The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography

BACKGROUND:Mirizzi syndrome is a rare complication of cholelithiasis,characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct.In this study,we aimed to describe the clinical presentations,investigations,operative details,and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center. METHOD:We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography. RESULTS:The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopan- creatography.Ultrasonography was able to diagnose one case.Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients.Four patients had cholecystectomy and T-tube placement,and two had cholecystectomy and choledochoduodenostomy.One patient with typeⅠMirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy. CONCLUSIONS:In the study,the incidence of Mirizzi syndrome was 1.07%of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopicretrograde cholangiopancreatography is important to prevent complications.

H pylori iceA alleles are disease-specific virulence factors

AIM: To characterize and compare genotype profiles of H pylori strains isolated from patients with chronic gastritis and duodenal ulcer in western part of Turkey. METHODS: A total of 46 patients [30 chronic gastritis (CG) and 16 duodenal ulcer (DU)] who had undergone endoscopy because of dyspeptic complaints were studied. The antral biopsy specimens were evaluated for the presence of H pylori by rapid urease test and culture, and the genotype profiles were determined by real-time PCR. RESULTS: The cagA gene was observed in 43 (93.5%) isolates. The vacA s1m2 genotype was the predominant subtype, found in 63.3% and 68.7% of isolates in patients with CG and DU, respectively. Twenty (66.6%) isolates from patients with CG were iceA2 positive while the iceA1 was predominant in those with DU (68.8%). In terms of the association of the iceA alleles to other genes, both alleles were significantly associated with the cagA vacA s1m2 genotype. CONCLUSION: The prevalent circulating genotypes in CG and DU were cagA vacA s1m2 iceA2 and cagA vacA s1m2 iceA1 genotype, respectively. It was found that cagA vacA s1m2 genotype seems to be common virulence factors in both CG and DU while iceA alleles show specificity for gastroduodenal pathologies in this study.