Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the ...population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt.
We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt.
This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.
5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them.
This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.
Background and aim Hepatic resection for hepatocellular carcinoma (HCC) is a main therapy for the treatment of surgical candidate patients. However, careful patient selection is required to balance ...the risk of postoperative liver failure and the potential benefit of long-term outcomes. We investigated the role of transient elastography and controlled attenuation parameter (CAP) in predicting portal hypertension in those patients, to assess if they could replace an invasive procedure hepatic venous pressure gradient (HVPG). Moreover, their role in prediction of HCC recurrence after surgical resection was assessed.
Patients and methods The study was performed at Ain Shams University hospitals, Tropical Medicine Department. A total of 30 patients with HCC, being candidate for surgical resection, were included in our study. We divided them into two groups according to the presence or absence of portal hypertension. Assessment of portal hypertension was done by laboratory markers, upper gastrointestinal endoscopy, and HVPG measurements. Transient elastography and CAP measurements were done for all patients. Correlations were done between transient elastography readings and CAP readings with other parameters of portal hypertension. Patients who underwent surgical resection were followed up for 6 months after liver resection to detect HCC recurrence.
Results A positive correlation between transient elastography, CAP, and HVPG was found. Receiver operating characteristic curves of transient elastography, CAP, and a combination between transient elastography+platelet were drawn to differentiate between the two groups. The best cutoff point for transient elastography to detect significant portal hypertension was more than 18, with sensitivity of 93.75%, specificity of 100.0%, and area under the curve (AUC) of 99.8. Moreover, the cutoff point for CAP to detect significant portal hypertension was more than 217, with sensitivity of 87.5%, specificity of 64.29%, and AUC of 81.2%. However, the cutoff point of the platelet count was 166, with sensitivity of 100%, specificity of 86.67%, and AUC of 100%. The combination between transient elastography and platelets showed sensitivity of 87.5%, specificity of 100.0%, and AUC of 95.5%. Moreover, transient elastography showed a significant role in predicting early recurrence of HCC, with P value of 0.011.
Conclusion Transient elastography and CAP can be used as a useful tool in evaluating portal hypertension and also can be used in predicting early recurrence of HCC after surgery.
