[Surveillance for hepatocellular carcinoma: does it work?]

Background: The surveillance of cirrhotic patients for early detection of hepatocellular carcinoma is recommended but its efficacy is now discussed

The aim of our study was to present the results of a screening program in 110 patients

Methods: it is a retrospective study that included 110 patients with cirrhosis in a screening program of hepatocellular carcinoma, based on the realization of abdominal ultrasound exam and the determination of alpha-fetoprotein amount every 6 months in 95 patients and every 3 months in 15 patients

Results: the mean duration of the surveillance was 36 months. A hepatocellular carcinoma was diagnosed in 13 patients. Curative treatment was done in only 3 cases and consisted in a hepatic resection in 1 patient and an alcoolisation in 2 cases. Ten patients had new treatment: for 8 patients the discussed was very aggressive and 2 patients had a server hepotic failure

The cost of this study was 37.500 Tunisian dinars

Conclusions: systematic screening for hepatocellular carcinoma offer a limited cost effectiveness ratio

[Biliary abnormalities associated to portal cavernoma: about 17 cases]

Portal biliopathy is a newly introduced term, describing the changes observed in the biliary ducts secondary to extrinsic compression by the portal cavernoma. It's a rare condition that is usually not diagnosed. To explore the principles of diagnosis and treatment of portal biliopathy. Seventeen patients with extrahepatic portal vein obstruction were reviewed prospectively. Symptomatic biliary obstruction was found in 82%. Endoscopic retrograde cholangiography revealed abnormality of the bile duct wall in all cases, with stricture in 11 patients. Endoscopic treatment was necessary in 10 patients. Whether portosystemic shunting was done only in 2 cases. Portal biliopathy is frequent and must be diagnosed early

Traitement endoscopique de la lithiase residuelle a propos de 661 cas

Endoscopic sphincterotomy is a well-established procedure for treating choledocolithiasis and particularly residual lithiasis. The aim of this study is to expose our experience with this method and to evaluate its safety and efficacy. It is a retrospectively collected series of 661 patients with residual choledocolithiasis. Endoscopic retrograde cholangio-pancreatographies were performed in 651 patients [98.5%]. Standard sphincterotomy was realized in 633 patients [95%] and a pre-cut technique was done in 15 [2%]. Bile duct clearance was achieved in 583 cases [91%]. Overall, the complication rate of sphincterotomy was about 8.4%. Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis