[Colonoscopic diagnostic findings in patients undergoing colonoscopy in Qom hazrat-e-masoome hospital during 2007-2008]

In recent years there have been noticeable changes in diagnosis and treatment of colon disorders by colonoscopy and direct vision. Along with its international development, this useful equipment is being used in Iran to treat various disorders. It should be mentioned that there are no exact statistics of these disorders to date. This study was done with aim of evaluating the diagnostic findings in patients undergoing colonoscopy in Qom during 2007-2008. This descriptive-cross sectional study was done on 500 patients having referred to colonoscopy ward of Hazrate-e-Masoome Hospital in Qom. After colonoscopy, patient data were entered into a special questionnaire and then pathologic findings were added to it. The data were taken for statistical analysis. Out of 500 patients undergoing colonoscopy 279 were male [55.8%] and 221 female [44.2%]. In all groups and both sexes the most common reason for carrying out colonoscopy was abdominal pain [46.6%] rectorrhagia [41%]. As regards diagnosis, a total of 199 cases [39.8%] of all 500 colonoscopies had normal colonoscopy,124 cases [24.8%] had hemorrhoid, 64 cases [12.8%] had polyp, 55 cases [11%] had inflammatory bowel diseases [IBD], 30 cases [6%] had tumor, 17 cases[3.2%] had diverticulosis and 12 cases [2.4%] had solitary rectal ulcer. There was a significant relationship between abdominal pain and tumor, polyp and diverticulosis. [p<0.001] There was also a significant relationship between age and the aforementioned disorders. [p<0.001] Based on the findings of this study, the prevalence of cancer and IBD is higher in men diverticulosis is higher in women. The highest prevalence of IBD was in the age group of 21-30 years. With an increase in age, the incidence rate of this disease decreases

[Celiac disease as a potential cause of idiopathic portal hypertension: a case report]

Celiac disease can be associated with various extra intestinal symptoms such as primary biliary cirrhosis and auto immune hepatitis but idiopathic portal hypertension is a very rare phenomenon. IPH patient typically has splenomegally, esophageal varices and sometimes Icter and ascitis. A case of IPH in a 38 year old woman with celiac disease. She had been suffering from Ascites, Splenomegally, malaise and apathy for several years and had undergone treatment for cryptogenic cirrhosis. Diagnostic re-examination of the patient such as Serology tests and markers from Wilson disease, auto immune and viral hepatitis showed negative reports, but her liver function test and ESR were prolonged In upper GI endoscopy esophageal varices was detected. Abdominal sonography reported moderate to severe splenomegally and rise of portal vein diameter but did not show any evidence of thrombosis. Liver biopsy revealed no sign of cirrhosis. But duodenal biopsy and serologic finding were compatible with celiac disease. Her symptoms improved on a gluten-free diet and her liver function test and ESR were normal

[Reusable design of esophageal band ligation device]

Variceal bleeding is one of the fatal complications of portal hypertension. There are several remedies for this problem but all of them have their own side effects. The treatment of choice is "endoscopic band ligation" but the high cost of the available instrument on the context of its single use design, is considered its only disadvantage [1.600.000 rials per session]. Therefore, many patients avoid purchasing the instrument.However, we decided to design a reusable device by reloading the original one, using suitable elastic bands and sophisticated deployer nodes taking into account easy use and high efficacy of this treatment modality. Instead of the available granules, a series of special and very suitable nodes was employed for stretching and deployment of the bands.Also, a conical piece was designed to insert bands on cap as a dilator. Hemorrhoid ligation bands [the product of Endo Flex, Germany] were used instead of bands of the original device. Results: Ten node types were consequentially tested on sample and endoscopic device and if suitable, were tested on endoscope and patients thereafter. Node "61" was the fittest among [complete success rate in 429 deployments]. The cost of new designed device is equal to 20.000 rials, which is very low compared to the original one. The new designed reloadable band ligator instrument is very economic and according to accomplished experiments, it has the same quality as the original one. Then, it would be suitable for both patient and physician to use new instrument for endoscopic band ligation

Efficacy and complications of endoscopic balloon dilation in treatment of benign gastric outlet obstruction

Gastric outlet obstruction [GOO] due to peptic stricture is one of three known complications of peptic ulcer disease and usually requires therapeutic intervention for symptoms relief. After Benjamin SB who primarily used balloon dilation for treatment of GOO in 1982, some series has been published investigating procedure efficacy with different results. The purpose of this study is to investigate efficacy of balloon dilation in some Iranian patients with GOO and also the probable role of some other factors on responsiveness. 23 patients were enrolled in a 10 month duration prospective case study and followed for mean of 30 weeks. some factors such as gender, age, cigarette smoking, Helicobacter pylori [H.p] infection, stenosis diameter, symptom duration, degree of weight loss, dilation sessions, response to therapy and time to response after procedure were registered for each patient. Mean age was 49.5 years and most patients were in the 5th decade of life. 2 and 23 of patients [8.7% and 91.3%] were female and male, respectively. the most common symptoms among patients were epigastric fullness and heart burn [each 87% of patients], nausea [82.6], vomiting [78.3%] and pain [69.6%]. 21 out of 23 patients were asymptomatic at end of study. 18 of 21 patients with response to therapy underwent only one session of dilation. There was not any statistically significant correlation between response to therapy and any one of factors as, gender, H.p infection, cigarette smoking, symptom duration and stenosis diameter. Time to response was shorter in males comparing to females [2.7 vs 8 weeks respectively] [p=0.002]. Trans the scope [TTS] balloon dilation of GOO in short term is effective and safe. if in long term, symptom recurrence rate proves to be acceptable, it will be recommended as first line treatment of benign GOO. Also it seems that use of fluoroscopy has not any additional advantage in increasing efficacy of the procedure