The Elastic Ligation of Internal Hemorrhoids: Where Are We Now?

Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.

Viral Hepatitis B during Chronic Inflammatory Bowel Diseases at Fez University Hospital: Prevalence and Risk Factors

Patients with chronic inflammatory bowel diseases (IBD) have long been considered at risk for viral hepatitis B. However, recent epidemiological studies have found similar prevalence, or even lower than in the general population. The objective of this work is to determine the prevalence of viral hepatitis B (HVB) during IBD, to determine the risk factors in the service of Hepato-gastroenterology of university hospital Hassan II-Fez, and of evaluate the impact on therapeutic management. PATIENTS AND METHODS: This is a retrospective study, spread over a period of 17 years and a half (January 2001-June 2017). All patients treated for IBD who are tested for Hbs Ag and anti Hbcwere included. The HVB DNA levels were tested in case of positivity of HbsAgor anti Hbc. Results: Over the study period, 755 patients were included. The average age of our patients was 35 years [14 - 87] with a sex-ratio H/F of 0.67. We had 391 cases (51.8%) of Crohn’s disease (CD) and 364 cases (48.2%) of ulcerative colitis (UC). Anti HBctest was positive in 1.98% of cases (N = 15). In these patients, HBsAg was positive in 1.19% of cases (N = 9). The prevalence of HVB was 2.55% in CD (N = 10) versus 1.37% in UC (N = 5). In our work, no history of surgery, digestive endoscopy or transfusion has been shown to be a risk factor for viral transmission. CONCLUSION: The prevalence of HVB in IBD is similar to that of the general population. The safety of blood transfusions and the improvement of asepsis probably explain these results. However, the risk of viral reactivation during HVB, sometimes fatal under immunosuppressive treatment, requires systematic screening.

Interest of Sclerosing Injections in Hemorrhoidal Pathology: Experience of the Service of Hepato-Gastroenterology of Fez

Hemorrhoids are a clinical and anatomical subject that has not been completely investigated [1]. This benign condition is expressed by intermittent functional manifestations as rectorrhagies and prolapse. while the medical treatments seek to relieve symptoms, the instrumental ones are intended to reposition and hold the hemorrhoids in an anatomically correct position and to reduce their vascularity [1]. Indeed, sclerotherapy seems an effective and safe method in fact. Aim of the Study: To report the results of a moroccan series of patients treated with sclerosing injections, emphasizing short- and long-term efficacy as well as the rate of complications. Methods: This is a descriptive retrospective study of the 148 patients with symptomatic internal hemorrhoids who have been treated with sclerotherapy in the gastroenterology department of the university medical center of Fez over a period of 17 years [2001-2018]. Results: The average age of our patients is 47.1 years [19 - 86]. We notified a large male predominance with a sex ratio M/F 2.58. Rectorrhagies and prolapse were the most frequent reasons for consultation;they were respectively notified in 96% (n = 143) and 83% of patients (n = 123). Anemia was found in 45 cases (30.4%), of which 29 cases required transfusion. Proctologic examination found internal hemorrhoids grade 2 in 83% (n = 124) and grade 1 in 16.2% (n = 24) of patients. Initial success was found in 119 cases (80.4%) after an average of 2.25 sessions (1 - 4). Nine patients (8, 11%) had minor complications dominated by minimal rectorrhagies in 8 cases, resolved spontaneously. In 29 cases (19.5%), the sessions were interrupted following a failure of the technique in 12 cases (41.3%), in 11 cases after change of the stage of hemorrhoids of stage II to III, in 4 cases following the appearance of an anal fissure contraindicating the procedure, and in 2 cases due to severe pain post sclerosis. Among these 29 cases, 13 patients were referred for surgery, while in 16 patients we opted for an instrumental treatment by ligature. The initial evolution was specified with a average follow-up of 3 months (1 - 13 months). The recurrence rate was 22.3% (N: 33 cases) after an average follow-up of 9.5 months (1 - 48 months). In the long term (over one year) and in the short term, the recidivism rate was 6% (n = 9 cases) and 16.2% (n = 24) respectively. Among recurrent patients, the sclerosis protocol was repeated in 20 patients (60.6%) with a success rate of 85%;for the remaining 13 patients, we opted for elastic ligation in 4 patients, and for surgery in 6 patients, while 3 patients were lost to follow-up. Conclusion: Since the end of the XIX century, sclerosis has been an instrumental technique, simple, inexpensive, and effective for the treatment of symptomatic internal hemorrhoids of grades 1 and 2, allowing good results in the long run, with minimal risk of complications.

Is there a correlation between endoscopy and imaging findings in Crohn’s disease

Background and Aims: Crohn’s disease is a chronic inflammatory bowel disease (IBD). Endoscopy and radiology play an important role in the diagnosis and management of this specific disease. The ability of each of these two tests to detect the gastrointestinal involvement (ulceration, stenosis, fistula, polyp, mucosal thickening) varies according to the type of Crohn’s lesions. The purpose of our study was to evaluate the correlation between these two diagnostic methods in the detection of those specific lesions in 70 patients diagnosed with Crohn’s Disease (CD) during the period of 3 years. Methods: In this retrospective study, including 70 patients with Crohn’s disease, Four major characteristic lesions (ulceration, stenosis, fistula and polyps) were studied by endoscopy and radiological exams to evaluate the relationship between endoscopy and imaging findings in the detection of these lesions. The analysis of our results was made by statistical analysis system: EpiInfo and SPSS. Results: The concordance of each of these diagnostic modalities is average for stenosis and fistulas and low diagnostic significance for ulcers and polyps. However, the imaging features of mucosal thickening are sensitive but not specific.

Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414 cases)

Peritoneal tuberculosis is still common in Morocco. Its diagnosis is based on several methods. Laparoscopy with directed biopsies is still considered as the referenced method. The aim of our work is to show the place and the importance of laparoscopy in the diagnosis of peritoneal tuberculosis through the study of various endoscopic aspects. Materials and Methods: This is a retrospective descriptive study extended from January 2001 to December 2011. We collected 414 cases of isolated ascites confirmed by ultrasonography. Different parameters were analyzed: epidemiological data, indications of laparoscopy and its results and complications. Results: The average age of our patients was 38 years (range: 8 years - 90 years) with a female predominance (sex ratio F/M: 2.3). Abdominal ultrasound performed in all patients has confirmed the presence of ascites in 100% of cases. Based on clinical data (soft or tense abdomen) and ultrasound (free or partitioned ascites), we performed a standard laparoscopy in 313 cases and open laparoscopy in 101 cases. The presence of granules was noted in 318 cases (76.8%). Peritoneal tuberculosis was found in 81.5% of cases with small whitish granulations distributed homogeneously, while peritoneal carcinomatosis was confirmed in 86.8% of patients with large granules distributed inhomogeneously. The presence of adhesions was observed in 33% of cases with peritoneal tuberculosis, while it was mentioned in only 2.8 cases of carcinomatosis. Conclusion: Despite the development of imaging means, ascitic fluid culture and PCR (polymerase chain reaction), laparoscopy remains indispensable for an early diagnosis of peritoneal tuberculosis and adequate management.