Gastroenterology, Hepatology and Endoscopy Practice

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Reticuloendothelial cells such as tissue-resident macrophages have an important function of clearing unwanted material from our bloodstream. Kupffer cells residing in liver sinusoids comprise the largest contingent of tissue-resident macrophages in our body. Different radiological techniques used to diagnose and treat patients with liver diseases employ the scavenging function of Kupffer cells to clear the contrast agents administered into peripheral vein or hepatic artery. It is useful for the clinician to understand the utility of these “unsung heroes” in liver microcirculation: The Kupffer cells act as scavengers removing waste material from bloodstream and work silently to maintain homeostasis.

The WHO guideline advocates for hepatitis B surface antigen (HBsAg) as the initial diagnostic test for hepatitis B virus (HBV) infection. There are, however, patients who may have the persistence of viral DNA in the liver or blood despite having undetectable HBsAg; these patients also need to be accounted for, especially in endemic areas. These groups of patients are also at risk of developing hepatocellular carcinoma, and they need to be identified. We advocate for funding to support projects and research centers that are able to detect occult HBV infection. This will be valuable in the reduction of the occult transmission of HBV and reactivation of quiescent HBV.

Fecal Microbiota Transplantation (FMT) involves a noninvasive technique of transferring fecal microbiota in patients from healthy donors. Donors are generally chosen from spouses or relatives, though the anonymous donation is also common. FMT is particularly useful in diseases like recurrent clostridium difficile infection, ulcerative colitis, hepatic encephalopathy, metabolic syndrome, autism spectrum disorders, anxiety, graft versus host disease, multiple sclerosis, multi drug resistance etc. FMT is gradually being adapted in India in the major cities but there are various regulatory challenges. Despite the promising nature of FMT in different pathologies, the different barriers ranging from the selection of a healthy donor, high quality control, uniform protocol maintenance, to ensuring effective mode of administration have to be addressed for FMT to become a widely accepted modality of therapy.

Acute necrotizing pancreatitis is associated with the formation of acute necrotic collection which eventually becomes encapsulated to form walled-off pancreatic necrosis (WOPN) in 4 weeks. Good quality randomized controlled trials published in the past two decades have helped us understand and refine the management of WOPN. This review summarizes the lessons learned from these trials. Sterile pancreatic necrosis is managed conservatively unless they cause symptoms. Infected pancreatic necrosis leads to organ failure and mortality. The treatment paradigm for infected pancreatic necrosis has shifted from early open necrosectomy to initial intensive medical management, followed by interventions. Step-up approach with initial drainage followed by minimally invasive necrosectomy, in selected patients who do not improve with drainage, has been shown to have better short-term and long-term outcomes. Endoscopic step-up approach has been associated with a lower incidence of pancreaticocutaneous fistula and similar mortality or organ failure as compared to surgical step-up approach. Dedicated endoscopic accessories for performing necrosectomy are undergoing validation studies, which hopefully will help perform necrosectomy with less complications.

Background: Adenocarcinomas are the most common malignancy of the gastrointestinal (GI) tract. Crush cytology is an effective method which can be used to detect neoplastic conditions of GI tract, especially in combination with biopsies. Materials and Methods: The objectives of the study were to study the efficacy of crush cytology as a convenient and near accurate method to evaluate endoscopic biopsy of GI neoplasms. Study Design: Retrospective and Prospective. The original cytopathology diagnoses were correlated with histology report on cases sent over 2-year period. In consecutive 89 patients attending the department of gastroenterology with clinical suspicion of malignancy, an endoscopy was performed. The material obtained was subjected to cytology as well as histopathology. The stained cytology slides along with corresponding histopathology slides were studied. Results: Out of 89 cases, both crush smear and histopathology sections were positive for malignant cells (65 cases), both negative for malignant cells (seven cases), crush smear positive and histopathology negative (three cases), and crush smear-negative and histopathology positive (14 cases). Out of the 14 cases which were negative in crush smears for malignancy, on histopathological examination, eight were signet-ring cell carcinoma, three were poorly differentiated adenocarcinoma, two turned out to be neuroendocrine carcinoma, and one non-Hodgkin lymphoma (NHL). Conclusion: Crush cytology smears can be used to diagnose malignant GI cases fairly accurately. Cases of signet-ring cell carcinoma, neuroendocrine tumor, poorly differentiated malignancy, and NHL may be missed by crush cytology technique alone. A special stain for mucin can be used to identify the signet-ring cells in signet-ring cell carcinoma cases.

We present a case of chronic calcific pancreatitis with diabetes mellitus who presented with multifocal liver and splenic abscesses which were found to be a coinfection of Entamoeba histolytica and Burkholderia pseudomallei. The existence of concurrent infection by two such unrelated organisms provides an example of the enigma of infections in areas of decreased host resistance.

Online since 22^nd September 2020