[Surveillance for hepatocellular carcinoma: does it work?]

BACKGROUND

The surveillance of cirrhotic patients for early detection of hepatocellular carcinoma is recommended but its efficacy is now discussed. The aim of our study was to present the results of a screening program in 110 patients.

METHODS

it is a retrospective study that included 110 patients with cirrhosis in a screening program of hepatocellular carcinoma, based on the realization of abdominal ultrasound exam and the determination of alpha-fetoprotein amount every 6 months in 95 patients and every 3 months in 15 patients.

RESULTS

the mean duration of the surveillance was 36 months. A hepatocellular carcinoma was diagnosed in 13 patients. Curative treatment was done in only 3 cases and consisted in a hepatic resection in 1 patient and an alcoolisation in 2 cases. Ten patients had new treatment : for 8 patients the discussed was very agressive and 2 patients had a server hepotic failure. The cost of this study was 37.500 Tunisian dinars.

CONCLUSIONS

systematic screening for hepatocellular carcinoma offer a limited cost effectiveness ratio.

[Biliary abnormalities associated to portal Cavernoma. About 17 cases]

Portal biliopathy is a newly introduced term, describing the changes observed in the biliary ducts secondary to extrinsic compression by the portal cavernoma. It's a rare condition that is usually not diagnosed.

OBJECTIVE

To explore the principles of diagnosis and treatment of portal biliopathy.

METHODS

seventeen patients with extrahepatic portal vein obstruction were reviewed prospectively.

RESULTS

symptomatic biliary obstruction was found in 82%. Endoscopic retrograde cholangiography revealed abnormality of the bile duct wall in all cases, with stricture in 11 patients. Endoscopic treatment was necessary in 10 patients, whether portosystemic shunting was done only in 2 cases.

CONCLUSION

Portal biliopathy is frequent and must be diagnosed early.

[Hepatic localization of sarcoidosis: about 2 cases]

Sarcoidosis is a disseminated disease defined by the presence of non-caseous granulomas. We report 2 cases of hepatic sarcoidosis in a 55- year old men and in 38- year old women. Sarcoidosis was diagnosed during a systematic examination in a patient and through the search for extra-digestive localizations in the other. We will try to focus on the main clinical, therapeutic features of this disease.

[Gastrointestinal angiodysplasia: about 54 cases]

Angiodysplasia is an arteriovenous malformation which can reach the entire gastrointestinal tract and especially the colon. Its management is often difficult. The aim of this study was to assess the clinical, topographic and therapeutic characteristics of angiodysplasia.

METHODS

it is a retrospective study including 54 cases of GI angiodysplasia collected over 13 years.

RESULTS

the mean age was 62 years: 66% were males. Angiodysplastic lesions were predominantly located in the colon (85%). Nine patients required an endoscopic treatment. Electrocoagulation wases used in 8 cases and a sclerotherapy in 1 case. Surgical resection was necessary in 2 patients which died of the after-effects of surgery.

CONCLUSION

angiodysplasia is a common etiology of chronic lower GI bleeding particularly in the elderly.