Long-term effect of argon plasma coagulation [APC] in the treatment of gastric antral vascular ectasia [GAVE]

Gastric antral vascular ectasia [GAVE] is a distinct vascular abnormality, mainly involving the gastric antrum. It is a rare but well-known cause of occult gastrointestinal bleeding. Various endoscopic treatment modalities have been tried in this condition. The aim of the study is to show the long-term effect of argon plasma coagulation [APC] on GAVE. Twenty-nine patients with endoscopically proved GAVE were enrolled in the study. Clinical assessment of GAVE patients, haemoglobin [Hb] level and transfused blood units were recorded after APC using 60-80-W power setting. A second session was done 1 month after the therapeutic procedure to ensure complete ablation of all lesions. The documented Hb levels and number of blood units transfused 3 months after APC were recorded. At endoscopy, all patients had the classic type of GAVE. The mean Hb level increased from 7.5 +/- 1.7 g dl[-1] before APC to 10.2 +/- 0.8 g dl[-1] after APC [p value <0.001]. The transfusion requirements significantly decreased to 0.2 +/- 0.5 units/patient [p value <0.001]. Endoscopic APC is a safe, effective and inexpensive modality in treating GAVE and could be an alternative to the currently available endoscopic methods

value of bile cytology in the diagnosis and early detection of malignancy in patients with obstructive jaundice

Bile was aspirated from 20 patients suffering from obstructive jaundice [10- males and 10 females] during endoscopic cholangiography [ERCP]. The patients were assessed clinically, by laboratory investigations, abdominal ultrasonography, ERCP, operative biopsy and by cytology. This is to determine the presence of malignancy as an underlying cause for the obstruction and to evaluate the diagnostic accuracy of bile cytology obtained during ERCP. The results of 19 cases were divided into two main groups where group A consisted of 10 malignant cases and 5 benign cases. One case showed false positive diagnosis and no false negative. Group B included 4 atypical smears which were considered benign until proved otherwise [I proved histologically benign the others were found to be malignant]. The sensitivity calculated for group A was 100% and 75% for group B, the specificity was 83.3% for A and 85.7% for B. The diagnostic accuracy was 93.3% for A and 78.9 for group B. The results of this pilot study are quite encouraging with respect to the reliability of diagnosis of bile samples particularly in association with ERCP, it can be considered as a simple reliable, rapid method for preoperative evaluation of patients with obstructive jaundice and for the early detection of malignancy in screening programs

Endoscopic management of obstructive jaundice

One hundred and sixty-seven patients with obstructive jaundice underwent successful ERCP over the past 6 months. In 121, endoscopic interventions were carried out to relief obstruction. Stones were demonstrated in 80 patients with a dilated common bile duct [CBD], 16 had in addition, gall stones and 2 had also stones in the cystic duct, stone extraction was successful on the first attempt in 71.3% of cases. In 5% of cases, stone extraction was successful on the second attempt. Extraction failed in 23.8% of cases, from these, 3 patients were subjected to mechanical endoscopic lithotripsy, 3 other patients were referred to shock wave lithotripsy after insertion of a nasobiliary tube. Tumors were found in 38 patients. Endoscopic stenting was successful in 84.2% of cases and failed in 15.8%. Stricture was diagnosed in 35 patients with sclerosing cholangitis in 4 of them. Choledochal cyst was diagnosed in 5 patients [type 1 in one case, type 3 in 2 patients who were subjected to endoscopic puncture and type 4 in 2 patients]. A pseudopancreatic cyst was diagnosed and was endoscopically drained in one patient. A single case of fascioliasis envading the common bile duct was diagnosed as was a case of hemibilia

Campylobacter pyloridis in gastric carcinoma

25 radical gastrectomy specimens and 4 autopsy control stomachs were selected, consisting of 7 well differentiated, 6 moderately differentiated adenocarcinomas and 12 poorly differentiated carcinomas [including anaplastic, signet ring and poorly differentiated adenocarcinomas]. H and E and PAS stained slides from the tumour and the adjacent tumour free mucosa were screened for Campylobacter pyloridis [C. pyloridis]. 9 out of the 25 neoplasm specimens [36 percent], demonstrated the organism which was prevalent in the more differentiated carcinomas. The incidence of C pyloridis in the adjacent mucosa presenting with active gastritis was [56.2 percent] and nearly half the positive tumours were also associated with C. pyloridis positive adjacent mucosa. The controls and the gastritis free mucosa around the neoplasma did not show the organisms