Gastroenterology and Hepatology

  • Isolated metastasis of hepatocellular carcinoma in the right atrium: a case observed in a university hospital in West Africa (Bouake, Ivory Coast)

    Intracardiac metastases from hepatocellular carcinoma (HCC) are rare and have a poor prognosis. We report an observation in a West African university hospital in a 39-year-old black patient admitted with upper gastrointestinal bleeding. Clinical examination noted signs of cirrhosis, namely hepatocellular failure, portal hypertension, melena and signs of right heart failure against a background of deterioration in general condition (WHO-3). The CT scan showed a focal hepatic lesion with arterial enhancement and portal lavage compatible with HCC and a right intracardiac mass taking contrast. Doppler echocardiography confirmed the presence of a large heterogeneous mass occupying almost the entire right atrium. Palliative and symptomatic treatment was instituted in the patient improving his clinical condition. His death occurred two months after his release. The intracardiac localization of HCC, although rare, is not exceptional and of appalling prognosis. It should be sought in the assessment of the extension of HCC, especially in the presence of signs of cardiac involvement.

  • Epidemiology and Risk Factors for Hepatitis C Infection in Malaysia: A Narrative Review

    Hepatitis C infection is a growing public health issue in Malaysia. A large number of people living with hepatitis C virus (HCV) are unaware of the infection. The treatment complexity warrants a comprehensive understanding of this infectious disease to support planning for strategies to reduce the burden of disease associated with hepatitis C. This study aimed to summarise the epidemiology and risk factors attributable to hepatitis C acquisition in Malaysia based on local published articles. Published articles related to epidemiology and risk factors for hepatitis C infection in Malaysia between 2005 and 2017 were searched through several online databases. Related information from the Ministry of Health official website was also compiled. An increasing trend in the incidence and mortality rate of hepatitis C infection is noted over the last decades. In 2009, the national prevalence of people infected with HCV was approximately 2.5%, with the prevalence rate varying according to different high-risk groups. The most common genotypes reported are genotypes 3 and 1. Frequently reported risk factor for HCV acquisition is injection drug use. Other identified risk factors are being a blood product recipient, haemodialysis patient or participant in high-risk sexual activity. Nevertheless, a considerable number of patients had no known risk factors. The prevalence and burden of HCV-related disease are substantial and can be attributed to many factors. High-quality design studies are needed to provide stronger evidence of the risk factors for hepatitis C infection in local populations for future public health planning.

  • Two-year Single-Center Real-Life Data of Tenofovir Disoproxil Fumarate Treatment for Chronic Hepatitis B Patients in Togo

    Objective: to evaluate the treatment efficacy of Tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) in the Teaching hospital campus of Lome. Patients and method: retrospective cross-sectional study, conducted in the outpatient department of the Hepato-Gastro-Enterology department of the Teaching hospital campus of Lome from January 2018 and December 2020. Patients with HBsAg were included. Outpatient patients having achieved at least HBeAg, anti-HBe antibody, anti-HCV antibody, anti-HBc IgG; viral load hepatic assessment; retroviral serology. Some patients had achieved actitest-fibrotest. Patients with abdominal pain, clinical signs of portal hypertension or hepatocellular insufficiency had achieved alphafetoprotein, protidogram, and abdominal ultrasound. These explorations made it possible to classify patients into different virological profiles. Results: More than sixty-four percent of the patients were male. The patients were asymptomatic at 97.37%. HBeAg was positive in 15.19% of patients. The viral load was detectable in 80.43% of cases with a value of 52000000 IU / ml +/- 280000000UI / ml. Ninety-five point twenty-four patients had an inflammatory activity less than 2 and 52.38% a fibrosis greater than 2 on the Metavir grid. The APRI and Fib-4 scores found a strong predictive value for fibrosis in 16.22% and 11.01% of cases, respectively. HBeAg negative chronic hepatitis was the most common virologic profile (58%). Cirrhosis was the most common complication (9.97%). Tenofovir was the therapeutic molecule used. At 12 months of treatment, HBe seroconversion was noted in 100% of cases, an undetectable viral load in 50% of cases and normalization of the hepatic balance in 84% of cases. No side effects of the treatment were reported Conclusion: TDF treatment shows high rate of complete virologic response in CHB patients. TDF is tolerable and safe during the 96 weeks of treatment period. Monitoring of HBV DNA level and drug adherence is important for achieving complete suppression…

  • Carnitine status before and after paracentesis in patients with ascites and liver cirrhosis and improvement of subjective symptoms by intravenous administration of carnitine ― Initial study

    Introduction: Recently, carnitine has been reported to be useful for improving blood ammonia and cognitive function in cirrhotic patients with subclinical hepatic encephalopathy In Japan, levocarnitine has become available, and there have been several reports in which the carnitine concentration was first measured and whether symptomatic patients improved or not . And, the examination of symptomatic state around the ascites centesis was also carried out. Method: Total carnitine concentration was measured in 5 cirrhotic patients undergoing ascites drainage during our hospital ambulatory, and after ascites drainage, intravenous administration of ercarnitine was conducted to examine whether or not the symptoms improved. Carnitine concentrations were measured before and after dialysis in four non-dialysis patients and one dialysis patient. Oral carnitine was administered in 3 patients (1 dialysis patient) because symptoms of cramps were noted, but in 2 cases. It was administered only after ascites drainage. Case presentation: The case was in a 55 year-old male. The chief complaint was persistent ascites, cramps and general malaise. The patient had a medical history of treatment with radiofrequency ablation (Radiofrequency: RFA) for hepatocellular carcinoma. The patient had been followed up at another hospital for chronic liver cirrhosis type C. Interferon therapy was performed for liver cirrhosis, resulting in a virological complete response (sustained virological response: SVR). The ascites storage was obvious, but the round was repeated from 2 to 3 times a week of golf. Because of frequent leg cramps during and at the end of golf, patients were given branched-chain amino acid preparations and liver protection drugs as oral medications. In a patient with liver cirrhosis, improvement of hepatic encephalopathy associated with decreased carnitine level and decreased ammonia were reported, and deterioration of muscle symptoms associated with carnitine deficiency in a dialysis patient was also reported [1-3]. Therefore, [4] Carnitine concentration and acylcarnitine/free carnitine…

  • A hypoechoic, tumor-like lesion in the pancreatic head and neck on endoscopic ultrasonography may be due to a high-grade pancreatic intraepithelial neoplasia/carcinoma in situ

    High-grade pancreatic intraepithelial neoplasia (HG PanIN)/carcinoma in situ (CIS) in the pancreatic body and tail can induce parenchymal atrophy through chronic inflammatory changes presenting as a Hypoechoic area on EUS (Hypocho) or focal pancreatic parenchymal atrophy (FPPA) on computed tomography (CT) and magnetic resonance imaging (MRI). We herein discussed two patients with a hypoechoic area in the pancreatic head and neck on EUS resembling pancreatic ductal adenocarcinoma (PDAC). The lesions consisted of dense fibrosis and fat infiltration with pancreatic parenchymal atrophy around the HG PanIN/CIS in the main pancreatic duct (MPD), which penetrated the lesion and showed mild stenosis and upstream dilation. CT and MRI were unable to visualize the lesions. A specimen was obtained from one lesion by fine-needle aspiration under EUS (EUS-FNA) guidance for histopathological and cytological analysis, but the tests returned negative for adenocarcinoma. However, serial pancreatic-juice aspiration cytologic examination (SPACE) revealed adenocarcinoma in both lesions, prompting surgical resection. Histopathological examination revealed non-invasive HG PanIN/CIS in the MPD surrounded by dense fibrosis and fat deposition in the area of parenchymal atrophy. The CIS was restricted to the area of parenchymal atrophy.These two cases are noteworthy in illustrating a hypoechoic area appearing on EUS as a tumor-like lesion resembling PDAC. EUS-FNA has recently been used histopathologically to diagnose a pancreatic lesion. However, in the present and similar cases, EUS-FNA can only reveal secondary changes due to CIS unless the pancreatic duct covered by the CIS is accidentally punctured. We should bear in mind that CIS can appear as a hypoechoic area resembling PDAC on EUS, and that SPACE is the best method for diagnosing CIS in such cases.

  • Colon Irrigation Bowel Preparation Supports Multiple Clinical Benefits in Over 8,000 Patients

    This retrospective clinical study evaluates an FDA-cleared high-volume colon irrigation bowel prep (BP) for colonoscopy, performed under standard operating procedures with Austin Gastroenterology (AG, Austin, TX). Patient related outcomes in 8,364 procedures, prescribed by 33 physicians in 4.5 years, demonstrated no serious adverse events and excellent satisfaction rates. The high level of adequacy using this BP far exceeds national benchmarking thresholds for adequate colon preparations. Adequacy rates remain high even when considering poor BP risk factors and patient noncompliance with ancillary pre-preparation regimens. Our analysis demonstrates that this colon irrigation BP has excellent Boston bowel preparation scores (BBPS), associated with high-level adenoma detection rates (ADR) and sessile serrated polyp (SSP) detection rates. ADR and SSP are inversely related to the patient’s post-colonoscopy interval colorectal cancer (CRC) risk, and are similarly related to an inadequate BP. Both modeling data and performance characteristics strongly suggest that this colon irrigation BP is highly safe, effective, and will reduce the costs and risks related to inadequate BP. This, accordingly, leads to significantly improved quality outcomes, savings to the healthcare systems, and a reduction of the patient’s burden.

  • A pilot study for using high-volume colon irrigation bowel preparation for colon capsule endoscopy shows feasibility of adequate bowel prep with high patient satisfaction

    A feasibility study was performed to test a bowel preparation (BP) method that would improve patients’ experience of colon capsule endoscope (CCE) while retaining clinical adequacy. Specifically, the use of high-volume colon irrigation with the Hygieacare® System, HygiPrep™, was tested in conjunction with Medtronic’s PillCam COLON 2 Capsule. This prospective, single-center, and IRB-approved study evaluated HygiPrep use prior to the PillCam COLON 2 procedure instead of the standard split-polyethylene glycol-electrolyte (PEG) oral prep. The study was performed at Austin Gastroenterology (Austin, TX), and all capsule video files were forwarded to a Central Reader to evaluate and compile a study report. Six of the seven (86%) subjects completed both the HygiPrep and PillCam COLON 2 exams and were graded as excellent, good, or adequate by the Central Reader. Patients’ feedback reported positive satisfaction scores for both the HygiPrep and the PillCam COLON 2 procedures. These results support our hypothesis that HygiPrep was as effective as Split-PEG BP. We suggest that the HygiPrep, is a suitable BP for CCE, providing adequate BP and high patient satisfaction.

  • Profile of Patients with Digestive Tube Cancer Infected With HIV in Two Cancerology Centers in Cameroon

    Background: Human Immunodeficiency Virus (HIV) infection is a major public health problem in Africa, which alone recorded 71% of HIV / AIDS-related deaths in 2018. There is a link between the infection to HIV and the occurrence of certain cancers, in particular digestive cancers. Very little data in Africa, especially Cameroon, exists on the association between HIV and digestive cancers. Our goal was to determine the prevalence of HIV in patients with cancer of the digestive tract as well as the factors related to the prognosis of these patients in Cameroon. Methods: We conducted a cross-sectional and analytical study over a 10-year period from January 2010 to December 2019. It was carried out in the general hospitals of the cities of Douala and Yaoundé. We included records of patients with histologically confirmed gastrointestinal cancer. We excluded records of patients with lymphoma or Kaposi’s sarcoma. The data collected were socio-demographic, clinical and paraclinical data. Chi-square test was used to determine statistically significant associations for p

  • Treatment of hepatocellular carcinoma using the Smart Fusion needle navigation system: conversion from real-time 4D-echo data

    Advances in ultrasound systems have improved the accuracy of hepatocellular carcinoma (HCC) diagnosis and treatment. We have been treating HCC using real-time 4D and Live 3D-echo technologies. However, these treatment methods have drawbacks such as vibrations during puncture and a limited angle of needle insertion. To overcome these problems, systems that can display ultrasound images simultaneously with computed tomography (CT) and magnetic resonance images in a real-time manner for reference purposes have been reported. These systems have recently been equipped with a needle tip navigation system, making it possible to reliably visualize tumors and determine the needle tip position in a tumor. These developments have enabled the safe treatment of HCC. Treatment using needle navigation is performed as follows: A Canon APLIO800 ultrasound system is used with a conventional convex probe (PVT-375BT) and a micro-convex probe (PVT-382BT). The system function is known as Smart Fusion. Ultrasound images can be displayed with volume data from other modalities, such as CT and magnetic resonance imaging (MRI), in relation to the positional information using a magnetic sensor. This enables the use of CT/MRI data as reference for accurate puncture and treatment of lesions that are difficult to identify by ultrasound alone. Axis alignment is also completed by displaying the xiphoid process on a CT image and having the system learn the orientation of the probe placed perpendicular to the body axis. Then, landmark alignment is performed and fine-adjusted by aligning a target point near the lesion with the same point as displayed on CT (Fig. 1). Case presentation A 7x-year-old woman was found to have elevated tumor markers and a liver tumor identified by regular blood testing and CT performed in August 20xx and was admitted to our hospital for treatment. Abdominal ultrasonography showed a hypoechoic lesion measuring approximately 3 cm in diameter…

  • Prevalence of HBsAg and anti-HCV antibodies during a screening campaign in August 2019

    Introduction: Hepatitis B (HBV) and C (HCV) virus infections represent a major public health problem, with significant mortality and morbidity worldwide. The aim of this study was to determine the prevalence of HBsAg and anti-HCV antibodies, and to investigate the risk factors associated with these two infections. Patients and methods: An analytical cross-sectional study was carried out during a free screening campaign for viral hepatitis B and C organized by the University Teaching Hospital of Yaounde from 20th to 23rd August 2019. Screening for HBsAg and anti-HCV antibodies was carried out using a rapid diagnostic test (On Site HBsAg/HCV Ab Rapid Test (CTK Inc 10110 Mesa Rim Road San Diego, CA 92121 USA) in accordance with the manufacturer’s Instruction. Positive samples had a confirmatory ELISA test. A structured questionnaire was used to investigate the risk factors for viral hepatitis B and C. Results: A total of 746 participants (412 women, 334 men) were registered. The average age of the participants was 29.6 ± 15.5 years. The prevalence of HBsAg was 10.3% (men: 14.7%; women: 7%; p = 0.002). The prevalence of HCV-Ab was 4.7% (men: 6.3%; women: 3.4%; p = 0.08). Unprotected sexual intercourse (59.4%), dental care (38.7%) and scarification (37.1%) were the main factors of HBV and HCV transmission. Male sex (OR = 2.2; IC = 1.3 – 3.6; p = 0.002), lack of vaccination (OR = 3.4; IC = 1.2 – 9.6; p = 0.01), tattoos (OR = 6.6; IC = 1.4 – 30.2; p = 0.02) and close contact with an HBV-infected person (OR = 1.7; IC = 1.01 – 2.9; p = 0.04) were the factors associated with HBV transmission. Age groups ≥ 55 years (OR = 1.3; IC = 1.1 – 1.5; p < 0.0001) and [45 – 54] (OR = 1.06; IC = 1.0...