Study on Endoscopic Retrograde Cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.

Significance of Age-Spleen-Platelet Ratio Index (ASPRI) to Exclude Cirrhosis in Patients with Chronic Hepatitis B.

Liver biopsy is an integral part of management of patients with Chronic Hepatitis B (CHB), which is helpful in confirming diagnosis, assessing grade of inflammation and stage of fibrosis and also in guiding treatment strategy. Although liver biopsy is relatively safe, morbidity occurs in 0.2-2% of patients. Hence various non-invasive markers, like AST-ALT Ratio (AAR), Age-Platelet Index (API), AST to Platelet Ratio Index (APRI), Fibroscan etc. have been developed worldwide to asses liver histology. Age-Spleen-Platelet Ratio Index (ASPRI) is new in this series. In this cross sectional study 51 (fifty one) patients with CHB, attending at Hepatology ward in Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2006 to May 2006, were studied. They were divided into two groups: Group I patients with ASPRI<5 and Group II patients with ASPRI>5. Clinical, serological, biochemical, virological parameters were analyzed and following liver biopsy, correlation of liver fibrosis with ASPRI was evaluated. Among 51 patients of CHB, 30 patients Group I with ASPRI<5 (mean 3.4) had mean fibrosis 1.3 using Knodell scoring system; while mean age, spleen size and platelet count were 23.2 years, 8.6cm and 278?109/L accordingly. In Group II, 21 patients with ASPRI>5 (mean 5.8) had mean fibrosis 1.8; mean age was 30.6 years, spleen size 9.5cm and platelet count 195?109/L. Mean liver fibrosis was significantly increased in Group II patients. In Group I patients, liver fibrosis showed significant correlation with platelet count (p=0.03) and ASPRI (p= 0.011), while none was observed in Group II patients. Age-Spleen-Platelet Ratio Index ASPRI can be used as a good tool for diagnosis of liver fibrosis in chronic hepatitis B. However, further study with larger study population is required to assess its validity.