Upper gastrointestinal endoscopy findings at Riyadh Armed Forces Hospital

To analyze the results of upper gastrointestinal endoscopic findings performed at Riyadh Armed Forces Hospital over a period of 15 years in 18,829 patients who were entered in the computer at the endoscopy unit. A retrospective study based on data of 18,829 patients who underwent upper gastrointestinal endoscopy. The data was entered into a computer with special codes for symptoms and endoscopic findings. Eighteen thousand eight hundred and twenty nine upper gastrointestinal endoscopy results were analyzed. Oesophagitis was found in 16.45%, Hiatus Hernia in 10%, Oesophageal varices in 7%, Oesophageal Cancer in 1.14%, Gastritis in 22%, Gastric erosions in 13.6%, Benign gastric ulcer in 3.29%, Gastric malignancy in 1.22%, Duodenal Ulcer in 14%, Duodenal erosions in 3.7% and Duodenitis in 12.7%. Only in 5.15% endoscopic findings were normal. In our analysis only 5.15% had normal upper gastrointestinal endoscopy findings while majority of patients had abnormal findings

Parasitic disease of the liver and biliary tree

Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. biliary tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliaiy tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobilialy parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography [ERCP] is safe and effective in diagnosis and management of biliary tree parasites

Significance of hepatitis B virus antibodies in Saudi patients with chronic hepatitis C infection

To study the clinical significance of antibodies to hepatitis B virus among 100 Saudi patients with chronic hepatitis C virus infection. The records of 100 patients with hepatitis C virus [HCV] infection who were admitted between November 1990 and January 1994 were retrospectively studied. These patients were classified into 3 groups according to their serological hepatitis B virus [HBV] status. Group one comprised of 43 patients lacking in HBV antibody and serving as controls. Twenty-nine patients in Group two were positive for HBcAb only, while Group three included 28 patients positive for both HBcAb and HBsAb. Patients with hepatitis C infection who had hepatitis B core antibodies [HBcAb] or both HBcAb and hepatitis B surface antibodies [ABsAb] were more likely to be cirrhotic as compared to sex and age, matched controls lacking antibodies to HBV [75.8%] and 80% respectively vs 48.5%]. When present, cirrhosis was more likely to be decompensated in patients with HBV antibodies as compared to controls [36% and 37.5%] vs 0% Child-Pugh's grade C. Number of hepatocellular carcinomas [HCC] appeared to be related to that of cirrhosis [28% and 34% vs 31% in controls]. It is concluded that patients with chronic hepatitis C virus infection have more severe liver disease when they have been previously infected by hepatitis B virus

Endoscopic ultrasonography in diagnosis of oesophageal submucosal lesion

We report a case of submucosal space occupying lesion detected on upper gastrointestinal endoscopy confirmed by the use of endoscopic ultrasonography as a solid submucosal tumour. This report indicates the usefulness of endoscopic ultrasonography in detecting and differentiating the nature of oesophageal submucosal mass

Endoscopic management of malignant biliary strictures: RAFH experience

To evaluate endoscopic management in patients with malignant biliary strictures. Retrospective study of all patients with malignant biliary strictures, who had endoscopic diagnosis and/or management between 1980 and 1993. During 14 years, 123 patients with malignant biliary strictures, had endoscopic diagnosis and management at the Gastroenterology Department, Armed Forces Hospital, Riyadh. Interventions: All patients had diagnostic endoscopic retrograde cholangiopancreatography [ERCP] and if possible sphincterotomy, nasobiliary tube insertion or biliary stricture dilatation and stent insertion to relieve biliary obstruction. Some patients were referred for surgery. Of these patients, 68 had cholangiocarcinoma, nine had gall bladder carcinoma, 16 had pancreatic head carcinoma, 23 had papillary carcinoma and seven had metastatic carcinoma. In 73 patients, biliary drainage was achieved endoscopically using nasobiliary tubes in 26 patients, plastic stents in 37 patients and expandable metal stents in 10 patients. In 13 patients only sphincterotomy or endoscopic choledochoduodenostomy were done. In the remaining 37 patients only diagnostic ERCP was done but endoscopic drainage was not possible and they were referred for surgery

Wide lumen metal stent in benign biliary stricture

In the last 10 years 44 patients with malignant stricture and 37 patients with benign stricture were diagnosed and managed in our unit. For both types of strictures we applied either a surgical, endoscopic or combined approach for managing these patients. In two patients with benign biliary stricture we performed endoscopic dilatations and/or single or double stenting repeatedly and despite performing the procedure [five times in one and 11 times in the other] and with the use of 7 or 10 French plastic stents, the outcome was disappointing and strictures were refractory to dilatation and long-term stenting. In these two cases we inserted large lumen metal stents with excellent outcome and no recurrence of cholangitis or any cholestasis. To our knowledge this was the first report on the use of metal stents in benign biliary strictures in Saudi Arabia

Causes of upper gastrointestinal bleeding: Experience at a major hospital in Riyadh

Over a period of 14 years, 1246 patients had emergency gastroscopy because of upper gastrointestinal tract [UGIT] bleeding. The endoscopic findings in these patients showed duodenal ulcer disease [DUD] in 364 [29.2%] was the most common followed by esophageal varices in 302 [24.2%], erosive gastritis in 198 [15.9%], gastroesophageal reflux disease [GERD] in 156 [12.5%], gastric ulcer in 69 [5.5%], and normal [negative] endoscopy in 132 [10.6%]. Only 65 [21.5%] patients with varices had active bleeding from the esophageal varices, 10 [3.3%] from the gastric varices and in 34 other patients with varices [11.3%], the bleeding was mainly from associated gastropathy. Eighty-six patients [23.6%] with DUD had active bleeding at endoscopy; 66 [80.5%] of these had ulcers showing stigmata of recent hemorrhage. Of those who had active bleeding, the source of the bleeding could not be identified in only five

Percutaneous management of liver hydatid cyst causing obstructive jaundice

Surgical treatment for liver hydatid cyst has been considered so far as standard therapy, but has a high recurrence rate as well as morbidity and mortality. We report a case of a 30-year-old Saudi male who presented with obstructive jaundice, secondary to a huge hydatid cyst of the liver of about 20 cm diameter. The cyst was compressing the right lobe of the liver and biliary tree causing the obstructive jaundice. There was no evidence for rupture of the cyst into the biliary tree; CT-guided percutaneous aspiration and drainage of the cyst was performed successfully. This was followed by irrigation of the cyst with hypertonic saline via retained intracystic pigtail catheters. Within the first 2 weeks the jaundice was resolved. Combined medical therapy of albendazole and praziquantel was also administered. The patient showed clear clinical improvement during regular follow-up. His repeated CT 4 months later showed disappearance of daughter cysts.The case illustrates the possibility of avoiding surgical management and it illustrates the successful percutaneous management of such a large hydatid cyst causing obstructing jaundice

Alpha interferon in treatment of chronic hepatitis C viral infection [CHCV]: Pilot study of 18 patients

Eighteen patients with chronic hepatitis C virus infection [CHCV] were treated with three million units of interferon [IFN] three times a week for a minimum of six months. Four [22.2%] had completely responded, two [11.1%] had partial response and the rest [eight or 44.4%] did not show any evidence of response. After stopping treatment, patients who had a complete or partial response developed a relapse during the follow-up period. Few reversible adverse effects of treatment were reported in more than half of the patients. So, we conclude that three million units of IFN three times weekly is not recommended for treating patients with CHCV. Perhaps a larger dose of five to six million units should be tried and for a longer duration

Albendazole in hydatid disease: results in 22 patients

A prospective study to evaluate the effect of albendazole in the treatment of echinococcus granulosus was conducted at the Gastroenterology Unit, Armed Forces Hospital, Riyadh since April 1985 to present involving 22 patients mainly with liver hydatid disease. Of these patients, 30% had a previous history of surgery for recurrence of previously operated hydatid cysts. The duration treatment and follow up period ranged from two months to three years. The only side effect was hair loss in two patients which was fully reversible on the termination of treatment. The following results were achieved: Radiological disappearance of the liver cysts were achieved in eight patients. Four of eight patients were treated only with albendazole and the other four patients with ruptured liver cysts to the biliary tree were treated with a combination of non-surgical endoscopic method, hypertonic saline irrigation and albendazole. In the remaining 14 patients, 5 [22.72%] had a 30% to 60% reduction in cyst size. Intracystic change was noted in five patients [22.72%], in two patients the cyst ruptured and there was no change in the cyst size in two patients [9.9%]. This study demonstrates that albendazole is a promising drug for the treatment of hydatid disease

Endoscopic biliary drainage of postoperative biliary fistulae and leak

Five consecutive patients with postoperative biliary fistulae or leak were diagnosed and treated successfully by endoscopic intervention The development of the fistulae were related to distal common bile duct obstruction by stones in four patients and in one patient by hydatid daughter cysts. Endoscopic sphincterotomy with stone or cyst extractions achieved decompression of the biliary system and initiated closure of the fistulae. In two patients, nasobiliary tube was used and endoscopic endoprosthesis was needed to close the fistula in another patient. In such cases, endoscopic management seems to be superior to surgical re-intervention for repair of fistulae or leak

Endoscopic choledochoduodenostomy [ECDT]: a practical approach to management of impacted papillary gallstones and ampullary tumors

We report five cases of impacted papillary stones and two cases of ampullary carcinoma treated by endoscopic choledochoduodenostomy [ECDT] at Riyadh Armed Forces Hospital [RAFH]. The procedure was carried out successfully in all five cases with impacted stones and in one of the two cases of ampullary carcinoma. No complications were noted. In the presence of the necessary endoscopic expertise and in cases of impossible cannulation of the papilla of Vater due to stone impaction or the presence of a papillary tumor, we recommend endoscopic choledochoduodenostomy [ECDT]. This approach provides an access to the common bile duct thus allowing appropriate therapeutic procedures on the biliary system to be performed