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Background Post-variceal band ligation bleeding ulcer is a severe complication with considerable mortality. We tried evaluating self-expandable metallic stent (SEMS) with concern to the ulcer morphology not well studied. Results We did a retrospective analysis of patients with bleeding post-band ulcers and treated by SEMS with concern to control bleeding and 6 weeks survival. Twenty-eight patients studied had their age (mean ± S.D.) 57.8 ± 8.6 years, and 85.7% were males. The Child-Pugh score range was 5–12]. Control of bleeding by SEMS was achieved in 23 (82.1%) patients, and overall, 6-week survival was 75%. Both post-band ulcer types B (oozing blood and type C (active spurted) were a risk for 6 weeks mortality (P = 0.04, OR 1.58, CI 95% 1.12–2.23). Conclusion SEMS is considered an excellent choice to control esophageal post-banding ulcer bleeding and a definite treatment bridge.

Background and aim Hepatocellular carcinoma (HCC) is a major health burden globally. Dysregulation of miRNA 148a-3p is engaged in carcinogenesis. TGF-β is a profibrogenic cytokine. This study assesses the expression level of miRNA 148a-3p and its relationship with serum TGF-β1 and fibrosis index based on four factors (FIB-4) in Egyptian patients with HCV-associated HCC. Subjects and Methods: The study included 72 HCC patients with HCV, 48 HCV cirrhotic patients, and 47 healthy controls. Serum TGF-β1 was assessed by ELISA and the expression of miRNA 148a-3p was measured by RT-PCR. Results Patients with HCC had lower plasma miRNA 148a-3p, higher serum TGF-β1, and higher FIB-4 levels than patients with cirrhosis and controls. miRNA 148a-3p discriminated HCC either from control (AUC: 0.997, 95.83% sensitivity, 85.11% specificity) or from cirrhosis (AUC: 0.943, 91.67% sensitivity, 81.25% specificity). Moreover, it distinguished metastatic from nonmetastatic patients (AUC: 0.800, 88.89% sensitivity, 60.0% specificity). The decreased miRNA 148a-3p and the increased TGF-β1 levels were related to distant metastasis, multinodular lesions, advanced TNM stage, and BCLC score (C). A negative correlation between miRNA 148a-3p and each of FIB-4 and TGF-β1 was detected. The decreased miRNA 148a-3p was associated with poor overall survival and poor progression-free survival. Conclusion An inverse relationship between miRNA 148a-3p and both TGF-β1 and FIB-4 was observed, which could be involved in HCC pathogenesis. Moreover, this miRNA is a potential diagnostic and prognostic biomarker for HCC.

Background:We aimed to evaluate the diagnostic roles of AFAP1-AS1 and ASB16-AS1 in colorectal cancer and highlight their roles in predicting colorectal cancer patients' prognosis. Methods: In this case-control study, 146 participants were involved. Group I included 47 patients with CRC. Group II composed of 49 patients with benign lesions in the colon, and Group III included 50 apparently normal subjects of coincided age and gender as controls. All participants were subjected to clinical and endoscopic evaluations, CA19-9, CEA, and quantification of relative expression of lncRNAs ASB16-AS1 and AFAP1-AS1. Results: CRC patients had significantly elevated expression levels of both lncRNAs in tissue and plasma samples versus benign and control groups (p < 0.001). Despite the higher sensitivity of tissue samples results, the relative expression of both lncRNAs in plasma samples was very encouraging in the discrimination between patients with CRC versus control and benign groups. Furthermore, both lncRNAs could discriminate patients with early-stage CRC (stage I&II) from being colonic lesion and control groups with better sensitivity and specificity presented by ASB16-AS1 in tissue and plasma than results detailed by AFAP1-AS1. High expression levels of ASB16-AS1 in tissue and plasma and tissue lncRNA AFAP1-AS1 are significantly correlated with decreased overall survival (p < 0.001) and reduced progression-free (p < 0.001) compared to low expression in CRC patients. Conclusion:We propose the utilization of lncRNA ASB16-AS1 and lncRNA AFAP1-AS1 as biomarkers in diagnosis and prognosis estimation for CRC patients. Moreover, their value in early CRC patients may affect the assortment of target therapy and treatment protocols.

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Background: Biliptysis means coughing of bile which is a presenting symptom of a rare condition called bronchobiliary fistula (BBF). BBF is a connection between the biliary tract and bronchial tree. BBF mostly occurs secondary to malignancy, liver abscess, and trauma. Surgical approach in BBF management was the main management strategy, then endoscopic approach. Case presentation: We managed our first encountered case of biliptysis endoscopically by endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: ERCP management seems to be effective in management of biliptysis.

Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancreaticoduodenectomy (PD) is still a point of controversy. The aim of this study was to identify the impact of biliary drainage (BD) prior to PD on the postoperative outcome. Methods: The data of patients, who underwent PD from February 2009 to February 2017, were retrospectively studied. A comparison was performed between 2 groups of patients; group A (with PBD) and group B (without PBD), according to preoperative, operative and postoperative data. Results: PD was performed in 158 patients with periampullary lesions. Group A, included 76 patients (48.1%) while 82 patients were included in group B (51.9%). The incidence of major postoperative complications was significantly higher in group A (P=0.04). The infectious complications were higher in group like; positive intraoperative bile culture (P=0.06), intraabdominal abscess (P=0.07) and wound infection (P=0.04). Also, hospital stay and mortality were higher in group A (P=0.05 and 0.08, respectively). High preoperative bilirubin level was not a risk factor for major postoperative complications (P=0.12). Conclusion: Patients with PBD had a significantly higher incidence of major postoperative complications mainly of infectious ones, thus PBD should be performed only in selected patients, not as a routine prior PD.

Background and aim: Non-invasive parameters of liver fibrosis are being widely incorporated and adopted in clinical practice, of them, 2 ratios APRI and FIB-4 were proposed and applied. The gamma-glutamyl transferase-toplatelet ratio (GPR) was developed and investigated as available test that is useful in predicting liver fibrosis stages in chronic HBV patients. We aimed to estimate the diagnostic performance of GPR compared to APRI in assessing different fibrosis stages estimated by ultrasound based Transient Elastography in chronic HCV Egyptian patients. Methods: This prospective study was conducted on 90 treatment-naive chronic HCV patients. Fibrosis stages were assessed by Transient Elastography. Serum aspartate transferase, alanine transferase, gamma-glutamyl transferase and platelets were estimated. APRI and GPR formulas were calculated. Results: GPR was significantly different with fibrosis stage (p value <0.001) in addition, higher GPR values associated with increasing fibrosis stage. The mean ± SD for GPR, APRI were 0.4 ± 0.31 and 0.38 ± 0.34 respectively. The AUROC of the GPR and APRI in predicting significant fibrosis (>F3) from nonsignificant fibrosis (< F3) was significant with GPR AUC was 0.97 while APRI AUC was 0.86. GPR at cutoff point 0.31 has sensitivity 92 %, specificity 88%, PPV 86 % and NPV 91 %. While, APRI at cutoff 0.26 has sensitivity 81 % and specificity 78 %. Conclusion: The GPR represents a simple, non-invasive, inexpensive model for assessment of liver fibrosis. The GPR is a more accurate model than APRI to stage liver fibrosis in chronic HCV patients in Egypt.