Endoscopic ultrasound-guided biliary drainage

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is emerging as a safe and effective alternative for endoscopic BD. The advantage of multiple access points from stomach and duodenum allows EUS-BD in patients with altered surgical anatomy and duodenal stenosis. EUS-BD is also useful in patients with failed endoscopic retrograde cholangiopancreatography or difficult biliary cannulation. Depending on the access and exit route of the stent, a variety of EUS-BD procedures have been described. Trans-papillary as well as trans-luminal stent placements are possible with EUS-BD. Recent studies have shown a clinical success rate in excess of 90% and complication rates of < 15%. Prospective studies are needed to know the long-term results and relative efficacy of this technique.

Clinical predictors of resectability of pancreatic adenocarcinoma

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery. A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information [age, gender], height, weight, body mass index, historical data [smoking, comorbidities], symptoms [abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color], jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor. A total of 61 patients were included, the mean age was 61.2 +/- 1.51 years, 25 [41%] were females. The tumors were located in the head [83.6%], body [10.9%], tail [1.8%], and in multiple locations [3.6%] of the pancreas. Half of the patients [50%] had Stage four, 16.7% stages two B and three, and only 8.3% were stages one B and two A. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 [95% confidence interval, 0.42-0.98], whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma. This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

accuracy of multi-detector row computerized tomography in staging rectal cancer compared to endoscopic ultrasound

Our aim was to evaluate the diagnostic accuracy of multi-detector row computerized tomography [MDCT] in staging of rectal cancer by comparing it to rectal endoscopic ultrasound [EUS]. We prospectively included all patients with rectal cancer referred to our gastroenterology unit for staging of rectal cancer from December 2007 until February 2011, 53 patients whose biopsy had proven rectal cancer underwent both MDCT scan of the pelvis and rectal EUS. Both imaging modalities were compared and the agreement between T- and N-staging of the disease was assessed. We staged 62 patients with rectal cancer during the study period. Of these, 53 patients met the inclusion criteria and were evaluated [25 women and 28 men]. The mean age was 57.79 +/- 14.99 years [range 21-87]. MDCT had poor accuracy compared with EUS in T-staging with a low degree of agreement [kappa = 0.26], while for N-staging MDCT had a better accuracy and a moderate degree of agreement with EUS [kappa = 0.45]. MDCT has a poor accuracy for predicting tumor invasion compared to EUS for T-staging while it has moderate accuracy for N-staging

Helicobacter pylori prevalence among medical students in a high endemic area

To evaluate the prevalence of Helicobacter pylori [H. pylori] among Saudi medical students. Volunteer medical students were randomly selected in the College of Medicine, King Saud University, Riyadh, Saudi Arabia from January 2005 to May 2005. A urea breath test [UBT] was performed for each medical student. Important demographic data was recorded. Each student had to answer a questionnaire on upper gastrointestinal [UGI] symptoms before the UBT. A total of 120 students were recruited [73 males [61%] and 47 females [39%]] with a mean age of 22.2 years [age varied from 18 to 28 years]. The prevalence of H. pylori was surprisingly low at 35%, compared to a previously reported high prevalence among the Saudi population [80%]. Thirty-one percent of medical students reported>/=1 UGI symptom with no significant differences between the positive and negative UBT results. Although there was a trend, there was no significant prevalence difference between the preclinical and the clinical group of students. We found a low prevalence of H. pylori in our young university medical student's population. The low prevalence of H. pylori in this young population may have important clinical and economic implications