Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

AIM To detect risk factors for post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) and investigate the predictors of its severity.METHODS This is a prospective cohort study of all patients who underwent ERCP.Pre-ERCP data,intraoperative data,and post-ERCP data were collected.RESULTS The study population consisted of 996 patients.Their mean age at presentation was 58.42(± 14.72) years,and there were 454 male and 442 female patients.Overall,PEP occurred in 102(10.2%) patients of the study population; eighty(78.4%) cases were of mild to moderate degree,while severe pancreatitis occurred in 22(21.6%) patients.No hospital mortality was reported for any of PEP patients during the study duration.Age less than 35 years(P = 0.001,OR = 0.035),narrower common bile duct(CBD) diameter(P = 0.0001) and increased number of pancreatic cannulations(P = 0.0001) were independent risk factors for the occurrence of PEP.CONCLUSION PEP is the most frequent and devastating complication after ERCP.Age less than 35 years,narrower median CBD diameter and increased number of pancreaticcannulations are independent risk factors for the occurrence of PEP.Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

Lack of estrogen receptors expression in malignant and pre-malignant colorectal lesions in Egyptian patients

Background: incidence of Colorectal cancer (CRC) is increasing globally. In Egypt, CRC ranks the sixth most common cancer in males and the fifth in females. Aim: To assess the expression of estrogen receptors (alpha and beta) in pre-malignant (adenomatous polyps and IBD), malignant colorectal lesions and normal colonic mucosa in group of Egyptian patients. Methods: This prospective study was done on 45 patients presenting with colonic symptoms, patients were divided into four groups;15 CRC patients, 10 patients with adenomatous polyps, 10 IBD patients and 10 patients in the control group. Patients subjected to: Stool analysis, FOBT, CBC, CEA, Abdominal ultrasound & colonoscopy and biopsy (number = 80), Pathological, immunohistochemistry and RT- PCR quantification of ERα and ERβ were done. Results: Mean age: 39.2 (12 - 73), gender: M/F: 28/17. Bleeding per rectum was the commonest presentation;29/45 (64.4%). CEA was significantly elevated in the CRC group compared with other studied groups (1692 mg/L vs. 4.0, 4.0 and 4.4 mg/L). Ultrasonography of the studied patients showed that metastatic CRC: 3/15 (20%);Colonic wall thickening: 5/15 (33.3%), 1/10 showed colonic polypoidal lesions in adenomatous polyps groups, in IBD group: 4/10 (40%) showed colonic and ileocecal thicknening. All the studied patients showed negative results for estrogen receptors (alpha and beta) by the use of immunohistochemistry staining and RT-PCR technique. Conclusion: Role of estrogen receptors in the colonic mucosa, precancerous and colorectal cancer is doubtful, contradictory results with some literature data could be due to racial and genetic difference in the studied population.

Prevalence of occult hepatitis C in egyptian patients with non alcoholic fatty liver disease

This study aim is to assess the prevalence of occult HCV infection among Egyptian patients with non alcoholic fatty liver disease (NAFLD) with elevated AST and ALT, and to correlate presence of occult HCV with severity of liver disease. Patients and Methods: After informed consent 27 patients with elevateed liver enzymes diagnosed as NAFLD were examined for demographic, clinical, laboratory data and Ultrasonography. Liver biopsy was done and tested for HCV RNA in tissue. Genotyping using RFLP analysis of PCR products in the 5’NCR was done for positive cases. Results: HCV RNA in tissue was positive in 11/27 patients (40.7%);genotype was 4a in all positive cases. AST and ALT values showed significantly lower values in occult HCV than the non HCV NAFLD group. Liver biopsy of studied patients showed no significant difference as regard inflammation and fibrosis according to METAVIR score. Conclusions: Occult HCV is highly prevalent among Egyptian NAFLD patients. It seems to induce a mild liver disease. Patients with elevated ALT and negative HCV RNA in sera might be investigated for tissue HCV RNA. Follow up is recommended for the occult HCV patients to monitor progression to overt disease.