The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics:■ Follow-up and survivorship of patients with resected colorectal cancer ■ Indications for liver metastasectomy ■ Treatment of oligometastases by stereotactic body radiation therapy ■ Treatment of borderline resectable and unresectable pancreatic cancer ■ Transarterial chemoembolization in hepatocellular carcinoma ■ Infectious complications of antineoplastic agents
Background:
Upper gastrointestinal bleeding (UGIB) is a frequent cause for emergency endoscopy and, in a proportion, requires the application of endotherapy. We aim to evaluate the proportion of variceal and nonvariceal upper gastrointestinal bleeding (NVUGIB), the endoscopic findings that were detected, as well as the temporal trends of endoscopic findings over a period of 13 years.
Methods:
This is a retrospective study of patients who underwent an esophagogastroduodenoscopy with an indication of UGIB or presented with hematemesis, melena, or both, as well as those who had hematochezia, from January 2004 to December 2016 (13 years).
Results:
A total of 2075 patients were included with a mean age of 56.8 years (range 18–113) and males constituted 67.9%, while 65.9% had at least one comorbidity. Symptoms on presentation included hematemesis (52.5%), melena (31.2%), both hematemesis & melena (15.1%), and hematochezia (1.2%). The majority of UGIB were from a NVUGIB source (80.5%) and a variceal source was found in 13.1%, while no endoscopic findings were found in 6.4% of cases. The most common endoscopic diagnosis was gastroduodenal erosions (23.8%), duodenal ulcers (23.5%), reflux esophagitis (16.0%), esophageal varices (12.1%), and gastric ulcers (10.8%). There was no change in the endoscopic findings over the time period of the study. A third of duodenal ulcers (33.3%) as well as 21.9% of gastric ulcers were actively bleeding at the time of endoscopy, while 3.3% of duodenal ulcers had an adherent clot.
Conclusions:
NVUGIB composed the majority of cases presenting with UGIB and variceal bleeding was lower than that described in prior studies, but there were no clear trends in the proportion of causes of UGIB during the study duration.
Hymenolepis nana infestation is commonly diagnosed in school-aged children and very rarely reported in adults patients in Saudi Arabia. We encountered an adult Saudi patient with a H. nana infection. The patient presented with a chronic history of vague abdominal pain and diarrhoea. He had negative laboratory examinations as well as a negative report on stool sample analysis. After misdiagnosis of his symptoms as Irritable Bowel Syndrome and failed treatment for Irritable Bowel Syndrome, he was readmitted to hospital. After thorough but negative physical, systemic and laboratory examinations, and stool sample microscopy, the patient underwent careful ileo-colonoscopy. He was found to have a H. nana infestation and after treatment with praziquantel, his symptoms were resolved. Our study supports the view that colonoscopy, with careful examination of intestinal mucosa, is a useful diagnostic approach for patients with parasitic infections and negative stool examinations.
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