|Year : 2022 | Volume
| Issue : 2 | Page : 79-83
Selected Abstracts Presented At The 14th Annual Scientific Conference Of Society For Gastroenterology And Hepatology In Nigeria, Kano, July 18–22, 2022
|Date of Web Publication||26-Dec-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Selected Abstracts Presented At The 14th Annual Scientific Conference Of Society For Gastroenterology And Hepatology In Nigeria, Kano, July 18–22, 2022. Niger J Gastroenterol Hepatol 2022;14:79-83
|How to cite this URL:|
. Selected Abstracts Presented At The 14th Annual Scientific Conference Of Society For Gastroenterology And Hepatology In Nigeria, Kano, July 18–22, 2022. Niger J Gastroenterol Hepatol [serial online] 2022 [cited 2023 Feb 8];14:79-83. Available from: https://www.njghonweb.org/text.asp?2022/14/2/79/365313
Abstract no.: 1
Capnoperitoneum failure: Nebulizer and mercury or digital manometry, novel methods to forestall conversion during laparoscopic surgeries
Patrick O. Igwe, Chula Chuaken1
Colorectal and Minimal Access, General Surgery Unit, Department of Surgery, University of Port Harcourt Teaching Hospital (UPTH) and Immaculate Conception Endoscopy and Minimal Access Surgery (ICE MASS) Clinic, Ozuoba, 1College of Health Science, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
Background: The use of carbon dioxide insufflation is the ideal method in achieving pneumoperitoneum or capnoperitoneum during laparoscopic surgery. The insufflator is also used to monitor abdominal pressure. Occasionally, failure or faulty insufflation may occur, hence leading to conversion.
Aim: We present the use of nebulizer to archive and maintain pneumoperitoneum and the use of mercury manometer to monitor the intra-abdominal pressure especially in the failure of routine methods.
Materials and Methods: Laparoscopic surgeries performed om January to May 2022 were included; ethical approval and informed consent were obtained. Five cases of laparoscopic cholecystectomies were performed using Onms 25-L insufflator; the same time a mercury manometer was connected in another 5 mm port. Insufflator and mercury manometer pressures were recorded at the same time. Capnography was routinely performed.
Results: The intra-abdominal pressure was maintained within 8–14 mmHg using the mercury manometer and room air nebulizer insufflation. The same abdominal pressure was recorded in insufflator and the mercury manometer. A room air nebulizer was also maintained in the intra-abdominal pressure with good outcome.
Conclusions: The use of nebulizer and mercury or digital manometer prevented conversion to open surgery by providing alternative monitoring with the same reliable method of capnoperitoneum during laparoscopy. A more randomized control trial is ongoing and will provide better information in this regard.
Keywords: Intra-abdominal pressure, mercury manometer, nebulizer
Abstract no.: 2
Percutaneous transhepatic biliary image-guided interventions: Experiences of Aminu Kano Teaching Hospital
Abdulqadri Musa Tabari, Kabiru Isyaku, Anas Ismail, Yusuf Lawal, Yusuf Inuwa, Nafiu Ahmad, Nasir Ismail1
Department of Radiology, Aminu Kano Teaching Hospital, 1Department of Surgery, Bayero University, Kano, Nigeria
Background: Cholestatic jaundice refers to yellow discoloration of the skin and mucous membranes because of rising levels of serum bilirubin due to the obstruction of the flow of bile from the liver to the duodenum. Percutaneous cholangiography and drainage (PTCD) are important noninvasive palliative methods of relieving cholestasis, which are not limited to malignant causes.
Aim: These case series represent our first cases of percutaneous transhepatic cholangiography and drainage, mainly caused by unresectable carcinoma of the pancreatic head.
Materials and Methods: The five patients consist of three females and two males. Their age ranged from 40 to 85 years.
Results: All of them presented with distressing deepening jaundice, distressing pruritus, and at least a month history of dull epigastric pain and fullness. In all cases, abdominal ultrasound and computed tomography revealed a mass at the pancreatic head, which encapsulated the superior mesenteric vessels and caused severe cholestasis. PTCD were done prior to the application of an external drain to decompress the dilated biliary system. Only one of the cases had cholangioplasty and the deployment of balloon-expandable stent over the stenotic segment. The postprocedure was satisfactory, and the patient showed gradual clearance of jaundice and resolution of pruritus.
Conclusion: Percutaneous biliary access and imaging resulted in intended beneficial outcomes in most cases.
Keywords: Cholangioplasty, cholestatic jaundice, imaging, percutaneous biliary access
Abstract no.: 3
One-year review of FibroScan experience in a tertiary health center: North-Western Nigeria
Musa Yusuf, Tijjani Habib, Muhammad Nurudeen Olalekan, Dada Idowu, Samaila Adamu Alhaji1, Borodo Musa Muhammad1
Department of Internal Medicine, Federal Teaching Hospital Katsina, Katsina, 1Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
Background: Liver cirrhosis is the 11th commonest cause of global mortality with two million deaths annually. The common causes include chronic viral hepatitis, alcoholic liver disease, and fatty liver disease, all of which are potentially reversible if detected early. Liver biopsy, though the gold standard for diagnosis, is invasive with associated interobserver differences. Thus, there is a need for an alternative. FibroScan is a novel, noninvasive, and user-friendly bedside method for assessing liver fibrosis and steatosis. It is powered by vibration-controlled transient elastography that examines 3 cm3 cylinder of the liver, which is more than 100 times the size of a standard biopsy specimen. In this study, we examine a 1-year experience of FibroScan practice in a tertiary health center in North-Western Nigeria.
Materials and Methods: This is a descriptive study where records of all FibroScans carried out from July 2021 to June 2022 were analyzed. Patients’ demographic data, indications, elastography, and continuous controlled attenuation parameter (CAP) values were all recorded and analyzed. Similarly, a record of spleen stiffness study was also analyzed accordingly. Data were analyzed using SPSS version 20.
Results: A total of 99 examinations were conducted over the 1-year period, 94 (94.9%) liver examination and five (5.1%) spleen examinations. The mean age ± standard deviation was 40.14 ± 11.7 years with male having 58.6%. The commonest indications were hepatitis B virus (HBV) (62.6%) followed by non-alcoholic fatty liver disease (NAFLD) (21.2%), cirrhosis, and portal hypertension. Fibrosis was detected in 95.6% with F1 having 77.7% and F4 in 7.5%. Splenic elastography was in a range of 14.1–90 kpa. Steatosis was detectable in 47.5% of the patients with severe steatosis accounting for 13.1%.
Conclusions: FibroScan is an easy bed side procedure that can revolutionize hepatology practice when employed appropriately. It can not only assess liver fibrosis and steatosis, but also accurately assess the presence of portal hypertension in patients with cirrhosis and hepatocellular cancer.
Keywords: FibroScan, hepatocellular carcinoma, liver cirrhosis, steatosis
Abstract no.: 4
Concurrent Sarcina ventriculi infection in a patient with Helicobacter pylori associated gastritis
Akinjo Andrea Oludolapo, Cookey Cara1, Haruna Muibah, Awolola Nicholas Awodele, Abdulkareem Fatimah Biade
Department of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, 1Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
Background:Sarcina ventriculi is a gram-positive, nonmotile, chemoorganotrophic anaerobic organism, which is rare in humans. It has been reported to be associated with conditions that result in delayed gastric emptying including gastric outlet obstruction and gastroparesis. There is also an association with emphysematous gastritis and gastric perforation.
Case Report: We report a case of a 34-year-old man with 2-year history of abdominal pain and 1-month history of frequent vomiting, with associated bloating, abdominal distention, belching, and farting. He was evaluated for gastric outlet obstruction secondary to a possible gastric tumor. Upper gastrointestinal (GI) endoscopy revealed food debris within the stomach with deformed hyperemic pylorus with no mass seen. Histology of biopsies taken revealed chronic severely active antral predominant gastritis with concurrent Helicobacter pylori and S. ventriculi infection. He subsequently had antibiotic treatment with repeat endoscopy carried out 6 weeks after the initial endoscopy. Repeat biopsy showed the absence of H. pylori and S. ventriculi.
Discussion: The role of S. ventriculi as a pathogen in humans is not clear. As previous reports have shown, S. ventriculi is associated with delayed gastric emptying as seen in the index case. A few cases of coinfection with H. pylori and S. ventriculi have been reported. The histologic features associated with S. ventriculi can range from normal mucosa to acute hemorrhagic gastritis with ulceration; none is pathognomonic. The distinct morphologic features of the organism, basophilic tetrad, or cubes of eight morphologies were demonstrated in the hematoxylin and eosin-stained sections from both the gastric and duodenal biopsy samples from the index patient.
Conclusion: A high index of suspicion is required when carrying out the examination of gastric biopsies obtained from patients with a history of delayed gastric emptying or GI surgery.
Keywords: Delayed gastric emptying, gastritis, Helicobacter pylori, Sarcina ventriculi
Abstract no.: 5
Endoscopic removal of plastic cover from the stomach at Federal Teaching Hospital, Katsina
Muhammad Nurudeen Olalekan, Yusuf Musa1, Dada Idowu, Tijjani Habib, Samaila Adamu Alhaji1, Borodo Musa Muhammad1
Department of Internal Medicine, Federal Teaching Hospital Katsina, Katsina, 1Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
Background: Foreign body (FB) ingestion is an endoscopic emergency seen globally. The object swallowed could be food, especially meat bolus impaction with background luminal narrowing, coins commonly in children, and fish bone or some isolated sharps usually in psychiatric patients in an attempted suicide. Impaction site depends on the size, shape, and type of the FB. The most common lodgement site is upper esophagus, then the middle esophagus, stomach, pharynx, lower esophagus, and the duodenum. Often, a FB in the stomach will pass within 4–6 days. In this report, we present a case of accidental bottle cover ingestion and successful endoscopic retrieval.
Case Report: A 37-year-old civil servant was referred for gastroscopy on an account of ingestion of bottle cover 3-months prior to presentation. The incident happened while licking an overflowing fermented drink (Fura da Nono) in a tightly closed plastic container where the cover forcefully popped into his throat. Had few episodes of hemoptysis, but no breathless. There was intermittent dysphagia and epigastric pain radiating to the shoulder. There was no vomiting, no history of psychiatric illness, the use of illicit drugs, or similar occurrence in the past. Abdominal x-ray showed radio-opaque object in the stomach. Endoscopy revealed about 3 × 3 cm mucous-coated bottle cap in the stomach with hyperemia around the area of basement, not embedded. The bottle cap was removed using Roth Net FB retriever.
Discussion: FB ingestion more commonly occurs in males. About 20% of adults who accidentally ingest FB do so while eating. This is the case with our index case who forcefully swallowed bottle cap while licking a spilling drink. Contrary to the common transit for most FB in stomach, our index case kept it for over 12 weeks, which may be responsible for the inflammatory changes seen on endoscopy. The over stay may be due to the size of FB, which is too big for the pylorus to pass.
Conclusion: Endoscopic removal might be feasible in carefully selected patients with an old FB in the stomach without the need for surgery.
Keywords: Endoscopic removal, foreign body, plastic cover
Abstract no.: 6
Factors that influence the acceptance of liver biopsy at a tertiary hospital in Nigeria
Adekanle Olusegun, Kolawole Olawumi Janet1, Ijarotimi Oluwasegun, Ndububa Dennis
Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, 1Department of Medicine, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria
Background: Liver biopsy is a procedure that is carried out for making the diagnosis of abnormal liver conditions.
Aims and Objectives: This study assessed the factors that influence patients’ acceptance of liver biopsy.
Materials and Methods: A hospital-based prospective study was carried among patients scheduled for outpatient liver biopsy after informed consent. All completed an interviewer-administered questionnaire that captured their prebiopsy expectations, the degree of pain, areas they think need improvement during a biopsy process, and whether they will consent to a second liver biopsy for 100 participants. A qualitative aspect involved sixteen participants that had an in-depth interview purposively selected for their experience of liver biopsy. All 116 subjects had percutaneous liver biopsy performed. Data from the quantitative group were entered into SPSS version 20 and analyzed using simple and inferential statistics, while content analysis was done for the qualitative aspect.
Results: There were 100 participants in the quantitative group, 61 males and 39 females, and 16 in the qualitative group. Participants in the quantitative group expected a painful procedure (92%) that was likely to restrict their movement (64%), but were not expecting a prolonged stay (53%) or admission (78%). After biopsy, 44%, 40%, 28%, 26%, 18%, and 17% of participants were unhappy with the long monitoring hours, biopsy needle pain, number of biopsy passes, lying on the biopsy site, shoulder tip pain, and pain of local anesthetic injection, respectively. A total of 84% rated the procedure as bearable, and 73% were willing to do a second biopsy. The qualitative aspect identified five thematic areas and showed that liver biopsy pain was influenced by preoperative anxiety occasioned by ill-advice and was exaggerated among females.
Conclusion: Consenting for liver biopsy may be influenced by advice from relations, whereas factors relating to the procedure and long monitoring period remain as deterrent.
Keywords: Consent, liver biopsy, qualitative study
Abstract no.: 7
Helicobacter pylori antibiotic sensitivity pattern in dyspeptic patients in Kano, Nigeria
Ahmad K. Bello, Musa M. Borodo1, Ahmad Y. Maifada2, Abubakar D. Tukur3
Department of Internal Medicine, ABU, Zaria, ABUTH, Zaria, 1Department of Internal Medicine, AKTH, 2Department of Internal Medicine, Yusuf Maitama University Teaching Hospital, 3Department of Microbiology, Aminu Kano University Teaching Hospital, Kano, Nigeria
Background:Helicobacter pylori (H. pylori) is common and believed to infect half of the world’s population. There is a high prevalence of H. pylori in resource-poor regions of the world, particularly in Africa, which has the highest burden of the infection. With the high prevalence of H. pylori in our environment, resistance to some of the antibiotics used in its treatment is posing a huge challenge in eradicating the pathogen. In North-West Nigeria, there are no studies on the antibiotic sensitivity pattern of this organism. This study aims to determine the antibiotic sensitivity pattern of this bacterium, as well as to bridge the gap in knowledge.
Aim: The aim of the study was to determine the antibiotic sensitivity pattern of H. pylori to some antibiotics, in Kano, North-West, Nigeria.
Materials and Methods: The study was cross-sectional in design. Questionnaires were administered in dyspeptic patients to obtain relevant data. Two sets of gastric biopsy specimens were taken during upper gastrointestinal endoscopy. One set was sent to the histopathology laboratory for histologic assessment, whereas the set for culture was minced and plated on Columbia blood agar media (Oxoid Ltd, England) incubated at 37°C in an anaerobic jar containing CampyGen (Oxoid Ltd) to provide the required microaerobic environment. The disc diffusion method was used in determining the sensitivity pattern of isolates. Pretreatment and posttreatment stool samples were collected from each patient for a H. pylori fecal antigen test to assess eradication rate.
Results: The sensitivity of H. pylori is 100% for both clarithromycin and levofloxacin, but only 9.2% to amoxicillin. There was 100% resistance to metronidazole, tetracycline, and eight other antibiotics. The prevalence of H. pylori at histology was 81.7%.
Conclusion: This study showed a high amoxicillin resistance; however, there is high sensitivity (100%) to clarithromycin and levofloxacin. We recommended that levofloxacin be adopted in preference to amoxicillin as a part of triple therapy in Nigeria.
Keywords: Antibiotic sensitivity, dyspepsia, Helicobacter pylori
Abstract no.: 8
Immunotherapy in HCC management-A case report
Nnabuchi C. V., Ijoma U. N.1, Shagaya U. N.2, Ezeude C. C.
Department of Internal Medicine, Asokoro District Hospital, Nile University Teaching Hospital, Abuja, 1Department of Internal Medicine, University of Nigeria Teaching Hospital, Enugu, 2Department of Oncology and Radiotherapy, National Hospital, Abuja, Nigeria
Background: Liver cancer is the sixth most common cancer worldwide, and hepatocellular cancer makes up ~90% of them. It is the fourth leading cause of global cancer mortality. Majority of cases (~80%) are caused by chronic hepatitis B & C virus infections. Most patients in sub-Saharan Africa present with advanced and unresectable disease at diagnosis only amenable to systemic therapy. The first-line systemic therapy has been with sorafenib since 2007 or lenvatinib since 2018. Immunotherapy with atezolizumab and bevacizumab has been approved as the first-line therapy in 2020 and adopted by several regional guidelines.
Aim: We present a Nigerian male with advanced hepatocellular carcinoma secondary to chronic hepatitis B infection in BCLC stage C managed with immunotherapy.
Case Report: A 47-year-old man with chronic HBV who presented in August 2020 with advanced HCC, Barcelona Clinic Liver Cancer (BCLC) stage C, Eastern Cooperative Oncology Group/World Health Organization (ECOG/WHO) performance status 1 was diagnosed in January 2020. He could not tolerate the adverse effects of sorafenib. He was evaluated including endoscopy to rule out varices and commenced on atezolizumab/bevacizumab 1200 mg/1200 mg in March 2021, which was administered every 3–6 weeks depending on the availability. The drugs were well tolerated by him with only difficulty controlling blood pressure as the notable adverse event. He had 11 courses of atezolizumab and bevacizumab before he began to deteriorate with marked weight loss, tumor progression, diarrhea, and weakness. After the 12th course, he developed jaundice, anorexia, generalized body pains, marked elevation of the liver enzymes, and bilirubin. He was commenced on steroids but he died June 2022.
Discussion: Atezolizumab and bevacizumab compared with sorafenib in the management of advanced and unresectable HCC (IMbrave 150) revealed a median progression free survival of 6.9 months vs. 4.3 months and a median overall survival of 19.2 vs. 13.4 months, respectively. Our patient lived for 15 months from the commencement of immunotherapy, and computed tomographic (CT) scan done after 11 months showed slowed progression. Median time to deterioration in physical functioning from the IMbrave 150 study was 13.1 vs. 4.9 months, respectively, whereas our patient was able to function effectively for 12 months before he deteriorated.
Conclusion: Compared with sorafenib, immunotherapy with atezolizumab and bevacizumab has a better overall and progression free survival for advanced and unresectable hepatocellular carcinoma (HCC) as demonstrated by our patient and was also better tolerated by our patient. Unfortunately, the high cost of these medications makes it largely unaffordable by a majority of our patients although the benefits are enormous.
Keywords: Chronic hepatitis B virus infection, hepatocellular carcinoma, immunotherapy
Abstract no.: 9
Liver fibrosis in a healthy population in Jos, North-Central Nigeria
Nyam P. David, Mary J. Duguru, Pantong M. Davwar, Atta Okwute, Shedrack F. Kenis1, Kefas P. Zawaya2, McHenry I. Stephen, Jireh D. Makpu, John E. Ogwuche, Solomon Obekpa, Edith N. Okeke
Department of Medicine, Jos University Teaching Hospital, Jos, 1Department of Radiology, Echolab Radiology and Laboratory Services, Abuja, 2Department of Medicine, Federal Teaching Hospital, Gombe, Nigeria
Background: The excessive accumulation of extracellular matrix protein, primarily collagen, leads to the fibrosis of the liver, and when fibrosis becomes advanced, it leads to liver cirrhosis. Liver cirrhosis is progressive hepatic fibrosis characterized by distortion of the liver parenchyma and the formation of regenerative nodules. Nigeria is one of the countries described as hyperendemic for hepatitis B with attendant high mortality from the impact of chronic liver disease. Thus, early detection and determination of the disease burden are essential tools that will help in public health interventions and the prioritization of intervention programs.
Aim: The study aims to determine the burden of liver fibrosis using FibroScan, in a healthy population.
Materials and Methods: This cross-sectional observational study was carried out among 223 healthy individuals, in a tertiary institution, in Jos, Nigeria. Ethical approval and informed consent were obtained prior to the data collection. Demographic data, weight, and height were determined, and each of the patients had a FibroScan carried out to determine the degree of liver fibrosis. Blood was taken for hepatitis B and C tests.
Results: There were 223 participants; males were 106 (47.53%) whereas females were 117 (52.4%). The mean BMI was 26.53 ± 5.47 kg/m2, it was 24.16 ± 3.26 kg/m2 vs. 28.98 ± 6.22 kg/m2 for males and females, respectively, P = 0007. The median (inter-quarter range [IQR]) fibrosis score for the general population was 5.4 (4.4–6.7) kpa, whereas it was 5.6 (4.6–6.8) kpa vs. 5.2 (4.2–6.7) kpa for males and females, respectively, P = 0.10. Thirty-seven (16.59%) participants had significant fibrosis (FibroScan score ≥ 7.2 kpa), and six (2.7%) had liver cirrhosis (FibroScan > 12.5 kpa). Fibrosis of the liver was associated with being obese, odds ratio = 1.20 (95% confidence interval [CI]: 0.43–3.3); alcohol ingestion, odds ratio = 1.17 (95% CI: 0.03–4.48); and female sex, odds ratio = 2.03 (95% CI: 0.82–5.01).
Conclusions: Hepatic fibrosis is a significant cause of morbidity and mortality. Screening individuals at a risk of liver fibrosis should be intensified in order to ensure early detection and deter further progression and complications.
Keywords: FibroScan, fibrosis, liver cirrhosis
Abstract no.: 10
Intrahepatic abscess with obstructive jaundice: An unusual presentation: A case report
Bashir Aminu, Mukoro D. George, Okafor I. Fidelis, Gundu Isaac, Dauda M. Maigatari
Department of Surgery, Ahmadu Bello Teaching Hospital, Shika, Nigeria
Background: A hepatic abscess is a benign disease caused by bacterial, fungal, or protozoan infection. The commonest cause of intrahepatic abscess is Entamoeba histolytica. Bacterial infections have been implicated in about 30% of cases. These organisms usually gain access into the liver via the portal, arterial, or lymphatic system. Diseased livers are usually at risk for abscess formation. Liver abscess rarely presents with jaundice.
Aim: The report intends to suggest that liver abscesses should be suspected in young persons with jaundice by clinicians.
Materials and Methods: The case report describes an unusual presentation of obstructive jaundice in a young woman with a huge liver abscess.
Case Report: A 32-year-old homemaker was presented to the surgical clinic with complaints of progressive abdominal swelling, intermittent epigastric pain for 2 years, and intermittent jaundice of a year duration, which was associated with passage of coca cola-colored urine, pale bulky stool, and severe pruritus. She had a positive hepatitis C serology diagnosed 2 years ago. On examination, a tachypnoeic and tachycardic young woman was seen with a basal metabolic index (BMI) of 20 kg/m2. Her abdomen was 36 weeks gestation in size with ascites. Radiological investigations revealed a huge intrahepatic cyst with hepatomegaly. Serum alkaline phosphatase was 3121 IU/L, markedly elevated, with high levels of conjugated bilirubin = 30 mmol/L and total bilirubin was 63 mmol/L. Hemoglobin concentration was 9 g/dL, clotting profile; prothrombin time (PT) was 13 s; and kaolin cephalin clotting time (KCCT) was 43 s. She had exploratory laparotomy with liver abscess drainage. The drainage was uneventful. Her jaundice, abdominal swelling, pruritus, and abdominal pain resolved, and coca cola-colored urine and pale stool color had resolved. Postoperatively, she received metronidazole, tinidazole, and chloroquine. She has remained well on follow-up.
Conclusion: Obstructive jaundice in well-preserved young people necessitates a high index of suspicion for huge intrahepatic abscesses.
Keywords: Hepatomegaly, jaundice, liver abscess