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Emara MH, Mazid U, Elshaer YA, Elkerdawy MA, Malik DF, Mahros AM. Trauma to the solid abdominal organs: The missed dark box of colonoscopy. World J Gastroenterol 2024; 30:624-630. [PMID: 38515946 PMCID: PMC10950622 DOI: 10.3748/wjg.v30.i7.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Usama Mazid
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Yasmine A Elshaer
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | | | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Emara MH, Mahros AM, Rasheda AMA, Radwan MI, Mohamed B, Abdelrazik O, Elazab M, Elbatae H. Schistosomal (bilharzial) polyps: Travel through the colon and beyond. World J Gastroenterol 2023; 29:4156-4165. [PMID: 37475844 PMCID: PMC10354569 DOI: 10.3748/wjg.v29.i26.4156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/18/2023] [Accepted: 03/29/2023] [Indexed: 07/10/2023] Open
Abstract
Schistosomiasis (bilharziasis) is a major neglected tropical disease. It is endemic in many tropical and subtropical communities. Schistosomal polyps (S. polyps) are not uncommon presentation of this infection. Although the colon is the most commonly affected organ, many other organs are affected. S. polyps are associated with a variable range of morbidity independent of the Schistosomal infection. S. polyps are frequently described in endemic areas and increasingly reported in non-endemic areas mainly among immigrants and visitors to the endemic areas. This review aimed to increase awareness of practitioners, especially gastroenterologists, for this peculiar type of polyps caused by this neglected infection hence improving patient outcomes. Web-based search of different databases was conducted for the literature focusing the development of S. polyps in the colon and other organs with analysis of the clinical manifestations, diagnosis and treatment. The following key words were used in the search, “Schistosomiasis” OR “Bilharziasis” AND “Polyps” OR “Polyp” AND “Colon” OR “Small intestine” OR “ Duodenum” OR “ Stomach” OR “Esophagus” OR ” Gallbladder” OR” Pharynx” OR “Larynx” OR “Trachea” OR ”Urinary bladder” OR “ Ureter” OR “Renal Pelvis” OR “Urethra”. All publication types including case reports, case series, original research, and review articles were retrieved and analyzed. S. polyps are not infrequent presentation of acute or chronic Schistosomal infection. S. polyps are described in many organs including the bowel, genitourinary tract, skin, gallbladder and the larynx. Presentation of S. polyps is variable and depends on the site, number as well as the polyp size. The relationship of S. polyps to malignant transformation is a matter of discussion. Presence of S. polyps is sometimes the only manifestation of Schistosomiasis. Small polyps can be treated medically with praziquantel, while large accessible polyps are amendable for endoscopic excision through different polyp resection techniques. However, huge, complicated, non-accessible and suspicious polyps are indicated for surgical management or advanced endoscopic resection when appropriate. Clinicians and endoscopists should be aware about these facts when treating patients living in, immigrated from or visiting endemic areas.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Abdelrahman M Ahmed Rasheda
- Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Ryiadh 11481, Saudi Arabia
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Besher Mohamed
- Department of Gastroenterology, Surrey and Sussex Hospitals NHS Trust, Surrey RH1 5RH, United Kingdom
| | - Osama Abdelrazik
- Department of Hepato-Gastroenterology and Infectious Diseases, Al-Azhar University, Cairo 11651, Egypt
| | - Mostafa Elazab
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Hassan Elbatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Emara MH, Zaghloul M, Amer IF, Mahros AM, Ahmed MH, Elkerdawy MA, Elshenawy E, Rasheda AMA, Zaher TI, Haseeb MT, Emara EH, Elbatae H. Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics. World J Hepatol 2023; 15:216-224. [PMID: 36926231 PMCID: PMC10011914 DOI: 10.4254/wjh.v15.i2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/25/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Ibrahim F Amer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Eslam Elshenawy
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Abdelrahman M Ahmed Rasheda
- Department of Internal Medicine, Gastroenterology Unit, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Tarik I Zaher
- Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mona Talaat Haseeb
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Hassan Elbatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Emara MH, Zaghloul M, Abdel-Gawad M, Makhlouf NA, Abdelghani M, Abdeltawab D, Mahros AM, Bekhit A, Behl NS, Mostafa S, Piscoya A, Abd-Elsalam S, Alboraie M. Effect of COVID-19 on gastrointestinal endoscopy practice: a systematic review. Ann Med 2022; 54:2875-2884. [PMID: 36369765 PMCID: PMC9665076 DOI: 10.1080/07853890.2022.2133163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the emergence of the novel corona virus (SARS-Cov-2) in the late 2019 and not only the endoscopy practice and training but also the health care systems around the globe suffers. This systematic review focused the impact of Corona Virus Disease (COVID-19) on the endoscopy practice. METHODS A web search of different databases combining different search terms describing the endoscopy practice and the COVID-19 pandemic was done. Articles were screened for selection of relevant articles in two steps: title and abstract step and full-text screening step, by two independent reviewers and any debate was solved by a third reviewer. RESULTS Final studies included in qualitative synthesis were 47. The data shown in the relevant articles were evident for marked reduction in the volume of endoscopy, marked affection of colorectal cancer screening, impairments in the workflow, deficiency in personal protective equipment (PPE) and increased likelihood of catching the infection among both the staff and the patients. CONCLUSION The main outcomes from this review are rescheduling of endoscopy procedures to be suitable with the situation of COVID-19 pandemic in each Country. Also, the endorsement of the importance of PPE use for health care workers and screening of COVID-19 infection pre-procedure.Key messagesThe data focussing Gastrointestinal Endoscopy and COVID-19 emerged from different areas around the globe. The data presented on the published studies were heterogeneous. However, there were remarkable reductions in the volume of GI endoscopy worldwideStaff reallocation added a burden to endoscopy practiceThere was a real risk for COVID-19 spread among both the staff and the patients.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Mariam Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt
| | - Nahed A Makhlouf
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdelghani
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Abdeltawab
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Ahmed Bekhit
- Department of Gastroenterology, Sharqia Health Directorate, Sharqia, Egypt
| | - Nitin S Behl
- Institute of Gastro and liver Diseases, Fortis Hospitals, Ludhiana, India
| | - Sadek Mostafa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Alejandro Piscoya
- Department of Gastroenterology, Hospital Guillermo Kaelin De la Fuente - EsSalud, Lima, Peru.,Systematic Reviews and Meta-analysis, Clinical Practice Guidelines and Health Technology Assessments Unit, Universidad San Ignacio Loyola, Lima, Peru
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
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Abdel-Gawad M, Zaghloul MS, Abd-Elsalam S, Hashem M, Lashen SA, Mahros AM, Mohammed AQ, Hassan AM, Bekhit AN, Mohammed W, Alboraie M. Post-COVID-19 Syndrome Clinical Manifestations: A Systematic Review. Antiinflamm Antiallergy Agents Med Chem 2022; 21:115-120. [PMID: 35346011 DOI: 10.2174/1871523021666220328115818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022]
Abstract
Background Coronavirus disease-2019 (COVID-19) is a global pandemic health problem
that causes a wide spectrum of clinical manifestations and considerable mortality rates. Unfortunately,
recovered patients who survive COVID-19 may continue to report a wide variety of clinical
manifestations of multisystem affection such as pulmonary embolism, deep vein thrombosis,
acute myocardial infarction, depression, anxiety, myalgia, dyspnea, and fatigue. Objective We aimed to summarize the current literature regarding the prevalence of post-COVID-
19 manifestations. Methods We conducted a systematic review of post-COVID-19 manifestations by searching
MEDLINE via PubMed, Scopus, Web of Science (WOS), EBSCO, Wily, and World health organization
(WHO) databases. Screening, study selection, data extraction, data synthesis, and quality
assessment were made by two independent reviewers. Results Of 1,371 references, 817 references remained after removing duplicates. Reviews, case
reports, commentaries, and any article containing non-original information were excluded. According
to the eligibility criteria for this systematic review, 12 studies were included for qualitative
synthesis. The overall prevalence of post-COVID-19 manifestations ranged from 35% to 90.5%.
Fatigue, dyspnea, neuropsychological disorders, and pain were the most frequent post-COVID-19
symptoms. Conclusion This systematic review showed that 35% to 90.5% of recovered patients who survive
COVID-19 continue to have a wide variety of clinical manifestations, including fatigue, dyspnea,
neuropsychological disorders, and pain as the most frequent post-COVID-19 symptoms.
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Affiliation(s)
- Muhammad Abdel-Gawad
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut, Egypt
| | - Mariam S Zaghloul
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Sherief Abd-Elsalam
- Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
| | - Mai Hashem
- Department of Tropical Medicine, Gastroenterology, and Hepatology, Assiut University, Assiut Egypt
| | - Sameh A Lashen
- Department of Internal Medicine, Alexandria University, Alexandria, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Ahmed Q Mohammed
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut, Egypt
| | - Amro M Hassan
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut, Egypt
| | - Ahmed N Bekhit
- Department of Gastroenterology, Sharqia Health Directorate, Sharqia, Egypt
| | - Weam Mohammed
- Family Medicine, Sudan Medical Specialization Board, Sudan
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
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Makhlouf NA, Abdel-Gawad M, Mahros AM, Lashen SA, Zaghloul M, Eliwa A, Elshemy EE, Ali-Eldin Z, Abdeltawab D, El-Raey F, Omran D, Khalaf M, Fanous N, Abdelmohsen AS, Abu-Elfatth A, Abdelghani M, Farouk M, Abdelaziz M, Alboraie M. Colorectal cancer in Arab world: A systematic review. World J Gastrointest Oncol 2021; 13:1791-1798. [PMID: 34853651 PMCID: PMC8603455 DOI: 10.4251/wjgo.v13.i11.1791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/08/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing among young individuals in the Arab world as well as in other regions of the world. AIM To explore the incidence and prevalence of CRC in the Arab world. METHODS The PubMed, Scopus, Web of Science, EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year. The search terms were "("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal") AND ("cancer OR malignancy OR malignant OR neoplasm") AND ("Jordan" OR "United Arab Emirates" OR "Bahrain" OR "Tunisia" OR "Algeria" OR "Djibouti" OR "Saudi Arabia" OR "Sudan" OR "Syria" OR "Somalia" OR "Iraq" OR "Oman" OR "Palestine" OR "Qatar" OR "Comoros" OR "Kuwait" OR "Lebanon" OR "Libya" OR "Egypt" OR "Morocco" OR "Mauritania" OR "Yemen"). Reviews, meta-analyses, and articles containing nonoriginal data were excluded. Retrieved articles were screened, and relevant data were extracted. Descriptive statistics were used for data analysis. RESULTS Nine studies were included. Five of the studies provided information regarding the prevalence of CRC. The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate, while in Egypt, it ranged from 0.4% to 14%. Four studies showed information regarding the incidence. The annual incidence rate of CRC in Qatar was 7.5/100000/year. In Egypt, the crude incidence rate (CIR) in males was 3.1 for colon cancer and 1 for rectal cancer, while in females, it was 2.3 for colon cancer and 0.8 for rectal cancer. The age-standardized rate for CRC incidence in 2003 was 36.90 for males, 26.50 for females, and 30.49 for both sexes in Saudi Arabia. In 2016, the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer, respectively, while in males, it was 3.3 and 2.8 for colon cancer and rectal cancer, respectively. One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old. CONCLUSION There is a considerable prevalence of CRC in some Arab countries. More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.
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Affiliation(s)
- Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Muhammad Abdel-Gawad
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Al-Azhar University, Assiut 71631, Egypt
| | - Aya M Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafrelsheikh 33656, Egypt
| | - Sameh A Lashen
- Department of Internal Medicine, Alexandria University, Alexandria 21521, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafrelsheikh 33656, Egypt
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Eman E Elshemy
- Department of Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo 11651, Egypt
| | - Zainab Ali-Eldin
- Department of Internal Medicine, Ain Shams University, Cairo 11646, Egypt
| | - Doaa Abdeltawab
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Fathiya El-Raey
- Department of Hepatogastroenterology and Infectious diseases, Faculty of Medicine, Al-Azhar University, Damietta 34511, Cairo, Egypt
| | - Dalia Omran
- Department of Endemic Medicine, Cairo University, Cairo 12613, Egypt
| | - Marwa Khalaf
- Department of Tropical Medicine and Gastroenterology, Assiut Liver Center, Assiut 71511, Egypt
| | - Nancy Fanous
- Department of Gastroenterology, Hepatology and Endoscopy, Police Authority Hospital, Cairo 12654, Egypt
| | - Ahmed Shawkat Abdelmohsen
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Abu-Elfatth
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Abdelghani
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Farouk
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Abdelaziz
- Department of Clinical Oncology and Nuclear Medicine, Al-Azhar University, Cairo 11824, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
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Abstract
BACKGROUND AND PURPOSE The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents. PATIENTS AND METHODS Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed. RESULTS Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps. CONCLUSION Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Mohammed Hussien Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Ahmed S Mohammed
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Radwan
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
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8
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Amer IF, El Shennawy EM, El Batea H, Ahmed MH, El Sharawy S, Mahros AM. Accuracy of noninvasive tests in the prediction of portal hypertensive gastropathy in Egyptian patients with cirrhosis. JGH Open 2021; 5:286-293. [PMID: 33553669 PMCID: PMC7857295 DOI: 10.1002/jgh3.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/23/2022]
Abstract
Background and Aim Liver cirrhosis (LC) is commonly associated with portal hypertensive gastropathy (PHG), and it causes gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard in diagnosing PHG. Besides its invasiveness, the disadvantages of EGD include psychological and financial problems. We aimed to evaluate the diagnostic accuracy of different noninvasive screening tools in predicting PHG. Methods This cross‐sectional study was conducted on 100 patients with LC who were divided into two groups based on EGD: group (A), 50 patients with LC with PHG, and group (B), 50 patients with LC without PHG. All patients were subjected to history taking, full clinical examination, laboratory investigations, abdominal–pelvic ultrasonography, and EGD. Results To predict PHG, the respective sensitivity and specificity of portal vein diameter (>10.5 mm) were 86 and 67%, of gallbladder wall thickness (GBWT) (>3.5 mm) were 64 and 68%, of platelets/GBWT (<40) were 68 and 78%, of aspartate aminotransferase (AST)/platelet ratio index (APRI) score (>1.1) were 60 and 66%, of platelet/spleen diameter (<1290) were 88 and 72%, of right liver lobe diameter/albumin ratio (>4) were 74 and 80%, and of AST/alanine aminotransferase (ALT) ratio (>1.1) were 50 and 58% (P = 0.353). Conclusion Portal vein diameter, platelet/spleen diameter, and right liver lobe diameter/albumin ratio were independently associated with PHG and were good predictors of the PHG, whereas AST/ALT ratio and King score are poor predictors.
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Affiliation(s)
- Ibrahim F Amer
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Eslam M El Shennawy
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Hassan El Batea
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Mohammed Hussien Ahmed
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Shimaa El Sharawy
- Tropical Medicine Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Aya M Mahros
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
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Emara MH, Zaghloul MS, Mahros AM, Ema EH. Choledocho-nodal Fistula: Uncommon Cause of Obstructive Jaundice in a Patient with HCC Diagnosed by Combined ERCP/EUS. J Clin Imaging Sci 2021; 11:32. [PMID: 34221641 PMCID: PMC8247659 DOI: 10.25259/jcis_57_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
A 58-year-old male patient presented with advanced hepatocellular carcinoma underwent transarterial chemoembolization (TACE) for hepatic focal lesions followed by TACE for a solitary hilar nodal metastasis combined with regorafenib therapy. One month later, the patient developed progressive jaundice. Work-up showed obstructive jaundice with intrahepatic biliary radicles dilatation. The diagnosis and treatment was achieved by combining endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography and showed uncommon cause of obstructive jaundice due to common bile duct compression by a choledocho-nodal fistula following TACE of a metastatic hilar lymph node.
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Affiliation(s)
- Mohamed H. Emara
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
- Corresponding author: Mohamed H. Emara, Departments of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, 33516, Kafr Elshikh, Egypt.
| | - Mariam S. Zaghloul
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
| | - Aya M. Mahros
- Department of Hepatology, Gastroenetrology and Infectious Diseases, Kafrelshiekh University, Kafr Elshikh, Egypt
| | - Emad H Ema
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, Egypt
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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