[Surveillance for hepatocellular carcinoma: does it work?]. / Faut il encore depister le carcinome hepatocellulaire chez le cirrhotique? Etude prospective a propos de 110 cas.

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 agressive 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]. / Les anomalies biliaires associees au cavernome porte. A propos de 17 cas.

UNLABELLED: 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. OBJECTIVE: To explore the principles of diagnosis and treatment of portal biliopathy. METHODS: seventeen patients with extrahepatic portal vein obstruction were reviewed prospectively. RESULTS: 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. CONCLUSION: Portal biliopathy is frequent and must be diagnosed early.

[Hepatic localization of sarcoidosis: about 2 cases]. / Atteinte hepatique au cours de la sarcoïdose: a propos de deux observations.

Sarcoidosis is a disseminated disease defined by the presence of non-caseous granulomas. We report 2 cases of hepatic sarcoidosis in a 55- year old men and in 38- year old women. Sarcoidosis was diagnosed during a systematic examination in a patient and through the search for extra-digestive localizations in the other. We will try to focus on the main clinical, therapeutic features of this disease.

[Endoscopic treatment of residual lithiasis. 661 cases]. / Traitement endoscopique de la lithiase residuelle a propos de 661 cas.

AIM: 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 his safety and efficacy. METHODOLOGY: It is a retrospectively collected series of 661 patients with residual choledocolithiasis. RESULTS: 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%. CONCLUSION: Endoscopic sphincterotomy is a safe and effective procedure for patients with residual choledocolithiasis.

[Gastrointestinal angiodysplasia: about 54 cases]. / L'angiodysplasie gastro-intestinale: à propos de 54 cas.

UNLABELLED: Angiodysplasia is an arteriovenous malformation which can reach the entire gastrointestinal tract and especially the colon. Its management is often difficult. The aim of this study was to assess the clinical, topographic and therapeutic characteristics of angiodysplasia. METHODS: it is a retrospective study including 54 cases of GI angiodysplasia collected over 13 years. RESULTS: the mean age was 62 years: 66% were males. Angiodysplastic lesions were predominantly located in the colon (85%). Nine patients required an endoscopic treatment. Electrocoagulation wases used in 8 cases and a sclerotherapy in 1 case. Surgical resection was necessary in 2 patients which died of the after-effects of surgery. CONCLUSION: angiodysplasia is a common etiology of chronic lower GI bleeding particularly in the elderly.

[Pneumatic dilatation in esophageal achalasia. Report of 61 cases]. / Interet de la dilatation pneumatique dans le traitement de l'achalasie de l'oesophage. A propos de 61 cas.

UNLABELLED: To assess the interest of pneumatic dilatation in patients with achalasia. MATERIAL AND METHODS: The work has interested 61 patients with achalasia who underwent pneumatic dilatation using polyethylene balloon (Rigiflex) dilators. 74 sessions of dilatation were performed and 13 patients underwent 2 sessions of dilatation (21%). One patient presented un esophageal perforation requiring a surgical treatment. The outcome was good on 88.9% and 83.3% of the patients after respectively one and six months. These results illustrate the interest of pneumatic dilatation in achalasia, which have to be proposed in the first line of the treatment.

[Gastric and colonic sarcoidosis. A case report]. / Sarcoidose gastrique et colique. A propos d'un cas.

Sarcoidosis is a disseminated disease defined by the presence of non-caseous granulomas. Digestive localizations are rare and the stomach is the mostly affected. The diagnosis is frequently difficult. We report the case of a digestive (gastric and colic) and hepatic sarcoidosis in a 38-year old woman. The clinical and endoscopic findings initially suggested linitis plastica. Subsequently the discovery of gastric granulomas led to the diagnosis of sarcoidosis. Coloscopy and abdominal scan were performed discovering a colic, hepatic and splenic localizations which were asymptomatic.