Endoscopic retrograde cholangio-pancreatographic diagnosis and extraction of massive biliary ascariasis presented with acute pancreatitis: a case report.

This paper reports the case of a young female Thai patient who presented with periodic severe abdominal pains which proved to be acute pancreatitis. Conventional investigations and treatments failed to prove and improve her condition. ERCP was done on the twelfth day after admission. 3 caudal ends of living round worms were noted protruding from the papillary orifice during endoscopy. Cholangiography revealed impacted multiple round worms in the common bile duct and both intrahepatic ducts. Endoscopic extraction of the worms was done by using dormia basket and removed with endoscope. Repeated procedure was done 21 times in two and a half hours, obtaining 26 live, mature Ascaris lumbricoides varying from 13 to 24 cm in length. Repeated cholangiogram confirmed complete removal of the worms. The patient was relieved from abdominal pain immediately after the procedure, and given oral albendazole 400 mg daily for 7 days. She was discharged asymptomatic 8 days after Ascaris removal.

Roxatidine versus ranitidine in the treatment of duodenal ulcer: a randomized, double blind, controlled, multicenter study in Thailand.

BACKGROUND: Roxatidine acetate is a novel H2-receptor antagonist and several studies have shown that it is effective in healing duodenal ulcers. We evaluated the efficacy of roxatidine in a non-western society with particular different features and its healing of duodenal ulcers was compared in Thailand with that of ranitidine. METHOD: The design was controlled, randomized, double-blind, and multicenter. The study recruited a total of 215 patients who were endoscoped at the start of the trial and then randomized to receive a single capsule of roxatidine acetate, 150 mg, or an identical capsule containing ranitidine, 300 mg, both to be taken at night. Patients were evaluated at 1, 2, and 4 weeks, including endoscopy at the last session, as well as at 6 weeks with repeat endoscopy if the ulcer had not healed. RESULT: Both drugs relieved pain rapidly, usually within a week, and at repeat endoscopy at 4 weeks most ulcers (78%) were healed, 77.0 and 79.5 per cent in ranitidine and roxatidine, and in those patients in whom healing was not completed the healing rate had risen appreciably to 89.8 and 93.8 per cent respectively at 6 weeks. Small ulcers tended to heal quicker than larger ones, but smoking and alcohol intake had no negative effects on the results. CONCLUSION: The study was valid proof that roxatidine, in a single evening dose of 150 mg, was found to be both safe and effective in the rapid healing of duodenal ulcers when compared with 300 mg ranitidine.

Causes of upper gastrointestinal bleeding in Thai patients: review of 5,000 upper gastrointestinal endoscopy.

Upper gastrointestinal endoscopies were performed in 5,000 patients who presented with upper gastrointestinal hemorrhage during a period of 20 years (between January 1973 and December 1992). The causes of bleeding were: peptic ulcer (G.U. & D.U.) in 51.24 per cent; acute mucosal lesion in 31.61 per cent; variceal bleeding in 8.20 per cent; Mallory-Weiss tears in 4.54 per cent; cancerous bleeding in 1.66 per cent; gastric polyps in 0.28 per cent and normal endoscopy in 2.46 per cent. The patients ages ranged from 12 to 91 years old and male to female ratio was 3.3: 1. The lesions found were 61.28 per cent in the stomach, 20.78 per cent in the duodenum and 15.48 per cent in the esophagus. The causes of bleeding could be detected in 97.54 per cent by endoscopy. No significant complications were encountered in the examinations. It was concluded that panendoscopy is a safe and useful procedure and should be done routinely as the primary diagnostic approach in the diagnosis of upper gastrointestinal bleeding.

Pancreas divisum: incidence and clinical evaluation in Thai patients.

Five hundred patients with successful pancreatogram between 1982 and 1990, 8 patients (1.6%) were found to have complete pancreas divisum. The sex distribution was equal (4 men, 4 women), and the average age was 42.5 years (22-77 years). No increased incidence of pancreas divisum in any of the three groups: a group with pancreatitis, a group with unexplained upper abdominal pain, and an incidental group (obstructive jaundice, gall bladder disease, abdominal mass, miscellaneous). These findings show that pancreas divisum is a normal anatomic variant with an incidence of 1.6 per cent in Thai patients, and is seldom a cause of pancreatic symptoms.

Endoscopic sphincterotomy in the treatment of acute gallstone pancreatitis.

Endoscopic sphincterotomy and removal of common bile duct stones were performed in 17 patients with acute gallstone pancreatitis. The procedure was successful in 16 patients (94.1%). The overall complications were 17.7 per cent (3 patients) without serious conditions. EST in acute gallstone pancreatitis is a safe and important procedure in the management of acute gallstone pancreatitis. This symptoms, and normalization of the laboratory technique can provide effective drainage, relief of findings in acute gallstone pancreatitis.

A prospective study of ERCP in the investigation of the patients after acute non-alcoholic pancreatitis.

ERCP was shown to be a safe diagnostic procedure within one week of resolution from acute pancreatitis in 46 patients. The bile duct was cannulated successfully in 95.7 per cent and the pancreatic duct in 89.1 per cent. The most common etiological factors in non-alcoholic acute pancreatitis were gall stone diseases (52.2%). ERCP was accurate in demonstrating the biliary causes of acute pancreatitis, and should be considered as a routine investigation for all suspected patients.

ERCP in diagnosis of adult choledochal cyst: report of five cases.

ERCP is the most reliable diagnostic technique, and should be used as the method of choice in the investigation of patients suspected of having choledochal cyst. This technique gives an accurate demonstration of both the biliary and pancreatic ducts. No complications occurred from the procedure.

Endoscopic sphincterotomy and removal of common bile duct stones in Police General Hospital.

Endoscopic sphincterotomy was attempted in 75 CBD stone patients. The procedure was successful in 62 patients (82.7%), and all duct stones were removed successfully in 59 patients (95.2% of successful EST). Immediate complications occurred in 7 patients (9.3%), who required no operation. No patient died. This procedure is a major therapeutic advance in the treatment of choledocholithiasis.

Omeprazole or cimetidine once daily for the treatment of duodenal ulcers?

Thai patients (n = 257) entered a double-blind randomized trial to compare omeprazole, 20 mg once daily, and cimetidine, 800 mg once daily for treatment of duodenal ulcer. The healing rates observed in the omeprazole and cimetidine groups were 65% versus 45% (P less than 0.01) at 2 weeks and 97% versus 85% (P less than 0.01) at 4 weeks. At the end of 4 weeks' treatment, omeprazole achieved equal healing rates (97%) for both large (greater than 10 mm) and small ulcers, whilst cimetidine healed large ulcers at a lower rate than that observed for small ulcers (71% versus 89%). There were significantly fewer reports of daytime epigastric pain after 2 weeks of omeprazole compared with cimetidine (P less than 0.01). No major clinical side-effects or changes in laboratory variables were detected during or after treatment with either drug. In conclusion, omeprazole (20 mg) was found to be superior to cimetidine (800 mg) administered once daily for the treatment of duodenal ulcer as measured by ulcer healing and pain relief.