Colonoscopic findings in Patients of Portal Hypertension Due to Different Etiologies and their Correlation.

INTRODUCTION: Recently, it is established that portal hypertension also produces vascular changes throughout the colon similar to lesion on Upper GI endoscopy. So we planned this study to see the spectrum and frequency of colonic lesions in patients with portal hypertension due to different etiologies, to assess whether the presence of portal hypertension related colonic lesions correlates with severity of liver disease as indicated by CTP and MELD scores and to study the relationship between upper GI lesions of portal hypertension and colonic lesions. MATERIAL AND METHODS: This study was done over a period of one year. In this study, 100 patients of portal hypertension due to different etiologies were taken if they met the inclusion criteria. RESULTS: The frequency of portal hypertension related colonic lesions including rectal varices, rectopathy and portal hypertensive colopathy increases with increase in the severity of liver disease as ascertained by Child-turcotte-Pugh score. Portal hypertension related colonic lesions and hemorrhoids are more frequent in cirrhotic patients with higher MELD score. Rectal varices are more frequent among who had esophageal varices on upper GI endoscopy. There is significant increase in bleeding PR as frequency of hemorrhoids increases, whereas there was not any significant relationship between bleeding PR and rectal varices suggesting that cause of lower GI bleeding in present were haemorrhoids most likly. CONCLUSION: Patients with portal hypertension due to any etiology have significantly higher frequency of colonic lesions as severity of liver disease increases indicated by worsening CTP and MELD scores. Inspite of large number of lower GI manifestations of Portal Hypertension seen in our patients none had significant life threatening lower GI bleeds. So it can be concluded that only upper GI manifestation of Portal Hypertension are clinically significant.

Management of ingested foreign bodies in upper gastrointestinal tract: report on 170 patients.

BACKGROUND: Ingestion of foreign bodies (FB) is commonly encountered in gastrointestinal practice. METHODS: Retrospective analysis of data on endoscopic removal of FB in 170 patients (124 children) who were managed at a tertiary referral center over a six-year period. OUTCOME: Coins were the most common FB removed (n=134). Dentures (12), food boluses (19), sharp objects such as needles and pins (7), and certain unusual FB (12) made up the remainder. Esophagus was the most common site of FB lodgement (56%). Most patients with esophageal FB complained of FB sensation, dysphagia, odynophagia or chest pain. Gastric and duodenal FB produced no symptoms. FB could be successfully removed endoscopically in 166 patients (97.6%) without morbidity or mortality. Four patients required surgical removal of FB. Certain Innovative methods like loop basket, electrocautery and suction retrieval were used to remove some FB. CONCLUSION: Endoscopic removal of FB in the esophagus and stomach is safe but often requires the use of innovative techniques and accessories.