Endoscopic retrograde cholangiopancreatography versus conservative treatment for patients with symptomatic small common bile duct stones: A randomized controlled trial

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended treatment for common bile duct stones (CBDS). However, CBDS, tiny ones, can spontaneously pass through the ampulla of Vater, reducing unnecessary ERCP and its related significant complications. Objectives: This study compared endoscopic stone extraction versus conservative treatment for managing symptomatic small CBDS. Patients and methods: This randomized controlled trial included 168 patients with symptomatic CBDS (≤ 7 mm) and gallbladder stones. Of these, 85 patients underwent endoscopic stone extraction, and 83 patients underwent conservative treatment for the CBDS, followed by laparoscopic cholecystectomy and intraoperative cholangiography between June 2019 and March 2023. The primary outcome was the overall success rate, while useless procedures, morbidity, mortality, length of hospital stay, total cost, and recurrent biliary symptoms were considered secondary outcomes. Results: Our study showed that the ERCP group had a significantly higher overall success rate (96.5% vs. 22.9%, P < 0.001), fewer useless procedures (14.1% vs. 77.1%, P < 0.001), a shorter median hospital stay (5 vs. 8 days, P < 0.001), and reduced total costs (1810 vs. 2250 US$, P < 0.001). Both groups had no significant difference in morbidity or recurrent biliary symptoms (2.4% vs. 7.2%, P = 0.14). There was no mortality rate in both groups. Conclusion: Symptomatic small CBDS should be managed surgically as early as possible. Endoscopic stone extraction has a significantly high success rate, a shorter hospital stay, and a lower total cost. The conservative treatment for symptomatic small CBDS is useless and should not be practiced

Diagnostic Value of Upper and Lower Endoscopy in Assessment of Patients with Microcytic Hypochromic Anaemia without Site-specific Gastrointestinal Manifestations

Background: Iron deficiency anemia (IDA), is often caused by digestive disorder and should always be assessed, as its causes could be severe illness such as cancer. Objectives: To study the diagnostic value of both upper and lower endoscopic examinations among patients with microcytic hypochromic anaemia without site -specific gastrointestinal (GIT) manifestations. Patients and methods: A total of 50 Egyptian patients with IDA were included. Patients were clinically evaluated and investigated for: Complete blood picture, serum ferritin, serum iron and total iron binding capacity (TIBC). Patients were screened with Esophagogastroduodenoscopy (EGD) and colonoscopy. Results: The mean ±SD age of the patients was 36.4 ± 16.7, 19 males (38%) and 31 females (62%). The most common finding of EGD was Gastritis, it was present in 20 patients (40%) followed by Peptic ulcer in 9 patients (18%). There were 2 patients (4%) with celiac disease, 1 patient (2%) with crohn’s disease, 2 patients (4%) with Gastric cancer, and 1 patient (2%) with angiodysplasia while there were 14 patients (28%) with normal EGD. Both procedures showed negative findings in 10 patients (20%), both procedures showed positive findings in 8 patients (16%) while 1 procedure only showed positive finding in 32 patients (64%). Conclusion: Bidirectional endoscopies are valuable to detect the cause of IDA in patients without site –specific (GIT) manifestations. The most common GIT lesions were gastritis followed by peptic ulcer

Rare cause of duodenal obstruction in a young-age female: a case report

Abstract Background Gastrointestinal tract can be compressed by many vascular structures in the abdomen; such compressions may be incidentally found or may result in compression symptoms like abdominal pain and vomiting. Case presentation We illustrate an uncommon cause of extrinsic compression of the third part of the duodenum by jejunal branches of the superior mesenteric artery in an 18-year-old female, presented with dull-aching epigastric pain and vomiting. Contrast Enhanced Computerized Tomography (CECT) showed atypical origin of the jejunal branches of superior mesenteric artery with relative space narrowing between it and the aorta, causing significant compression on the third part of the duodenum. Barium follow-through confirmed indentation of the duodenal lumen at the same level of the aberrant vessel. Conservative treatment failed to control her symptoms, and the patient referred to the surgery. Conclusion High index of suspicion is required for diagnosis of atypical causes of upper abdominal pain and vomiting. CECT guided by a well-descriptive comment of the treating doctor is very helpful diagnostic tool for detecting such rare condition. Barium studies still have a valuable role for determining the level of obstruction and confirming the diagnosis of such rare cases. </jats:sec