An experience of capsule endoscopy from a tertiary care hospital in Pakistan

To evaluate the effectiveness of capsule endoscopy in the management of patients with obscure gastrointestinal bleeding. A prospective descriptive study was conducted at surgical unit IV, Civil Hospital Karachi over a period of 2 years from December 2007 to November 2009. Twenty eight consecutive patients presenting with obscure gastrointestinal bleeding were included in the study. Patients having history of acute intestinal obstruction were excluded. Study was approved by the hospital ethical committee. Informed and written consent was taken from all the patients included in the study. The procedure was performed as day case. Patients were asked to swallow a capsule with a glass of water after an overnight fast and bowel preparation. Endocapsule [Olympus MAJ-1469] was used in the study. Examination was termed as complete when the capsule reached the caecum or incomplete if capsule failed to enter the caecum or the battery life was exhausted. Computer recordings were read by two examiners and finally results were interpreted. Follow up was done on telephone every 24 hours till the passage of capsule and then monthly for 4 months. In case of failure to pass the capsule after 14 days or adverse effects like vomiting, abdominal pain, an abdominal radiograph was obtained and decision regarding surgical intervention was made. A total of twenty eight patients were included in this study, 15 [53.6%] males and 13 [46.4%] females. Age of the patients ranged from 15-85 years [mean 56.25 +/- 19.6 years]. There were 8[28.6%] diabetics, 8[28.6%] hypertensives and 5[17.9%] hepatitis C positive patients. The indication for the capsule endoscopy was malena in 9 [32.1%], occult bleed in 18 [64.3%] and non specific abdominal pain in 1[3.6%]. Examination was completed in 22/28 [78.6%] patients while 6 [21.4%] patients had incomplete examination. In 2/28 [7.1%] patients endoscopic assistance was required to push the capsule through the pylorus. There was history of abdominal surgery in 3/28 [10.7%] patients prior to capsule endoscopy. Capsule entrapment occurred in 2/28 [7.1%] patients who were subjected to surgery. The results of capsule endoscopy showed ulceration and bleeding in distal ileum in 7 patients followed by Arterio Venous Malformation in 6 patients. The management and follow up was done accordingly. The diagnostic yield of CE in this study was 64.28% [18/28 patients].In a total of 28 patients referred for capsule endoscopy, bleeding was resolved in 13 patients [46.42%]. Capsule endoscopy is a well tolerated and safe examination of the small bowel with a diagnostic yield superior to radiological investigations

Pattern of malignant tumours in general surgical practice

To study the pattern of malignant tumours in relation to various variables like age, sex, histology, anatomical involvement, etc. A retrospective study from June 2001 to May 2007. Surgical Unit V of Civil Hospital, Karachi. All patients who presented with malignant tumours were included. The data of all the patients was collected from case sheets and analyzed. A total of 217 patients, 96 males and 121 females were included in this study. The most common tumour was carcinoma of the oespophagus [23 males, 32 females], followed by carcinoma of the breast in 42 females. There were no case of male breast cancer. Malignant tumours are commonly seen in surgical units. It is important to increase public awareness about them so that patients can present at an early stage for a better outcome