Euroasian journal of hepato-gastroenterology

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2021 | January-June | Volume 11 | Issue 1

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[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ejohg-11-1-iv  |  Open Access |  How to cite  | 


Original Article

Shah Naveed, Hasina Qari, Cao M Thau, Pipit Burasakarn, Abdul W Mir, Brij Bhushan Panday

Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:5] [Pages No:1 - 5]

   DOI: 10.5005/jp-journals-10018-1336  |  Open Access |  How to cite  | 


Background: Metastasis to lymph nodes is a bad prognostic factor in patients with gallbladder carcinoma who undergo radical cholecystectomy. During the past decade, studies have brought focus on lymph node ratio (LNR) as an additional valuable prognostic factor in these cases. Our research studied the factors that predicted the recurrence of disease and survival of patients with gallbladder carcinoma who were treated with surgical resection, concentrating especially on the lymph nodal status as a prognostic factor and LNR in node-positive T1–T3 cases. Methods: In our hospital, Mahavir Cancer Institute and Research Centre, we reviewed retrospective data, from 2009 to 2014, of 60 patients who had undergone radical cholecystectomy for gallbladder carcinoma. We staged the patients as per the AJCC eight edition. Predictive factors that affect disease-free survival (DFS), like age, gender, postoperative complications, lymphovascular invasion (LVI) and perineural invasion (PVI), lymph node dissection, differentiation, T stage, N stage, number of lymph nodes involved, and LNR, were examined statistically. Results: Lymph nodal involvement was found to be a principal predictive factor in cases in whom radical cholecystectomy was done. The number of lymph nodes dissected determined the prognosis in N0 cases. LNR was a strong prognostic factor for DFS in cases of curatively resected gallbladder cancer. Conclusion: LNR is a strong predictive factor in radically resected gallbladder carcinoma cases.


Original Article

Ulas Aday, Mehmet T Kafadar, Abdullah Oğuz, Mehmet V Bahadır, Baran Demir, Faik V Akpulat, Baris Gulturk, Abdullah Böyük

Polyposis and Oncologic Outcomes in Young-onset Sporadic Colorectal Cancer

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:5] [Pages No:6 - 10]

   DOI: 10.5005/jp-journals-10018-1334  |  Open Access |  How to cite  | 


Aim: The present study aimed to investigate the effect of the presence of polyposis in sporadic early-onset colorectal cancer (EOCRC) on clinicopathological and oncological outcomes. Methods: The retrospective study included patients with sporadic colorectal cancer aged 16 to 50 years who underwent curative resection at the general surgery clinics in two healthcare centers between 2013 and 2019. Patients were divided into two groups: polyposis and nonpolyposis. Clinicopathological characteristics and oncological outcomes were compared between the two groups. Results: A total of 127 patients were included, of whom 60.6% were men. There were 25 (19.68%) patients in the polyposis group and 102 (80.31%) patients in the nonpolyposis group. Seventy-one (69.6%) of the nonpolyposis group and 23 (92.0%) of the polyposis group had adenocarcinoma histological types. The total number of patients with mucinous tumor and signet ring cell carcinoma in the nonpolyposis and polyposis groups was 31 (30.4%) and 2 (8.0%), respectively (p = 0.042). Five-year overall survival (OS) was 60 and 72% in the nonpolyposis and polyposis groups, respectively, and no significant difference was found (p = 0.332). In univariate analysis, American Joint Committee on Cancer (AJCC) tumor stage (pT) ≥3–4, lymph node positivity, presence of mucinous tumor and signet ring cell carcinoma, lymphovascular invasion, and advanced tumor-lymph nodesmetastasis (TNM) stage (III–IV) were found to be significant negative prognostic factors for OS, whereas none of these parameters were found to be prognostic factors in multivariate analysis. The presence of polyposis was not a significant factor on both univariate and multivariate analyses. Conclusion: Although the sporadic EOCRC cases developing on the basis of polyposis can have slightly better oncological outcomes, these outcomes are mostly similar to those of cases with nonpolyposis.


Original Article

Apoorv Goel, Shyam Kothari, Roli Bansal

Comparative Analysis of Early versus Late Laparoscopic Cholecystectomy Following Endoscopic Retrograde Cholangiopancreaticography in Cases of Cholelithiasis with Choledocholithiasis

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:3] [Pages No:11 - 13]

   DOI: 10.5005/jp-journals-10018-1338  |  Open Access |  How to cite  | 


Introduction: A preferred treatment for cholelithiasis with choledocholithiasis is endoscopic retrograde cholangiopancreaticography (ERCP) followed by laparoscopic cholecystectomy (LC), which can be performed early (within 72 hours) or can be delayed for 6 to 8 weeks. This study is conducted to compare and analyze the outcome of early versus late LC following common bile duct (CBD) clearance by ERCP and determine the optimum timing for performing LC post-ERCP. Materials and methods: This comparative analysis was conducted at St Joseph Hospital, Ghaziabad, from September 2019 to March 2021 on 89 cases of cholelithiasis with choledocholithiasis. Patients were divided into two groups. Group I (n = 45) patients underwent early LC within 72 hours post-ERCP and group II (n = 44) patients underwent late LC after an interval of 8 weeks. Various preoperative, perioperative, and postoperative clinical parameters like operative difficulty, complications, surgery duration, hospital stay, and conversion to open cholecystectomy were analyzed. Results: There was no significant difference in demographic and laboratory findings in both groups. Group I patients had significantly shorter hospital stay and less operative difficulty. The duration of surgery was significantly low in group I. There was no significant difference in rate of conversion to open cholecystectomy. Conclusion: Early LC post-ERCP is associated with short hospital stay and duration of surgery and less operative difficulty and complications. Therefore, we recommend that LC can be safely performed within 48 to 72 hours after ERCP.


Original Article

Modhusudon Shaha, Md A Islam, Faizul Huq, Bithi Roy, Md A Kabir, Md Salimullah, Sheikh MF Akbar

Clinical Manifestations of Hospitalized COVID-19 Patients in Bangladesh: A 14-day Observational Study

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:7] [Pages No:14 - 20]

   DOI: 10.5005/jp-journals-10018-1340  |  Open Access |  How to cite  | 


Objectives: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is currently a significant public health concern and causing a pandemic in the world. Despite immense attention to the coronavirus disease 2019 (COVID-19), very little attention has been given to the kinetics of disease progression in infected patients. Therefore, in this study, we present a 14-day clinical observation of hospital-admitted COVID-19 patients. Methods: After recording the demography of 42 COVID-19 patients on day 1, we observed the clinical progression for 14 days by investigating the hematological and biochemical responses of patients’ blood and serum, respectively. Results: Approximately, 62% of the hospital-admitted COVID-19 patients presented cough, followed by fever (~52%). The top comorbidities of these patients were hypertension (30%) and diabetes mellitus (19%). The average blood hemoglobin (Hb) level was slightly low among the patients in the early days of infection and went up to the normal level on the later days. A substantial increase in the level of ALT or SGPT [up to 106 IU/L; standard error of the mean (SEM): 12.64] and AST or SGOT (up to 64.35 IU/L; SEM: 5.013) in COVID-19 patients was observed, which may suggest that infection with coronavirus is associated with the functionality of other organs of COVID-19 patients. Conclusion: This 14-day observational study may help clinicians to decide the choice of treatment for COVID-19 patients.



Sanjoy K Dey, Sultana Jahan, Ismat Jahan, Mohammad S Islam, Mohammad KH Shabuj

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:6] [Pages No:21 - 26]

   DOI: 10.5005/jp-journals-10018-1331  |  Open Access |  How to cite  | 


Background: Exchange transfusion in newborns is recommended as emergency management of hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Aim: This study aimed to determine the frequency and document common side effects of exchange transfusion and outcomes of newborns requiring exchange transfusion. Materials and methods: This prospective study was done in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2016 to December 2019. Information was obtained regarding maternal details, newborn demographics, and clinical status. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, Coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, hemoglobin, random blood sugar, serum electrolyte, and calcium were done. G6PD level was done wherever suspected. Frequency, maternal and neonatal factors, indications, and outcomes were analyzed. Results: Among 839 admitted cases of unconjugated hyperbilirubinemia, 41 patients (4.9%) required exchange transfusion. Most of the babies were inborn (90.2%). Ninety-five percent of mothers received regular antenatal care; among them, 76.3% had bad obstetric history. Only 36.6% of mothers received anti-D in previous pregnancy. None had sonographic findings of hydrops. The commonest indication was Rh incompatibility (80.5%). Coombs test was positive in 58.5% of cases. Mean pre-exchange TSB was 9.44 ± 6.4, and post-exchange TSB was 4.41 ± 2.59. The commonest adverse events noted were hyperglycemia (51.2%), sepsis (19.5%), anemia requiring top-up transfusion (17.1%), and hypocalcemia (14.6%). There were no catheter-related complications. Bilirubin encephalopathy was present in 4.9% of cases. There was one mortality but not due to the procedure. Conclusion: Exchange transfusion was required among 4.9% of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effects were hyperglycemia and sepsis. The commonest indication was Rh incompatibility (80.5%). Overall outcome after exchange transfusion was favorable.



Sheikh Mohammad Fazle Akbar, Julio C Aguilar, Md H Uddin, Md Sakirul I Khan, Osamu Yoshida, Eduardo Penton, Guillen N Gerardo, Yoichi Hiasa

Role of Pegylated Interferon in Patients with Chronic Liver Diseases in the Context of SARS-CoV-2 Infection

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:5] [Pages No:27 - 31]

   DOI: 10.5005/jp-journals-10018-1341  |  Open Access |  How to cite  | 


The coronavirus 2019 (COVID-19) pandemic has resulted in 168 million cases and about 3.5 million deaths (as of May 26, 2021) during the last 18 months. These 18 months of the COVID-19 pandemic have been characterized by phases or waves of new cases, the emergence of new variants of the deadly virus, and several new complications. After providing emergency approval to several drugs and adherence to several public health measures with frequent full and partial lockdowns, the incidence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could not be contained till now on a global basis. Although prophylactic vaccines have inspired optimism, the scarcity of vaccines and several vaccine-related regulations indicate that the vaccine's benefit would not be reaching the people of developing countries anytime soon. In the course of our clinical practice, we used pegylated interferon (Peg-IFN) in 35 patients with chronic liver diseases (CLD), and we found that only two of them were infected with SARS-CoV-2 that was mild in nature. These two patients with CLD have a mild course of disease cured without any specific therapy. Patients with CLD are usually immune-compromised. However, three CLD patients remained free of SARS-CoV-2 although they had COVID-19 patients among their family members. Next, we accomplished two studies for assessing the immune-modulatory capacities of Peg-IFN, 1 and 12 injections following administration of Peg-IFN. The data revealed that peripheral blood mononuclear cells (PBMCs) of Peg-IFN-administered CLD patients produced significantly higher levels of some cytokines of innate immunity in comparison with the cytokines produced by PBMC of CLD patients before Peg-IFN intake. The pattern of cytokine responses and absence of infection of SARS-CoV-2 in 33 of 35 CLD patients represent some preliminary observations indicating a possible role of Peg-IFN in patients with CLD. The study may be extended to other chronic infections and cancers in which patients receive Peg-IFN. The role of Peg-IFN for pre- or postexposure prophylaxis in the acquisition of SARS-CoV-2 infection and influencing the natural course of COVID-19 remains to be clarified.



Aimun Raees, Muhammad Kamran, Wasim Jafri

Updates on the Diagnosis and Management of Hepatocellular Carcinoma

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:9] [Pages No:32 - 40]

   DOI: 10.5005/jp-journals-10018-1335  |  Open Access |  How to cite  | 


Introduction: Globally, the incidence, as well as mortality, related to hepatocellular carcinoma (HCC) is on the rise, owing to relatively few curative options. Underlying cirrhosis is the most common etiology leading to HCC, but risk factors of cirrhosis show great regional variability. Over the years, there has been a steady development in the diagnostic and therapeutic modalities of HCC, including the availability of a wide range of systemic chemotherapeutic agents. We aim to review the recent advancements in the diagnostic and therapeutic strategies for HCC. Methodology: The literature search was done using databases PubMed, Cochrane, and Science Direct, and the latest relevant articles were reviewed. Findings: Screening of HCC is a pivotal step in the early diagnosis of the disease. Current guidelines recommend using ultrasound and alfa fetoprotein but various new biomarkers are under active research that might aid in diagnosing very small tumors, not picked up by the current screening methods. Treatment options are decided based upon the overall performance of the patient and the extent of the disease, as per the Barcelona classification. There are very few options that offer a cure for the disease, ranging from liver resection and transplantation to tumor ablation. Downstaging has proven to have a significant role in the course of the disease. An attempt to control the disease can be made via radiological interventions, such as transarterial chemoembolization, transarterial radioembolization, or radiation therapy. For advanced disease, sorafenib used to be the only option until a couple of years ago. Recently, many other systemic agents have received approval as first-line and second-line therapies for HCC. Genomics is an area of active clinical research as understanding the mutations and genomics involved in the evolution of HCC might lead to a breakthrough therapy.



Dynamic Intraductal Endoscopic Visualization of Right Hepatic Artery Pulsation Underlying Minor Vascular Impression of the Proximal Bile Duct

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:2] [Pages No:41 - 42]

   DOI: 10.5005/jp-journals-10018-1332  |  Open Access |  How to cite  | 


Right hepatic artery (RHA) syndrome is a well-recognized, though an uncommon cause of benign bile duct stricture, potentially simulating malignancy. Albeit the latter was not the case in this unique clinical report after cholangitis resolution and clearance of biliary sludge and debris, high-quality direct cholangioscopy (DC) illustration of the RHA overriding the proximal common bile duct with well visible arterial pulsation has not yet been reported before. Beyond its potential visual informativeness, this uncommon cholangioscopic documentation may provide key didactic advances in terms of intraductal visualization of the anatomy of the biliary tree.



Kai Emrich

Cold Snare Papillectomy for Re-redo Endoscopic Resection of a Defiant Adenoma Recurrence with a Unique Growth Pattern

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:2] [Pages No:43 - 44]

   DOI: 10.5005/jp-journals-10018-1333  |  Open Access |  How to cite  | 


Endoscopic papillectomy has become the mainstay treatment in early papillary neoplasia. However, local recurrence remains the Achilles heel of the procedure due to the complex anatomy and limited ductal involvement unappreciated on endoscopic ultrasound (EUS) and/or endoscopic retrograde cholangiopancreatography (ERCP). While re-do papillectomy is, in general, technically feasible and widely accepted to treat recurrent adenoma, re-redo procedures to this end have rarely been reported. Likewise, utilization of cold snare technology is rarely considered in papillectomy and has, in fact, only once been reported in the literature before. We present a unique clinical case with a highly atypical growth pattern with a bonnet-like pedunculated lesion with a small insertion point just at the pancreatic duct orifice treated by re-redo cold snare papillectomy.



Gautham Krishnamurthy, Senthil Ganesan, Jayapriya Ramas, Patta Radhakrishna

Ruptured Mucinous Cystadenoma Pancreas: A Case Report and Review of Literature

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:4] [Pages No:45 - 48]

   DOI: 10.5005/jp-journals-10018-1337  |  Open Access |  How to cite  | 


Mucinous cystic neoplasm (MCN) of the pancreas is a rare neoplasm affecting the elderly women. They vary in their clinical presentation and biological behavior. Spontaneous rupture of MCN is very rare and only eight cases have been reported so far in the English literature. We report a case of a young woman presenting with abdominal pain following spontaneous contained rupture of MCN managed with surgical resection.



SM Rashed Ul Islam, Umme Shahera, Munira Jahan, Shahina Tabassum

Prevalent HBeAg-negative HBV DNA-positive Chronic Hepatitis B Individuals in Bangladesh

[Year:2021] [Month:January-June] [Volume:11] [Number:1] [Pages:2] [Pages No:49 - 50]

   DOI: 10.5005/jp-journals-10018-1339  |  Open Access |  How to cite  | 


journal videos

Video illustration of cold snare re-redo papillectomy

Cold Snare Papillectomy for Re-redo Endoscopic Resection of a Defiant Adenoma Recurrence with a Unique Growth Pattern

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