[Stomach cancer: a descriptive study of 101 cases at the gastrointestinal endoscopy center at Aristide Le Dantec University Hospital]

INTRODUCTION

Stomach cancer is a real public health problem in Black Africa. We report its epidemiological, endoscopic, and histological aspects, as observed in our gastrointestinal endoscopy center at Aristide Le Dantec University Hospital in Dakar (Senegal).

PATIENTS AND METHODS

This retrospective study covered the 5-year period from January 1, 2006, to December 31, 2010 and included all patients with stomach cancer confirmed by anatomo-pathological examination. We collected data about age, sex, indications for the examination, and description of the gastric lesions and any other associated lesions from the upper GI endoscopy reports. We also recorded information from the histological reports of all lesions.

RESULTS

The study included 101 patients. The incidence of gastric cancer was 20 cases/year. Patients’ mean age was 58 years [range: 24-83]. The sex ratio was 2.48. The main indications for the upper GI endoscopy were epigastralgia (33.3%), vomiting (26.1%), and tumoral hepatomegalia (10.81%). The examination found mainly ulcerative and protruded lesions (59.40%). Other types of lesions associated with the tumor were esophageal candidiasis (34.6%), peptic esophagitis (25%), and gastroesophageal junction incompetence (25%). The tumor was located in the antrum in 68% of the cases and was an adenocarcinoma in 83.2%.

CONCLUSION

A cancer register to determine the characteristics and prevalence of stomach cancer in Senegal would be useful. The link with Helicobacter pylori requires further study.

[Endoscopic aspects of toxic ingestions during attempted suicides at Lome Campus teaching hospital (Togo)]

GOAL

To describe the epidemiological, clinical, and endoscopic aspects of attempted suicides treated in the gastroenterology department of Lome Campus Teaching Hospital.

METHODS

This retrospective study examined data collected over a 5-year period for patients admitted for attempted suicide by consumption of toxic substances (for example, caustics, medications, and insecticides) and who had an upper gastrointestinal endoscopy. Caustic lesions are described according to Di Costanzo's classification.

RESULTS

Of 3075 admissions in the department during the study period, 35 (1.14%) were admitted for attempted suicide. Only 21 of these cases (60%) met our inclusion criteria. The patients' mean age was 25.86 years old, and 71% were female. These attempted suicides were most frequent among high school and college students (52%). The ingested substances were mostly caustic in nature (13 cases). Twenty patients (95%) were admitted less than 12 hours after the suicide attempt. The dominant symptoms at the department were abdominal pain and throat inflammation. Ten patients had an upper gastrointestinal endoscopy within 24 hours after the attempt. In the case of caustic ingestion, severe lesions (IIb, III) represented 53% of the cases. An esophageal stricture was noticed on the patient admitted 45 days after a suicide attempt by ingestion of a caustic substance.

CONCLUSION

The frequency of attempted suicides is underestimated here because most patients are admitted to the internal medicine or psychiatric departments. Caustic substances were the main substances used and caused severe lesions.

Esophageal involvement in Bullous pemphigoid: Case report

Bullous pemphigoid is a rare chronic autoimmune dermatologic blistering disease that usually affects elderly patients. Mucosal lesions are present in about 10%-35% of cases and affects most frequently the mucous membranes of the eye or the mouth. Esophageal involvement is possible but is rare (4% of cases). It could be asymptomatic, or presents with dysphagia, odynophagia, chest pain, or upper gastro-intestinal bleeding. We report the case of a recently diagnosed bullous pemphigoid in a 73-years-old female with normochromic normocytic anemia due to vitamin B12 deficiency who was referred to our unity for esophagogastroduodenoscopy. Our endoscopic examination revealed two bullae filled with blood at upper esophagus with linear ulcerations and membrane detachment upon withdrawal of the endoscope. Although bullous pemphigoid is mainly a skin disease, invasion of esophagus needs to be considered especially when symptoms are present or when no cause was found for blood loss or anemia.

[Upper Digestive Endoscopy at Zinder National Hospital: Indications and Results]

OBJECTIVE

to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital.

MATERIALS AND METHODS

this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH.

RESULTS

the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polyp.

CONCLUSION

Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients.

Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial

BACKGROUND

The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method.

METHODS

This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects.

RESULTS

A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group.

CONCLUSION

The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.

[Upper Digestive Endoscopy at Zinder National Hospital: Indications and Results]

OBJECTIVE

to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital.

MATERIALS AND METHODS

this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH.

RESULTS

the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27 Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polyp.

CONCLUSION

Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients.

RLLB/Alb ratio: a promising noninvasive diagnostic marker in assessing esophageal varices in cirrhotic patients

BACKGROUND

Endoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non-invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital.

PARTICIPANTS AND METHODS

A total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades.

RESULTS

The upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut-off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa (r = 0.630, p < 0.001).

CONCLUSION

The RLLD/Alb ratio is a non-invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.