ABSTRACT
In unresectable malignant hilar obstruction, adequate biliary drainage can be achieved with endoscopic placement of plastic or metal stents. Stent patency and patient survival may differ, depending on the primary disease, disease progression and stent type. Metal and plastic stents were compared in patients with malignant hilar strictures in several studies, but these studies mainly included patients who had cholangiocarcinoma, without taking into consideration potential differences in the invasion properties of tumor cells, histological differentiation and the biological behavior of different tumors. Gallbladder cancer (GBC) is the most common malignancy of the biliary tract, especially in the Indian subcontinent and Latin America. About half the patients with GBC present with jaundice, which usually means the tumor is inoperable. Palliative endoscopic stenting remains the first-line treatment of unresectable GBC with biliary obstruction. Primary disease progression is faster in GBC compared to cholangiocarcinoma. There is a paucity of data on the selection of stents for inoperable GBC with hilar biliary obstruction. This review focuses on the published literature related to the selection of stents for unresectable GBC with hilar obstruction.
ABSTRACT
BACKGROUND AND AIM: Data regarding the comparison of colonoscopic preparation regimens are still variable. We aimed to assess the adequacy and tolerability of two bowel preparation regimens for afternoon colonoscopy. METHODS: In a randomized, investigator-blinded trial, two preparation regimens [4-L split-dose polyethylene glycol-electrolytes (PEG-ELS) and 2-L PEG-ELS plus bisacodyl) were compared in terms of bowel cleansing efficacy and adverse effects. RESULTS: The mean (±SD) age (years) of the 4-L split-dose PEG-ELS group (N = 147) and the 2-L PEG-ELS plus bisacodyl (N = 155) were 44.09 (±15.62) (M:F : 2:1) and 44.12 years (±15.61) (M:F : 1.7:1), respectively. Percentage of patients with excellent and good preparation was higher in the 4-L split-dose PEG-ELS regimen compared with the 2-L PEG-ELS plus bisacodyl regimen (22.44 vs 17.41 and 44.21% vs 36.12%). Percentage of patients with fair and poor preparation was lower in 4-L split-dose PEG-ELS regimen compared with the 2-L PEG-ELS plus bisacodyl regimen (21.08% vs 27.74% and 12.24% vs 18.70%). In comparison with the 2-L PEG-ELS plus bisacodyl group, the incidences of abdominal pain (11% vs 15%), bloating (9% vs 12.24%), nausea/vomiting (8.38% vs 9.52%), and sleep disturbance (11% vs 12%) were slightly more common in the 4-L split-dose PEG-ELS group. There were no statistically significant differences between the two regimens with regard to bowel cleansing efficacy and adverse events. CONCLUSIONS: The 2-L PEG-ELS plus bisacodyl (10 mg) preparation is as efficacious as the 4-L split-dose PEG-ELS regimen for afternoon colonoscopy. Optimal preparation for colonoscopy can be achieved with the 2-L PEG-ELS plus bisacodyl regimen with slightly fewer adverse events and lower cost compared to the 4-L split-dose PEG-ELS regimen.
ABSTRACT
AIM: To assess the vitamin D (VD) deficiency as a prognostic factor and effect of replenishment of VD on mortality in decompensated cirrhosis. METHODS: Patients with decompensated liver cirrhosis were screened for serum VD levels. A total of 101 VD deficient patients (< 20 ng/mL) were randomly enrolled in two groups: Treatment group (n = 51) and control group (n = 50). Treatment group received VD treatment in the form of intramuscular cholecalciferol 300000 IU as loading dose and 800 IU/d oral as maintenance dose along with 1000 mg oral calcium supplementation. The VD level, clinical parameters and survival of both the groups were compared for 6-mo. RESULTS: Prevalence of vitamin D deficiency (VDD) in decompensated CLD was 84.31%. The mean (SD) age of the patients in the treatment group (M:F: 40:11) and control group (M:F: 37:13) were 46.2 (± 14.93) years and 43.28 (± 12.53) years, respectively. Baseline mean (CI) VD (ng/mL) in control group and treatment group were 9.15 (8.35-9.94) and 9.65 (8.63-10.7), respectively. Mean (CI) serum VD level (ng/mL) at 6-mo in control group and treatment group were 9.02 (6.88-11.17) and 29 (23-35), respectively. Over the period of time the VD, calcium and phosphorus level was improved in treatment group compared to control group. There was non-significant trend seen in greater survival (69% vs 64%; P > 0.05) and longer survival (155 d vs 141 d; P > 0.05) in treatment group compared to control group. VD level had no significant association with mortality (P > 0.05). In multivariate analysis, treatment with VD supplement was found significantly (P < 0.05; adjusted hazard ratio: 0.48) associated with survival of the patients over 6-mo. CONCLUSION: VD deficiency is very common in patients of decompensated CLD. Replenishment of VD may improve survival in patients with decompensated liver cirrhosis.
