LONG TERM FOLLOW UP OF ESOPHAGEAL VARICES PATIENTS' AFTER ENDOSCOPIC BAND LIGATION PLUS ARGON PLASMA COAGULATION: 3 YEARS FOLLOW-UP

Background: Endoscopic band ligation (EBL) is an established maneuver for secondary prevention of variceal bleeding. However, recurrence of varices and postbanding ulcers are frequent problems. This is the first retrospective study that determined the the long-term re-bleeding rate in patients with esophageal varices who had done endoscopic Argon plasma photocoagulation (APC) after endoscopic band ligation. Aim: To determine the long-term re-bleeding rate of APC after endoscopic band ligation versus endoscopic band ligation alone for eradication of esophageal varices. Methods: Two hundred patients with cirrhosis, and had performed endoscopic band ligation for eradication of varices were randomized to either argon plasma coagulation after band ligation or observation. Endoscopy was performed every 3 months to check for recurrence of varices in both groups. If varices were unremarkable twice, patients were moved to every six months throughout the whole period of the study. Results: The 1-year, 2-year and 3-years rebleeding rates in the group of APC were 1%, 3% and 3%, respectively. While, rebleeding rates in the control group were 26%, 29% and 29% at 1-year, 2-years and 3-years respectively. Conclusions: The present study confirms the effectiveness of APC in significantly reducing the rate of rebleeding after endoscopic band ligation

Epidemiology of liver cancer in Nile delta over a decade: A single-center study

Background: In Egypt, there has been a remarkable increase in the proportion of hepatocellular carcinoma (HCC) among chronic liver diseases patients. This rising proportion may be explained by the increasing risk factors as hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, improvement of the diagnostic tools of HCC as well as the extended survival among patients with cirrhosis to allow time for some of them to develop HCC. The aim of this study was to study the epidemiology of HCC in Nile delta over the last decade. Methods: The study was carried out on patients diagnosed as HCC in liver cancer clinic in Tanta University Hospital, Egypt, from January 2005 to January 2015. This retrospective study reviewed the files of HCC patients with special stress on age, sex, residence, occupation, smoking, and viral markers. Results: Over the last decade, 1440 HCC patients were diagnosed or referred to liver cancer clinic in Tropical Medicine Department in Tanta University Hospital from January 2005 to January 2015. The mean age of HCC patients was 56.13 ± 9.53 years. Nearly, half of the patients with HCC were smokers and quarter of HCC patients were diabetics. HBV surface antigen-positive patients were only 3.26%, and the majority of patients were HCV-Ab positive (94.86% of patients). Conclusions: In Nile delta, hepatitis C rather than hepatitis B was linked to the development of HCC in our region which may be related to the high prevalence of HCV in this area

Pigtail Catheter: A Less Invasive Option for Pleural Drainage in Egyptian Patients with Recurrent Hepatic Hydrothorax

Background and Aims. Treatment of hepatic hydrothorax is a clinical challenge. Chest tube insertion for hepatic hydrothorax is associated with high complication rates. We assessed the use of pigtail catheter as a safe and practical method for treatment of recurrent hepatic hydrothorax as it had not been assessed before in a large series of patients. Methods. This study was conducted on 60 patients admitted to Tanta University Hospital, Egypt, suffering from recurrent hepatic hydrothorax. The site of pigtail catheter insertion was determined by ultrasound guidance under complete aseptic measures and proper local anesthesia. Insertion was done by pushing the trocar and catheter until reaching the pleural cavity and then the trocar was withdrawn gradually while inserting the catheter which was then connected to a collecting bag via a triple way valve. Results. The use of pigtail catheter was successful in pleural drainage in 48 (80%) patients with hepatic hydrothorax. Complications were few and included pain at the site of insertion in 12 (20%) patients, blockage of the catheter in only 2 (3.3%) patients, and rapid reaccumulation of fluid in 12 (20%) patients. Pleurodesis was performed on 38 patients with no recurrence of fluid within three months of observation. Conclusions. Pigtail catheter insertion is a practical method for treatment of recurrent hepatic hydrothorax with a low rate of complications. This trial is registered with ClinicalTrials.gov Identifier: NCT02119169