Hospital Endoscopy Unit Research Articles

Appropriateness of colonoscopies in a Tunisian endoscopy center: factors and EPAGE-I/II criteria comparison

BackgroundThere is a growing demand for colonoscopy, worldwide, resulting in increased rate of inappropriate referrals. This “overuse” of colonoscopies has become a major burden for health care.Objectivesto assess the appropriateness of colonoscopies performed at the endoscopy unit of the university hospital of Sousse and to compare these results of appropriateness according to the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) I and EPAGE II criteria.Patients and methodsthis cross-sectional study included all consecutive patients referred for a diagnostic colonoscopy, between January 2017 and December 2018. Patients referred for exclusively therapeutic indications, those with incomplete colonoscopies were not included. Patients with poor bowel preparation or missing data were also excluded. Indications were assessed using the EPAGE I and EPAGE II criteria.ResultsFrom 1972 consecutive patients, 1307 were included. Overall, 986 (75.4%) of all referrals were for out-patients. The majority of patients were referred by gastroenterologists (n = 1026 patients; 78.5%), followed by general surgeons (n = 85; 6.5%). The commonest indications were lower abdominal symptoms (275; 21%) followed by uncomplicated diarrhea (152; 11.6%). Relevant findings were present in 363 patients (27.7%). Neoplastic lesions were the dominant finding in 221 patients (16.9%). EPAGE I and EPAGE II criteria were applicable for 1237 (88.8%) and 1276 (97.7%) patients respectively. Hematochezia and abdominal pain recorded the highest inappropriate rates with both sets of criteria. Appropriate colonoscopies increased to 76.4% when EPAGE II criteria were applied; whereas uncertain and inappropriate procedures decreased to 10.3% and 10.9% respectively Appropriateness of indication was significantly higher in hospitalized patients. For the EPAGE II criteria, the specialty of the referring physician was also significantly associated to the appropriate use. The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version of k (k = 0.153).ConclusionsThe updated and improved EPAGE II guidelines are a simple and valid tool for assessing the appropriateness of colonoscopies. They decreased the inappropriate rate and the possibility of missing potentially severe diagnoses.

Stricture dilation via balloon-assisted endoscopy in Crohn's disease: approach and intraprocedural outcomes with the single-balloon and double-balloon systems.

Despite recent emerging literature involving the utility of endoscopic balloon dilation (EBD) of strictures via balloon-assisted endoscopy (BAE), specifically regarding the management of Crohn's disease (CD), the optimal clinical approach with balloon systems has been largely neglected in academic literature. This study assesses the intra-procedural success and safety of EBD via BAE for small bowel CD strictures while detailing our clinical approach and technique. Secondarily, we compare the single-balloon endoscope (SBE) and double-balloon endoscope (DBE) systems for EBD-related outcomes. Retrospective consecutive patient cohort analysis. We retrospectively assessed a consecutive small bowel CD patient cohort undergoing BAE at the University of Alberta Hospital endoscopy unit from 2013 to 2020. The primary endpoint discerned the safety and immediate success rate of EBD during endoscopy, and comparisons of the dilation parameters and efficacy of SBE versus DBE were assessed as secondary outcomes. During the study period, 87 patients (44 male) with a mean age of 56 ± 14.7 years underwent 179 endoscopic procedures (92 DBE and 87 SBE). Of 358 strictures encountered, 320 (89.4%) were successfully dilated and traversed. The mean maximum dilation diameter was 15.76 ± 2.10 mm. There were no perforations or major adverse events. EBD via BAE is a safe procedure in small bowel CD with a high intraprocedural success rate. Overall, SBE had a higher success rate in traversing strictures before and after dilation using our technique. This analysis is limited by the retrospective nature of our study and must be balanced against the inherent benefits of the DBE system.

Colonoscopic Findings in Patients Attended At Al Azhar Assiut University Hospital Endoscopy Unit in the Last Two Years

Colonoscopic Findings in Patients Attended At Al Azhar Assiut University Hospital Endoscopy Unit in the Last Two Years

Value of integrated pulmonary index monitoring for the detection of adverse respiratory events in patients undergoing sedation for gastrointestinal system endoscopy.

To determine if the integrated pulmonary index detects changes in ventilation status early in patients undergoing gastrointestinal endoscopy under sedation, and to determine the risk factors affecting hypoxia. The retrospective study was conducted at the endoscopy unit of a tertiary university hospital in Turkey and comprised data between October 2018 and December 2019 related to patients of either gender aged >18 years who were assessed as American Society of Anaesthesiologists grade I-III and underwent elective lower and upper gastrointestinal endoscopy. Monitoring was done with capnography in addition to standard procedures. Data was analysed using SPSS 23. Of the 154 patients, 94(%) were females and 60(%) were males. The overall mean age was 50.88±11.8 years (range: 20-70 years). Mean time under anaesthesia was 23.58±4.91 minutes and mean endoscopy time was 21.73±5.06 minutes. During the procedure, hypoxia was observed in 42(27.3%) patients, severe hypoxia in 23(14.9%) and apnoea in 70(45.5%). Mean time between apnoea and hypoxia was 12.59±7.99 seconds, between apnoea and serious hypoxia 21.07±17.64 seconds, between integrated pulmonary index score 1 and hypoxia 12.91±8.17 sec, between integrated pulmonary index score 1 and serious hypoxia 21.59±14.13 seconds, between integrated pulmonary index score <7 and hypoxia 19.63±8.89 seconds, between integrated pulmonary index score <7 and serious hypoxia 28.39±12.66 seconds, between end-tidal carbon dioxide and hypoxia 12.95±8.33 seconds, and between end-tidal carbon dioxide and serious hypoxia 21.29±7.55 seconds. With integrated pulmonary index score 1, sensitivity value for predicting hypoxia and severe hypoxia was 88.1% and 95.7%, respectively, and specificity was 67% and 60.3%, respectively. With integrated pulmonary index score <7, the corresponding values were 100%, 100%, 42% and 64.1%, respectively. Capnographic monitoring, especially the follow-up integrated pulmonary index score, was found to be valuable and reliable in terms of finding both time and accuracy of the risk factor in the diagnosis of respiratory events.

Upper endoscopic findings in patients attending the endoscopy unit of al-azhar assiut university hospital: 2019–2020

Background and aim An endoscope is a visual instrument used to inspect the internal cavities of the human body. Upper endoscopy has effective diagnostic and therapeutic functions; it can be used in patients with signs or symptoms suggestive of upper gastrointestinal (GI) disease, surveillance for upper gastrointestinal tract (GIT) malignancy in high-risk population, and also stoppage of upper GIT bleeding. The work is aimed to document the demographic characteristics, indications, endoscopic findings, and interventions done among patients referred to Al-Azhar Assiut University Hospital in the last 2 years (2019–2020). Patients and methods The study was conducted at the endoscopy unit in from January 2019 to December 2020. Results Our study showed that the most prevalent age group was aged between 20 and 50 years (65.4%). There is a slight predominance of female patients (51%) versus 49% who were males and the most common indications, while peptic ulcer disease was the most common endoscopic finding. Conclusion The most common indications were epigastric pain and upper GIT bleeding, while the most common GI finding was peptic ulcer disease. Also, esophageal varices were common esophageal findings for which band ligation and injection sclerotherapy were done.

Is Prolonged Sitting a Risk Factor in Developing Hemorrhoids and Anal Fissures?

Background: Anal fissures and hemorrhoids are common anal conditions. They cause significant morbidity, social embarrassment, and work absenteeism. In addition, they form a significant workload on the healthcare system. Nevertheless, the etiology of these conditions is still contentious. It has been observed that hemorrhoids and anal fissures are associated with prolonged sitting. This study aims to investigate this observation.Methods: This is a case–control study. We compared 81 patients with symptomatic and endoscopically proven hemorrhoids and/or anal fissures with 162 controls with no symptoms or endoscopic evidence of perianal disease. The study was conducted at Khartoum North Teaching Hospital (KNTH) endoscopy unit between January and December 2019. Demographic data, sitting hours per day, and endoscopic findings of patients and controls were recorded in a proforma. The cases and controls were matched for age, sex, and bowel habits. Data were analyzed and compared using the SPSS version 23.Results: The mean sitting hours for cases was 5.99 (SD 3.4) whereas that for controls was 4.0 (SD 3.0) with a highly significant difference (P &lt; 0.001). Sitting for 5 hr or more per day (exposure) was associated with an increased risk of developing hemorrhoids and/or anal fissures [odds ratio 3.68, 95% CI: 2.1–6.47].Conclusion: The study showed that sitting down for 5 hr or more per day might increase the risk of developing hemorrhoids and/or anal fissures. This finding could help in the prevention and treatment of these diseases and the reduction of recurrences.

Patients’ readiness before undergoing gastrointestinal endoscopy: a descriptive study

To analyse patients' anxiety related to endoscopy. The descriptive study was conducted from July 23 to September 14, 2020, at the Endoscopy Unit of Dr Abdoer Rahem Situbondo General Region Hospital, Dr Koesnadi Bondowoso General Region Hospital and Ibnu Sina Gresik General Region Hospital, East Java, Indonesia. The sample comprised endoscopy patients of either gender aged >20 years. Data was collected using the Endoscopy Confidence Questionnaire. Of the 50 patients, 28(56%) were males and 22(44%) were females. The largest age group was 41-50 years 17(34%), followed by 31-40 years 13(26%). Overall, 48(96%) subjects were married. Abdominal pain was most common indication for the procedure 10(20%). Esophagogastroduodenoscopy was the procedure in 29(58%) patients, 42(84%) had no history of endoscopy, and 41(82%) were reluctant to undergo the procedure. Patients' anxiety rises before endoscopy. Nurses need to provide complete and clear information related to the procedure, including the less pleasant elements.

Risks of infection associated with aerosol generation during medical procedures in an endoscopy unit

Several medical procedures for treatment or diagnosis of diseases have been identified as potentially aerosol generators. The aim of this study is to investigate the potential exposure of the health professionals to aerosols generation during different medical procedures in a hospital endoscopy unit, and to characterize the emitted aerosols in terms of airborne concentration and size. Aerosols number concentrations and sizes, were measured and indoor activity was collected and correlated with the emitting sources. Endoscopy, bronchoscopy, colonoscopy, and bidirectional endoscopy procedures were identified as the most important aerosol sources. During these procedures, the increases in mean aerosols concentration (< 5 µm) in relation to the reference concentration for colonoscopy, upper endoscopy, bronchoscopy and bidirectional endoscopy procedures were 12, 72, 39, and 141%, respectively. These results showed that, depending on the type of activity performed inside the room, the concentration of aerosols varied considerably in relation to the reference concentration. The results also demonstrated that aerosols generation events during medical procedures in an endoscopy unit are divided into two categories: the events that create and disperse aerosols mechanically and events that induce the patient to produce aerosols.In the SARS-CoV-2 context, the virus stability characteristics and modes of transmission make all sources analyzed as high risk for COVID-19 transmission.

Optimising the reprocessing of endoscopes for patient safety

Background: Annually, millions of endoscopies are performed around the globe. Endoscopes are reused countless times, and it is essential to reprocess them. Appropriate reprocessing maximises safety for patients undergoing endoscopy. Aim: This study aimed to assess practices before and after implementation of an evidence-based protocol in the endoscopy unit of a tertiary hospital in India. Methods: The protocol was communicated to healthcare professionals (HCPs) in a blended learning format. A validated reliable checklist was used by one group of HCPs to assess factors, practice and microbial growth before and after implementation of the protocol. Results: Most HCPs were male (71.42%) and nurses (57.14%). With no formal training, the practice scores were in an unacceptable range before the protocol and reached acceptable levels after. While the outer tip of endoscope showed no microbial growth, high concern organisms such as Escherichia coli were detected in suction channels. The protocol was effective in improving practice (t=-23.86; p&lt;0.00) and reducing microbial growth (11.07; p&lt;0.003), respectively. Conclusion: Facilities need to standardise guidelines of practice to ensure training, provide oversight and assess competency.

Setting up a three-stage pre-endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study.

ObjectivesBetween May and July 2021, the coronavirus disease 2019 (COVID‐19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three‐stage restructuring process of pre‐endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff.MethodsThe pre‐endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test.ResultsForehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre‐endoscopy screening methods used displayed regional variations in COVID‐19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre‐endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy‐related nosocomial COVID‐19 infections were reported during the pandemic.ConclusionsWe present a three‐stage pre‐endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID‐19 pandemic.

Intraperitoneal Coil Migration Causing Appendicular Bisection Treated By Laparoscopic Appendectomy: A Call for Alternatives

Objective: To describe the clinical presentation, laparoscopic findings, and management of a case of intraperitoneal migration of a copper coil with appendicular bisection and to highlight alternative approaches to avoid this serious complication. Design: A case report. Setting. Endoscopy Unit of a tertiary University hospital. Patients: A multiparous woman presented with chronic pelvic pain.

Риск-ориентированные подходы к эндоскопической диагностике рака ЖКТ в медицинских организациях первичного звена (на примере ГАУЗ СО ГБ № 1 г. Нижний Тагил)

Early detection of gastrointestinal cancer is an actual public health problem. The implementation of the modern endoscopic diagnostic methods based on the progressive digital technologies significantly reduce the risks of diagnostic errors and contributes to the effective solution of that problem. P u r p o s e : to clarify the possibilities of the early detection of gastrointestinal cancer by equipping the endoscopy unit of the city district hospital with the modern digital endoscopes, including devices with zoom functions – ZOOM. M a t e r i a l s a n d m e t h o d s . The article analyzes the statistical data of the work of the endoscopy unit of Nizniy Tagil State city hospital № 1 from 2013 to 2022 (except 2020–21, when the hospital was completely redesigned as a COVID-hospital). R e s u l t s . A clear relationship between the increase in the number of detected oncopathologies of the gastrointestinal tract and the modern technical equipment of the endoscopic units under the modernization of primary health care program in the Sverdlovsk region in 2021 is presented. Based on risk-based approaches and evidence-based medicine data, the importance expert-class equipment in the routine endoscopic practice in the primary healthcare district hospital for diagnosing gastrointestinal cancer at an early stage is shown. Modern approaches to optical endoscopic diagnostics are analyzed, as well as the potential risks of diagnostic errors associated with technical equipment and possible measures to reduce these risks for further improvement of primary endoscopic diagnostics aimed at detecting gastrointestinal cancer in the early stages are determined, the expediency of equipping endoscopic units of primary care medical organizations with endoscopes inreached magnification functions – ZOOM, as well as photo and video recording of digital images with the possibility of archiving, color printing and further expert analysis of endoscopic images. C o n s e q u e n c e . From the presented statistical data, it is clearly seen how with the improvement of the equipment quality, the detection of gastrointestinal cancer of various localizations is growing.

GERD and Its Association with BMI in Adult Patients Undergoing Upper GI Endoscopy at the Kenyatta National Hospital

Background: Gastroesophageal reflux disease (GERD) is a common clinical problem affecting millions of people worldwide. GERD is highly prevalent in morbidly obese patients and a high body mass index (BMI) is a risk factor for this condition. However, there is differing data on the use of BMI as a predictor of GERD, its severity and frequency. We therefore aimed to determine the association between GERD and high BMI and to document the esophageal mucosal changes in these patients during endoscopy. Methodology: We conducted a cross-sectional study among the 174 GERD patients to investigate the association between BMI and GERD at Kenyatta National Hospital endoscopy unit. Patients aged 18 years and above presenting with classical symptoms of GERD were evaluated upon voluntary enrolment. Ethical approval was sought from the KNH-UON ethics&amp; research committee. A questionnaire was administered with demographic data (age, gender, weight, height) and specific questions assessing for GERD. At endoscopy, the mucosal changes were recorded. Data was then summarized using means, frequencies and proportions. Association between patient demographics and GERD was evaluated using the Student t-test or Mann–Whitney U test for continuous variables. Chi-square analysis was applied for categorical variables. A p-value of &lt;0.05 was considered statistically significant. Results: This was an analysis of 174 patients (56.9% Female, 43.1% Male) between ages 18- 80 years (x̄=43) who underwent endoscopy. The BMI ranges were 14.5 to 38.6 Kg/m2 (x̄=26.6 Kg/m2). The proportion of patients who were overweight was 40.2% and obese patients made up 21.8% of the population. There was no significant association between BMI measurements and frequency scale of GERD (FSSG) symptoms (p=0.217). During endoscopy, 35.6% of the patients had esophagitis (LA-A -28.7%, LA-B – 6.9%). Hiatal hernia was diagnosed in 20.7% of the patients. There was no significant association between the diagnoses of esophagitis and hiatal hernia and the BMI status of the patients. However, older age was associated with a higher prevalence of hiatal hernia (p=0.002). Conclusion: There was no association between increasing BMI and frequency and severity of GERD symptoms in the study population.

A114 QUALITY AND EFFICACY OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: A RETROSPECTIVE CHART REVIEW STUDY

Abstract Background Passage of food along the digestive tract can be compromised by a number of conditions. Nasogastric tube (NGT) feeding is used in these cases but prolonged use can lead to various complications. Percutaneous endoscopy gastrostomy (PEG) has been reported as an effective and safe alternative to NGT. Clinical efficacy and adverse events related to PEG insertion are largely dependent on post-procedure care. Aims To assess the clinical significance of PEG tube insertion procedure and impact of post-procedure care and diet protocol on associated adverse events and success rate at two Canadian tertiary care units. Methods The retrospective electronic chart review was conducted on all patients who underwent endoscopic PEG fixation or replacement procedure at University of British Columbia Gastroenterology clinic and Vancouver General hospital Endoscopy Unit from 1st April 2020 to 31st March 2021. Data related to patient demographics, indications for insertion, insertion technique, quality of PEG insertion protocol, antibiotic prophylaxis, success rate, and rate of PEG-related complications were collected and analysed. An evaluation protocol was devised to evaluate the impact of indication-based diet protocols on frequency of adverse events and success rate. Results are suggested to be analysed using SPSS v 2021 with significance threshold of P-value &amp;lt; 0.05. Results 43 PEG insertion procedures were performed, of which 3 failed due to structural reasonsincluding post gastric sleeve surgery, small stomach and difficulty in finding transillumination point. 25 cases underwent PEG insertion endoscopically for the first time, and 14 required exchanges, of which 2 underwent non-endoscopic exchange. Of 37 patients who underwent endoscopic PEG insertion 18(48.64%) were males and 19(51.36%) were females. Acute infection was reported in 6(14%) and chronic infection in 4 patients (9.3%). Tube dislodgment was reported in 10(23%), peristomal leak in 4(9.3%), miinor bleeding in 3(6.9%), and post-operative granulation in 4(9%) procedures. The evaluation protocol divides patients into two groups: Group a included d subjects who would receive low-volume (≤150 mL/d) and Group b who would receive a high-volume (≥300 mL/d) of feeding formula. Conclusions PEG tube insertion is a very successful procedure with high clinical significance and low complications rate at VGH and UBC. A follow-up plan is therefore being initiated to evaluate impact of feeding volumes on rate of success and adverse events. Combined, the previous studies, suggest that the high-feeding volumes can be safely administered to rapidly attain calorie targets to increase the procedure efficacy. . Funding Agencies CAG

Esophagogastroduodenoscopy in Patients Aged 75 Years and Older: A Single-Center Study.

Introduction: Esophagogastroduodenoscopy is frequently used for the elderly population. Older patients are more fragile than younger patients because of multiple age-related chronic diseases and the common use of polypharmacy. There is no adequate data in the existing literature regarding the application of upper gastrointestinal system endoscopy in the elderly population. Therefore, in this article, we evaluated esophagogastroduodenoscopy procedures that were performed on patients aged 75 years or older in the secondary care hospital.Methods: We performed a retrospective observational study of patients aged 75 years or older who underwent esophagogastroduodenoscopy between January 2016 and January 2021 at the Istanbul Sultanbeyli State Hospital Endoscopy Unit. Indications of endoscopy, ages, genders, endoscopic diagnoses, polyp/tumor/biopsy localizations, histopathological examination of biopsies, and complications of esophagogastroduodenoscopy were analyzed.Results: A total of 202 patients were analyzed. The most common indication was dyspepsia (25%), followed by gastrointestinal bleeding, reflux, anemia, and screening/surveillance. For patients aged 75-79 years and patients aged ≥80 years, endoscopic diagnoses of esophageal and gastric malignancies were observed as 6.4% and 18%, respectively. Very relevant findings of endoscopy (esophageal and gastric malignancies; gastric and duodenal ulcers) were detected in 39 (19.3%) of all included patients. No complications due to endoscopic procedures were observed, but complications due to sedation (hypotension and hypoxemia) were observed in 5.0%.Conclusion: After pre-procedural evaluation, we must be careful while doing endoscopic procedures in the elderly because of multiple age-related chronic diseases and the common use of polypharmacy. This present study showed that esophagogastroduodenoscopy is a safe procedure with a high diagnostic yield in patients aged 75 years and older.

A colonoscopy quality improvement intervention in an endoscopy unit

Many studies identified colonoscopy quality indicators in order to improve performance and safety. We conducted a colonoscopy improvement study. Our study was designed according to a Plan-Do-Study-Act cycle: first recording of our quality indicators and identification of shortcomings, second identification of improvement targets and implementation of new procedures, third second recording of quality indicators, fourth validation of procedures and identification of new goals. Quality indicators derived from European and French guidelines were recorded before and after our improvement actions. We were mainly interested in the quality indicators of the colonic preparation, the description of the diagnosed lesions and on the examination reports. The data of 134 patients prospectively included in January–February 2017 were compared to 133 patients included in May–June 2019, after implementation of improvement procedures, in the digestive endoscopy unit of the university hospital of Dijon, France. Our intervention, and in particular the implementation of new standardized forms, improved preparation quality: Boston Bowel Preparation Scale scores increased significantly from 7.8 to 8.2. Cecal intubation rate increased by 6%, and more adenomas were diagnosed and removed (+3.3%). Adenoma detection rate increased significantly from 26 to 42%. The completion of withdrawal time measure improved from 6.7 to 100%. Our study led to the rapid implementation of corrective actions and improved quality in our unit and in our personal practice. This quality improvement strategy could be easily implemented in every digestive endoscopy unit.

Characteristics of the endoscopic procedures performed in a hybrid tertiary-level hospital during the first year of the COVID-19 pandemic.

The COVID-19 pandemic caused many changes in gastrointestinal endoscopy units. To describe the changes that occurred in a gastrointestinal endoscopy unit of a hybrid hospital during the COVID-19 pandemic. We performed a retrospective study of endoscopies performed in the first year of the COVID-19 pandemic. We collected and described the data of interest to the study, which is presented with numbers and percentages or measures of central tendency and dispersion as appropriate. Fisher's exact test or the χ2 test were used as appropriate. A total of 507 procedures were performed. There was a 92.5% reduction in the performance of endoscopic procedures. In all, 77 (15%) procedures were performed on patients with COVID-19. The most frequent procedures were esophagogastroduodenoscopy (EGD), colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). The main indications were gastrointestinal bleeding, placement of enteral accesses, and alterations in the biliary and pancreatic ducts. Of these, 37 (48%) were therapeutic. Patients with COVID-19 were more susceptible to the development of complications. During the first year of the COVID-19 pandemic, the number of endoscopic procedures performed decreased significantly. The procedures most often required were EGD, colonoscopy, and ERCP, mainly indicated by gastrointestinal bleeding, placement of enteral accesses, and alterations of the bile and pancreatic ducts.

Association between Helicobacter Pylori infection and autoimmune thyroid disease

Introduction: Helicobacter Pylori (HP) is the most common bacteria that causes chronic bacterial infections in humans. We aimed to investigate the possible relationship between HP infection and autoimmune thyroid diseases, as well as the possible relationship between HP density and platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). Methods: A total of 3380 patients who underwent upper gastro intestinal system endoscopy in our tertiary hospital endoscopy unit between 2010 and 2018 were scanned, and 250 patients who met the inclusion criteria were included in our retrospective study. Results: The study was examined under 2 groups: 104 (41.6%) were HP negative and 146 (58.4%) were positive. While TPOAb was positive in 63 (25.2%) patients, 61 (24.4%) patients were found to be TgAb positive. Atrophy was detected in 11 (4.4%) patients and metaplasia in 20 (8%). There was no statistically significant difference between HP-positive and HP-negative patients in terms of age, gender, Wbc, Hg, Neu, Lymp, Plt, PLR, and NLR (P &gt; 0.05). There was no significant concordance between HP positivity and TPOAb and TgAb positivity. There was no statistically significant relationship between HP density and PLR and NLR (Spearman’s rho correlation analysis, P &gt; 0.05). Discussion and conclusion: In conclusion, no relationship was found between HP infection and autoimmune thyroid disease in our study. Similarly, there was no significant relationship between HP density and PLR and NLR.

Peptic Ulcer Diseases in Patients with Liver Cirrhosis and Portal Hypertension: Experience in a Tertiary Level Hospital in Bangladesh

Introduction: Cirrhosis of liver and peptic ulcer disease (PUD) are very common in Bangladesh. PUD may coexist with cirrhosis and portal hypertension. Haematemesis and melaena in cirrhosis of liver are not always from ruptured oesophageal varices; rather it may be due to bleeding peptic ulcer disease. Objective: To find the prevalence of PUD among patients with liver cirrhosis and portal hypertension. Materials and Methods: This cross sectional, descriptive study was conducted on 96 patients of cirrhosis of liver diagnosed with oesophageal varices at endoscopy unit of Kurmitola general hospital, during endoscopic evaluations in 4 months period from september 2017 to december 2017. Results: Total cirrhotic patients enrolled were 96 (M=61, F=35), mean age was 51.8 ± 14.2 yrs (18-86years). Hepatitis B virus (HBV) was the leading cause of cirrhosis in 54.1%, Hepatitis C virus (HCV) 5.2 %, proven non-alcoholic steatohepatitis (NASH) were 11.5% and rest were from unknown aetiology. Their average Child-Turcotte-Pugh (CTP) score were 8.6 (12-5), 37.6% associated with portal hypertensive gastropathy. Grade-III oesophageal varices found in 52 patients, whereas grade-II in 25 patients. Among this 96 patients 39 (40.6%) revealed peptic ulcer disease more in the form of gastric ulcer (n=23) than duodenal ulcer (n=10) and both (n=6). Most of the ulcers belonged to Forrest class III (76.9%). Conclusions: Variceal bleeding and portal hypertensive gastropathy are the common causes of bleeding and anaemia in patients with cirrhosis of liver. Peptic ulcer disease has been found to be one of the potential causes of haematemesis, melaena, and anaemia among these patients in Bangladesh. Large multicenter controlled studies are needed to confirm the reports. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 68-71

EP.WE.718An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital

Abstract Introduction A joint statement by the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons in 2017 recommended that photographic documentation of relevant anatomical landmarks should be a Key Performance Indicator of oesophagogastroduodenoscopy (OGD). The aim of this study was to assess this photodocumentation standard among surgeons and gastroenterologists in a tertiary referral centre. Methods Cork University Hospital endoscopy unit records were examined for a 2-month period from 01/10/20-27/11/20. OGDs were performed by 3 consultant colorectal surgeons and 4 consultant gastroenterologists over the time period. Demographic data and photodoumentation information were obtained from the Endoraad GI reporting tool. Surgeons and gastroenterologists performances was compared using the chi-squared test. Results 104 OGDs were analysed. Fifty-three (51%) OGDs were performed in women and 51(49%) OGDs were performed by surgeons. The documentation for each site was; gastro-oesophageal junction- 68% (69/102), fundus on retroflexion- 71% (72/102), gastric body- 32% (33/102), antrum- 61% (62/102), and duodenal bulb- 35% (36/102), without significant differences (p &amp;gt; 0.05) for these sites between surgeons and gastroenterologists. There was more documentation of the upper oesophagus by surgeons (31% vs.12%, p = 0.030) and there was more documentation of the distal duodenum by gastroenterologists (90% vs.47%, p &amp;lt; 0.01). Pictures were unable to be saved in two patients due to technical failure. Discussion Photodocumentation is increasingly important from a medico-legal viewpoint. There is room for improvement in our centre, but these rates are comparable to other published series. An educational session is being planned and following this adherence to photodocumentation standards will be re-examined.