Screening for hepatocellular carcinoma.

Liver cancer remains one of the most common causes of cancer death globally, and its cure rate has not improved for the past 20 years. Hepatocellular carcinoma develops in patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in screening program aiming to achieve early detection and effective treatment for HCC. Only those patients diagnosed with HCC who would benefit with the available treatment, should undergo the screening procedure. This is based on ultrasonography and alpha-fetoprotein every 3-6 months based on the prevalence and economic status of the community being tested.

Basketing a basket: A novel emergency rescue technique.

Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct (CBD) stones poses a special challenge. Different maneuvers have been described to resolve this problem. Most techniques require equipment or facilities which may not be readily available in small community hospitals. We present here a similar situation in a patient with a large stone at the level of the cystic duct. Through the duodenoscope, a smaller Dormia basket was introduced into the CBD along the side of the impacted broken basket. The tip of the impacted basket was grasped and, by pulling downwards, the basket was disengaged from the stone. The two baskets were then removed successfully. We suggest this simple technique should be tried initially, before resorting to more advanced procedures.

Diseases of the appendix recognized during colonoscopy.

Although the appendiceal orifice is routinely identified during a total colonoscopic examination, there are only a few reports in the English literature describing abnormalities in this region. Many recent case reports have described endoscopic features of various appendiceal pathologies. In order to increase the awareness as well as facilitate the recognition of these uncommon encounters a review of the literature on the endoscopic features of various appendiceal problems is provided. The most frequently reported abnormalities are related to appendiceal neoplasms or intussusception. Interesting observations and new features of appendiceal regional abnormalities in acute appendicitis and ulcerative colitis are being described. Importance of appendiceal involvement in ulcerative colitis is of interest in particular. This may have impact on the disease prognosis and management. The knowledge of the emerging role of colonoscopy in the diagnosis and management of complicated appendicitis might encourage a more aggressive non-operative approach in some of these cases. Recognition of rare entities requires knowledge of their endoscopic appearance. Awareness of these new developments is essential for all endoscopists performing routine colonoscopic examination. In order to detect any abnormality, the appendiceal orifice should be carefully inspected during all routine colonoscopic examinations. This systematic approach may eventually result in more frequent pre-operative diagnosis of appendiceal problems.