis. The average length of hospital stay was 9.58 +/- 5.97 days. The overall mortality rate of 10.4% was correlated, on the basis of multivariate analysis to 1/ cirrhosis, 2/ creatinin level higher than 110 micro mil/l, 3/ hemoglobin level at admission lower than 5 g/dl, 4/ prothrombin time below 60% and 5/ defective hemostasis after endoscopic intervention. In conclusion, when UGIB occurs in cirrhotic or renal insufficient patients or in the presence of coagulation disorders and when it is massive and uncontrollable it will be associated with a bad prognosis. In these cases a more aggressive treatment may be able to improve their outcome

Cirrhosis and renal insufficiency influence of the value of creatinine on prognosis

Renal failure in cirrhosis has multiple etiologies and numerous aggravating factors with evidence of worsening of prognosis. Our study was performed on 130 cirrhotic patients hospitalized in HDF between January 1st, 1994, and December 31st, 1999. We have evaluated the causes of renal failure and the relation of different aggravating factors with the onset of renal failure. Causes of renal failure included drug-induced renal failure, organic nephropathy, pre-renal azotemia, acute tubular necrosis and hepato-renal syndrome. Among the aggravating factors, lactulose was found to alter renal function [p = 0.0175]. We studied the survival with respect to the serum creatinine levels and to the severity of liver disease. Three-year survival was respectively 59% and 42% in case of Child A and Child B patients with creatinine lower than 90 micro mol/L. No three-year survivors were noted in these subsets of patients when creatinine level was higher than 90 micro mol/L [p = 0.0247 and p = 0.0121 respectively]. No difference in survival was noted in Child C cirrhosis The occurrence of renal failure is a factor of bad prognosis in cirrhotic patients irrespective of Child's classification. In patients with Child A and Child B cirrhosis, a serum creatinine level higher than 90 micro mol/L is a bad prognostic factor with a significantly decreased survival rate. This factor does not affect survival in Child C cirrhosis because of mortality related to cirrhosis complications

Traitement endoscopique des lesions de Dieulafoy

Dieulafoy's lesion is a rare and important cause of gastrointestinal hemorrhage. It is a relatively large artery which lies in close proximity to the mucosal surface. Hemorrhage is often torrential and life threatening. Endoscopy is the most sensitive diagnostic test. Many reports described successful hemostasis utilizing a variety of endoscopic modalities in > 95% of cases. We report an upper gastrointestinal hemorrhage in a patient with Dieulafoy lesion treated successfully by injection, and a literature review