Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Reader Login   Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 1796 
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2015| January-February  | Volume 21 | Issue 1  
    Online since February 11, 2015

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
REVIEW ARTICLES
Surgical Treatment for Hepatocellular Carcinoma
Ahmad A Madkhali, Zahir T Fadel, Murad M Aljiffry, Mazen M Hassanain
January-February 2015, 21(1):11-17
DOI:10.4103/1319-3767.151216  PMID:25672233
Hepatocellular carcinoma (HCC) is an epithelial tumor derived from hepatocytes; it accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related deaths. HCC treatment is a multidisciplinary and a multimodal task, with surgery in the form of liver resection and liver transplantation (LT) representing the only potentially curative modality. However, there are variable opinions and discussions about applying these surgical options and using other supporting treatments. This article is a narrative review that includes articles published from 1984 to 2013 located by searching scientific databases such as PubMed, SCOPUS, and Elsevier, with the main keyword of hepatocellular carcinoma in addition to other keywords such as liver transplantation, liver resection, transarterial chemoembolization, portal vein embolization, bridging therapy, and downstaging. In this review, we focus mainly on the surgical treatment options offered for HCC, in order to illustrate the current relevant data available in the literature to help in applying these surgical options and to use other supporting treatment modalities when appropriate.
  2,720 468 -
CASE REPORT
Common bile duct duplication: The more the murkier
Ankur Arora, Binit Sureka, Vivek Kasana, Yashwant Patidar, Kalpana Bansal
January-February 2015, 21(1):51-54
DOI:10.4103/1319-3767.151231  PMID:25672240
Congenital duplication of the common bile duct is an extremely rare anomaly of the biliary tract, which putatively represents failure of regression of the embryological double biliary system. Depending on the morphology of the duplicated bile duct, the anomaly can be classified into five distinct subtypes as per the modified classification (proposed by Choi et al). Among the five subtypes of bile duct duplication, type V duplication is considered to be the least common with only two previous cases of type Va variant reported in medical literature prior to the current report.
  2,490 344 -
EDITORIAL
Journal's impact factor: Setting the stage for an inspiring new era
Ayman A Abdo, Faisal M Sanai
January-February 2015, 21(1):1-2
DOI:10.4103/1319-3767.151208  PMID:25672230
  2,448 386 -
ORIGINAL ARTICLES
Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation
Chang W Kim, Jae H Chang, Tae H Kim, Sok W Han
January-February 2015, 21(1):18-24
DOI:10.4103/1319-3767.151212  PMID:25672234
Background/Aims: The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK). Patients and Methods: Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed. Results: DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023). Conclusions: Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.
  2,322 404 -
REVIEW ARTICLES
Autologous bone marrow-derived cells in the treatment of liver disease patients
Leenah S AlAhmari, Jumanah Y AlShenaifi, Reema A AlAnazi, Ayman A Abdo
January-February 2015, 21(1):5-10
DOI:10.4103/1319-3767.151211  PMID:25672232
Liver transplantation is universally accepted as a "cure" procedure, and yet is not universally applicable for the treatment of end-stage liver diseases (ESLD) because of the shortage of donors, operative complications, risk of rejection, and high cost. Bioartificial liver device is an option to temporarily improve the liver function and to bridge the patients to liver transplantation. However, bioartificial liver device has many problems in clinical application, such as hepatocyte allograft rejection and maintenance of hepatocyte viability and function. Another therapeutic option is stem cell transplantation. There are two broad types of stem cells: Embryonic stem cells and adult stem cells. The latter are sourced from bone marrow (BM), adipose tissue, and blood. This review will concentrate on BM-derived cells. BM-derived cell transplantation, although not ideal, is theoretically an optimal modality for the treatment of ESLD. Autologous BM-derived cells have no graft rejection, have the capability of regeneration and self-renewal, and are multipotent stem cells that can differentiate into a variety of cell types which include hepatocytes. The pathway from BM-derived cell to hepatocyte is well documented. The present review summarizes the delivery routes of BM-derived cells to the liver, the evidences of engraftment of BM-derived cells in the liver, and the possible mechanisms of BM-derived cells in liver repair and regeneration, and finally, updates the clinical applications.
  2,277 425 -
ORIGINAL ARTICLES
Acute liver failure in pregnancy: Causative and prognostic factors
Shweta Sahai, Ravi Kiran
January-February 2015, 21(1):30-34
DOI:10.4103/1319-3767.151221  PMID:25672236
Background/Aims: Acute liver failure (ALF) in pregnancy is often associated with a poor prognosis. In this single-center observational study we aim to study the incidence, causes, and factors affecting mortality in pregnant women with ALF. Patients and Methods: Sixty-eight pregnant women reporting with clinical features of liver dysfunction were enrolled as "cases." Their clinical course was followed and laboratory studies were performed. The presence of ALF was defined as the appearance of encephalopathy. The results were compared with a "control" group of 16 nonpregnant women presenting with similar complaints. The cases were further subdivided into two groups of "survivors" and "nonsurvivors" and were compared to find out the factors that contribute to mortality. Results: ALF was seen in significantly more number of pregnant women than the controls (P = 0.0019). The mortality rate was also significantly higher (P = 0.0287). Hepatitis E virus (HEV) caused jaundice in a higher number of pregnant women (P < 0.001). It also caused ALF in majority (70.3%) of pregnant women, but HEV infection was comparable between the survivors and nonsurvivors (P = 0.0668), hence could not be correlated with mortality. Conclusions: Pregnant women appear to be more susceptible for HEV infection and development of ALF. The mortality of jaundiced pregnant women increased significantly with appearance of ALF, higher bilirubin, lower platelet count, higher international normalized ratio, and spontaneous delivery.
  2,018 637 -
Prognostic significance of serum galectin-3 levels in patients with hepatocellular cancer and chronic viral hepatitis
Mehmet Ulu, Ahmet Alacacioglu, Esma Yuksel, Baris O Pamukk, Giray Bozkaya, Alpay Ari, Arif Yuksel, Gulten Sop, Inci Alacacioglu
January-February 2015, 21(1):47-50
DOI:10.4103/1319-3767.151228  PMID:25672239
Background/Aim: Galectins affect diverse physiological and pathophysiological processes such as development, inflammation, and tumor growth. We aimed to compare serum galectin-3 levels in three patient groups with chronic hepatitis B and C virus (HBV, HCV), cirrhosis secondary to HBV or HCV, and hepatocellular carcinoma (HCC) secondary to HBV or HCV and evaluate the role of galectin-3 during HCC progression. Patients and Methods: Nineteen patients with hepatocellular cancer, 22 patients with cirrhosis, and 24 patients with chronic hepatitis B and C were included in this study. Serum galectin-3 levels in different liver diseases were assessed by enzyme-linked immunosorbent assay. Results: The mean galectin-3 levels were 4.61 ng/mL (±2.32) in HCC patients, 5.68 ng/mL (±2,2) in cirrhotic patients, 1.98 ng/mL (±1.50) in chronic viral hepatitis group. There were no statistical differences between HCC and cirrhotic patients (P = 0.5), but lower in chronic hepatitis group statistically compared with cirrhosis and HCC (P < 0.001, P = 0.002, respectively). In case of cirrhotic patients, galectin-3 levels were significantly higher in patients with cirrhosis secondary to HCV compared with HBV (P = 0.03). When we evaluated galectin-3 levels in HCC patients, it was found to be 3.92 ng/mL in HCC secondary to hepatitis B and 5.37 ng/mL in HCC secondary to hepatitis C. Conclusion: Serum galectin-3 levels in patients with chronic HBV or HCV may guide us about progression to cirrhosis or HCC and prognosis of the disease. Especially, galectin-3 levels may be more pronounced in case of HCV.
  2,088 427 -
Gastric mucosal protection by aegle marmelos against gastric mucosal damage: Role of enterochromaffin cell and serotonin
Purnima Singh, Shubha R Dutta, Debjani Guha
January-February 2015, 21(1):35-42
DOI:10.4103/1319-3767.151224  PMID:25672237
Background/Aims: Serotonin (5-hydroxytryptamine; 5-HT) released from enterochromaffin (EC) cells in gastric mucosa inhibits gastric acidity by increasing the gastric mucus secretion. In the present study, we evaluated the effect of aqueous extract of Aegle marmelos (AM) ripe fruit pulp (250 mg/kg body weight) on mean ulcer index (MUI), EC cells, 5-HT content, and adherent mucosal thickness of ulcerated gastric tissue in adult albino rats. Material and Methods: Ulceration was induced by using aspirin (500 mg/kg, p.o.), cerebellar nodular lesion and applying cold-restraint stress. Results: In all cases increased MUI in gastric tissue along with decreased EC cell count was observed with concomitant decrease of 5-HT content and adherent mucosal thickness (P < 0.05). Pretreatment with AM for 14 days decreased MUI, increased EC cell count, and 5-HT content as well as adherent mucosal thickness in all ulcerated group (P < 0.05). Conclusion: AM produces gastric mucosal protection mediated by increased EC cell count and 5-HT levels.
  2,104 344 -
Predictors of In-hospital Mortality Among Patients Presenting with Variceal Gastrointestinal Bleeding
Amith S Kumar, Raminderpal S Sibia
January-February 2015, 21(1):43-46
DOI:10.4103/1319-3767.151226  PMID:25672238
Background/Aim: The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2) to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding. Patients and Methods: This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20. Results: Cirrhosis accounted for 308 (97.16%) subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84%) completing the tally. Sixty-three (19.87%) subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000), Child-Pugh Class (P = 0.002), altered sensorium (P = 0.037), rebleeding within 24 h of admission (P = 0.000), low hemoglobin level (P = 0.023), and serum bilirubin (P = 0.002). Conclusion: Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.
  1,675 329 -
Wire-guided cannulation versus contrast-guided cannulation in pediatric endoscopic retrograde cholangiopancreatography
Maher Al Hatlani, Paul Kortan, Gary May, Simon C Ling, Thomas Walters, Yaron Avitzur
January-February 2015, 21(1):25-29
DOI:10.4103/1319-3767.151219  PMID:25672235
Background/Aim: Wire-guided cannulation (WGC) of the common bile duct may be associated with fewer complications and higher success rate compared with contrast-guided cannulation (CGC) in adults. Data in children are lacking. The aim of this study was to compare the successful cannulation and complication rate of WGC and CGC in pediatric endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods: We report a retrospective cohort study comparing WGC to CGC in a pediatric cohort. We reviewed the medical records of 167 children who underwent ERCP over a 10-year time period (CGC, 1999-2003, WGC, 2003-2009). Indications, findings, and success were analyzed. Results: A total of 93 patients (56%) underwent WGC and 74 (44%) CGC. Children in the WGC group were younger (9.5 ± 4.7 vs. 11.5 ± 4.6 years in CGC; P = 0.006) and underwent more therapeutic ERCP interventions (70% vs. 40% in CGC), whereas diagnostic ERCP was more common in the CGC group (60%; P < 0.005). The overall success (96%) and complication rate (8%) were identical in both groups but a trend toward a reduction in the complication rate over time was noted in the WGC group. Post-ERCP pancreatitis (PEP) was documented in one patient in the WGC group (1.1%) and three patients (4.2%) in the CGC group (P-NS). Conclusion: The success and complication rate in both CGC and WGC are comparable in children but considering the patient and procedure complexity and the trend toward lower PEP in the WGC group, WGC may be the preferable cannulation technique for ERCP in children.
  1,631 285 -
EDITORIAL
Is a guidewire a magic wand? Is a knife the final weapon?
Hiroyuki Isayama, Yousuke Nakai, Kazuhiko Koike
January-February 2015, 21(1):3-4
DOI:10.4103/1319-3767.151209  PMID:25672231
  1,489 265 -
LETTERS TO EDITOR
Helicobacter pylori: Indian perspective
Rashmi Patnayak, Amitabh Jena, Venkat R Reddy, Thota Asha
January-February 2015, 21(1):55-55
DOI:10.4103/1319-3767.151232  PMID:25672241
  1,155 204 -
Comment on: Efficacy and safety of gum chewing in adjunct to high-dose senna for bowel cleansing before colonoscopy: A single-blind randomized controlled trial
Yusuf Serdar Sakin, Ahmet Uygun, Sait Bagci
January-February 2015, 21(1):56-56
DOI:10.4103/1319-3767.151233  PMID:25672242
  1,135 182 -
ERRATUM
Correlation of pretreatment hemoglobin and platelet counts with clinicopathological features in colorectal cancer in saudi population: Erratum

January-February 2015, 21(1):58-58
DOI:10.4103/1319-3767.151237  PMID:25672244
  957 155 -
LETTERS TO EDITOR
Response to 'Letter to Editor'
Bilal Ergül, Levent Filik, Erdem Koçak, Zeynal Dogan, Murat Sarikaya
January-February 2015, 21(1):57-57
DOI:10.4103/1319-3767.151235  PMID:25672243
  497 68 -
  Search 
  The Journal 
  Site Statistics 
  Addresses 
  My Preferences 
  Online Submission