The prevalence of nonalcoholic steatohepatitis in Thai patients with non-HBV, non-HCV chronic hepatitis.

This study aimed to determine the prevalence of nonalcoholic steatohepatitis in Thai patients with non-HBV, non-HCVchronic hepatitis. The clinical and laboratory findings associated with non alcoholic steatohepatitis were discussed. Forty-six patients with negative markers for viral hepatitis B and viral hepatitis C and no history of alcohol consumption or consumption less than 20 grams of ethanol per day were recruited. The informed consent for liver biopsy and blood collecting to identify the etiology of chronic hepatitis was performed. Most patients (76.1%) exhibited fatty metamorphosis of the liver which included steatosis (21.8%) as well as steatohepatitis (54.3%). Eleven of 46 patients (23.9%) were classified as cryptogenic chronic hepatitis. There were statistically significant differences between the fatty metamorphosis group and the cryptogenic chronic hepatitis group with regard to the fasting blood sugar, serum alkaline phosphatase, serum ferritin and histologically necroinflammatory grading score (p < 0.05). Between the steatosis group and the steatohe-patitis group, body mass index (BMI) was the only factor showing statistically significant difference (p = 0.02). Eight from 25 NASH-patients had diabetes mellitus (32.0%) and the AST to ALT ratio in this group was 0.6. The histopathological assessment for inflammation and fibrosis by using Knodell score, the fibrosis score which equal or higher than 3 was found in 20.0% of NASH-patients. CONCLUSION: The prevalence of NASH-patients in Thai patients, with non HBV, non HCV chronic hepatitis was 76.1%, while the liver biopsy can add the diagnostic yield especially in the group of unexplained chronic hepatitis with obesity, diabetes mellitus and dyslipidemia.

Feasibility and complications of endoscopic biliary drainage in patients with malignant biliary obstruction at King Chulalongkorn Memorial Hospital.

Currently the best curative therapy for primary malignant biliary tumor is surgery. Unfortunately, many patients present at a very late stage and only palliative biliary drainage is possible. Usually nonsurgical palliative biliary drainage means either percutaneous or endoscopic approach. In this series, the authors reported the rate of technical success and immediate complications in patients with malignant biliary obstruction who underwent endoscopic biliary drainage. From endoscopic retrograde cholangiopancreatography (ERCP) database between September 2000 and October 2001, there were 273 ERCP performed for obstructive jaundice. Of these, 50 patients with malignant tumor underwent 80 procedures for endoscopic biliary drainage. The patients were divided into three groups according to the cholangiographic findings and clinical diagnoses. Patients with carcinoma of the pancreatic head were categorized as group I (n=10). Group II (n=20) and III (n=20) were patients with extrahepatic cholangiocarcinoma and hilar cholangiocarcinoma respectively. All patients received either plastic or metallic endoprothesis placement for biliary drainage. All patients except two in group I had successful endoscopic treatment. Complications in group I, II and III were 15.4 per cent, 14.3 per cent and 53.1 per cent respectively. Only one patient in group II developed significant hypotension during the procedure. Another complication was defined as post procedure cholangitis. In conclusion endoscopic biliary drainage was technically feasible in 97.5 per cent of patients who had malignant biliary obstruction. In patients with hilar tumor the incidence of post procedure cholangitis was high (53.1%). Improvement in technique, avoiding unnecessary contrast injection, and draining the obstructed bile duct after injecting the contrast may improve the outcome and decrease the rate of post procedure cholangitis in these patients.