Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis

Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan? (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to société fran?aise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan? at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880;P = 0.272];0.588 [0.436 - 0.739;P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.

Duodenal Metastases of Malignant Melanoma: One Case Report

The duodenal metastases of a malignant melanoma are rare. We report a case at a 86-year-old, hypertense patient, without tumoral history, who was hospitalized in our department for a change of the general state and an anaemia ferriprive without found home (foyer) of display. In the clinical examination, we had found anemia syndrome, nodules under cutaneous about 2 cm in diameter at the level of the thorax, of the belly, the members and of the lower lip partners in a painless left adenopathy axillary about 3 cm in diameter and an absence of méléna in the rectal touch. The gastroscopy had highlighted polypoides ulcéro-bourgeonnantes hurts with a blackish pigmentation by places at the level of the bulb and of the second duodenum. In the histology of biopsie fragments, we noted a fuso-cellular proliferation and epithelioid with deposits of melanin. The positivity of antibodies anti-protein S100 and anti HMB45 in the immunohistochemical study allowed confirming the diagnosis. The gastroduodenal hurts, persons suffering from a liver complaint and lungworts in the scanner testify of a terminal metastatic scattering. The death arose two months later, in a picture of circulatory collapse further to a high digestive bleeding of big abundance.

Endoscopic profile of caustic burns of the university hospital center of Cocody Abidjan / Côte d’Ivoire

Background:To determine the clinical and endoscopic demographic characteristics of the ingestion of acidic products in the digestive endoscopy unit of the Cocody University Hospital.Methods:This was a retrospective,descriptive and analytical study on endoscopic reports,which took place for five years,from January 1,2014,to December 31,2018.All patients were admitted to the digestive endoscopy unit with the indication of ingestion of caustic products.The parameters studied:are demographic,clinical,and endoscopic.The statistical tests used were Pearson’s CHI 2 and Fisher’s exact tests.The significance threshold was set at 5%.Results:83 patients were included for an endoscopic prevalence of 1.33%.The mean age was 20.77±16.58 years,with extremes ranging from 1 to 63 years.They were divided into 34 men and 49 women for a sex ratio of 0.69.Accidental circumstances were observed in 73.49%of cases,followed by attempted autolysis(26.51%).Bleach was the most offending caustic(75.90%),followed by hydrochloric acid(14.46%).FOGD was normal in 53.01%and revealed stage I(41.54%)digestive lesions,followed by stage II(35.39%)and stage III(21.53%).The lesions were preferentially gastric(36.11%),esogastroduodenal(27.78%),and esogastric(22.23%).Based on severity,54.55%of esophageal lesions were stage IIA,53.12%were stage I gastric lesions,and 54.55%were stage IIA duodenal lesions.One case of gastric perforation was noted(1.54%).In univariate analysis,we found a statistically significant link between the age group of 1–14 years and the accidental intake of caustics(P<0.001)on the one hand and the other hand between the age group of 26 years and over and taking for autolysis(P=0.02).Likewise,bleaching was responsible for less severe lesions(P=0.006).Conclusions:The seriousness of the ingestion of caustic products requires early,specialized and multidisciplinary management to improve the short,medium,and long-term prognosis of patients.