PE-165: Pyloric Gland Adenoma of the Common Bile Duct: A Case Report and Review of Literature

( Gian Carlo Carpio ),( Guinevere T. Ang ),( Albert E. Ismael ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: A pylori gland adenoma(PGA) is a rare tumor found in the gastrointestinal tract. It is most commonly located in the stomach, but very rarely found in the common bile duct(CBD). In the literature, there are only 4 reported cases of PGA in the CBD and, to our knowledge, this is the first report done in the Philippines. Methods: We present the case of a 75-year old male who complained of progressive jaundice, pruritus, tea-colored urine and acholic stools for one month. Results: Bilirubin, AST, ALT and alkaline phosphatase were elevated. Ultrasound showed dilated intrahepatic ducts and CBD. ERCP revealed a 2.3cm dilated bile duct with an irregular filling defect at the distal portion causing the inability to deep cannulate the bile duct. MRI with MRCP demostrated marked intrahepatic and extrahepatic biliary ductal dilatation with CBD measuring 3.5cm and a lobulated intraductal mass that was considered as cholangiocarcinoma. The patient underwent exploratory laparotomy with duodenotomy and ampulectomy and a light to dark brown, fleshy pedunculated mass was excised. Upon histopathological analysis, the mass was consistent with PGA. Conclusions: The diagnosis of these lesions pose a challenge to clinicians; therefore, it is important to correctly interpret radiologic imaging tests and correlate them with the clinical findings and histopathological results. Although very rare, it should be considered as a differential diagnosis for an obstructive biliary tumor. Due to its high risk malignancy conversion potential, complete surgical resection is recommended for all PGA.

PE-166: The Role of Endoscopic Ultrasound in a Tertiary Hospital:

( Gian Carlo A. Carpio ),( Ramon E. Carpio ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Endoscopic Ultrasound (EUS) is an emerging diagnostic modality for the GI tract. The aim of this study is to determine the demographic profile, common indications, findings and diagnosis of patients who underwent endoscopic ultrasound Also, another aim of this study is to compare the profile, usual indications and diagnosis of patients who underwent EUS before 2013 and from September 2015 to present. Methods: This is a retrospective cross-sectional study of all adult patients who underwent endoscopic ultrasound from January 1, 2008 to February 22, 2016. Data were encoded using MS Excel and analysis was done using SPSS. Results: Among 482 patients who underwent EUS, mean age was 57 with almost equal ratio for males (49.8%) and females (50.2%). Majority of patients had a CT scan (34%) done prior to procedure. Most patients were given sedation with Propofol (36.7%). Majority of patients (68.3%) had an upper EUS. The most common indication was to do further studies for rectal masses (23.9]. The most common diagnosis was rectal malignancy (20.5). Hepatoma was found in 2.7%. The difference among the past and present groups was found to be statistically significant with the type of sedation (increase in Propofol use) and type of endoscopy (increase in upper EUS) with p value <0.001). For the past group, the top indication was rectal mass (26.2%) while in the present group, the top was pancreatic mass (21.1%). The top diagnosis in the past was rectal malignancy (22.6%) while in the present, it was GIST (17%). Conclusions: Endoscopic ultrasound has emerged into a highly effective tool in diagnosing and treating gastrointestinal diseases. Being a relatively underutilized tool in our country, there is a need to continue striving for increased utilization to maximize its benefit to our patients.

Demographic Profile, Imaging Findings and Treatment Outcomes of Hepatobiliary Ascariasis

( Gian Carlo A. Carpio ),( Jenina Joy E. Jorge ),( Rommel P. Romano ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Ascariasis is the most common helminthic infection in humans. It is very frequent in developing countries such as Asia due to poverty, overcrowding and poor sanitation. A serious manifestation of infection is hepatobiliary ascariasis due to potential for complications. The aim of this study is to describe the demographic profile, risk factors, clinical presentation, usual diagnostic findings and treatment options of hepatobiliary ascariasis patients in the Philippines. Methods: This is a retrospective cross-sectional study of all patients diagnosed with hepatobiliary ascariasis from January 2005 to February 2016. Diagnosis of hepatobiliary ascariasis were confirmed by findings and signs of worms in the biliary tract through ERCP or imaging findings. Data were encoded using MS Excel and analysis done by SPSS. Results: Among 23 patients, mean age was 39.9. Majority were female patients(82.6%). From available data, all patients earned less than 100,000/ year and finished only up to High School. 13% had previous sphincterotomy while 8.7% had previous gallbladder surgery. Common indications include RUQ pain or biliary colic (56.5%), epigastric pain (21.7%) and diffuse abdominal pain (21.7%). For complications, 26.1% had obstructive jaundice, 4.3% had acute cholangitis, and 8.7% had acute pancreatitis. Usual initial test was ultrasound mostly showing a tubular filling defect at the bile ducts (78.2%) 20 patients underwent ERCP with cholangiogram showing a tubular filling defect for 18 patients, a dilated common bile duct and a patulous ampulla for some. Majority of worms were removed by basket extraction (73.9%). 73.9% showed dead worms with mean procedure time of 34.6 minutes. Conclusions: Hepatobiliary ascariasis is a serious manifestation of ascariasis infection. A thorough history for risk factors and examination with the help of imaging findings can help us in adequately diagnosing this condition. Importance of adequate treatment with extraction of worms should be emphasized to prevent severe complications of disease.

Slide Session : OS-IFD-06 ; Infectious Disease : Steroids for Pulmonary Involvement in Leptospirosis: A Meta-Analysis

( Gian Carlo Carpio ),( Dianne Bernardo ),( Louren Blanquisco ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Pulmonary involvement in leptospirosis is associated with rapid clinical deterioration and high mortality. The role of steroids in treating the immunologically-mediated pulmonary insult in leptospirosis has been described in anecdotal reports. Objectives: To investigate the effect of steroids as adjunct to standard care in reducing mortality, the need for and the duration of mechanical ventilation among leptospirosis patients with pulmonary manifestations. Methods: Authors included all available randomized and nonrandomized studies on patients with pulmonary manifestations, who were given steroids of any type in addition to standard care. The primary outcome was mortality rate. The secondary outcomes were duration of hospital stay, adverse effects of steroids, and number of days requiring mechanical ventilation. Three reviewers did trial selection and assessed methodologic quality of randomized studies using the Cochrane Collaboration Criteria and the Downs and Black Tool. Data were extracted independently by three reviewers, and were analysed using Review Manager Version 5. Heterogeneity was determined by chi square and I2 test. Results: Of thirteen studies initially identifi ed, fi ve passed the selection criteria however one was excluded for lack of full data on Results: The studies included were 3 prospective cohorts and 1 randomized controlled trial comparing steroids (methylprednisolone, dexamethasone) in addition to standard care versus standard care alone on adult patients with pulmonary manifestations of leptospirosis. Pooled data from nonrandomized studies show that methylprednisolone or dexamethasone decreased mortality among patients with pulmonary leptospirosis (OR 0.20 95% CI 0.09-0.45, chi2=0.44, I2=0%, df=2, p=0.80). The randomized controlled trial showed no mortality benefi t with the addition of dexamethasone to standard care. Conclusions: Data from nonrandomized studies suggest a mortality benefi t. Randomized trials are needed to strengthen the evidence on the effectiveness of steroids in decreasing mortality as well as to identify all relevant outcomes including adverse effects of steroids.

Poster Session : PS 0635 ; Respiratory Medicine ; A Survey of Practice Patterns of Medical Residents on the Use of Non-Invasive Ventilation at Philippine General Hospital

( Gian Carlo Carpio ),( Roy Ballaso ),( Gene Ambrosio ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Provision of non-invasive ventilation (NIV) among selected patients with respiratory failure remained challenging to clinicians. There is limited data regarding clinical and technical utilization locally especially among medical residents. Objective: The purpose of this study is to determine the practice patterns of medical residents on the use of non-invasive ventilation in a tertiary care hospital. Methods: Descriptive survey involving 56 participants. Results: Majority of participants have attended NIV lectures, but only few have joined hands-on workshop. None of them knew any existing guideline about NIV. Majority of respondents have practiced NIV (60.71%). Overall utilization rate was low and < 10% of all mechanical ventilation. High cost of equipment rental (81.82%) and lack of knowledge were identifi ed as major barriers to NIV use. Top clinical indications include COPD exacerbation (100%) and respiratory failure in do-not-intubate patient (52.9%). Majority of participants will monitor response after 1 hour (55.9%). Face mask was the preferred interface (94%) irrespective of clinical scenario. ICU ventilator with NIV module was frequently used both for COPD and ACPE. Bi-level mode ventilation (76%) was more frequently used than CPAP. All medical residents agreed to stop NIV and proceed to intubation in the presence of respiratory pause or arrest and poorly tolerated cardiac arrhythmia. Practical and academic teaching and network organization for NIV were highly suggested. Conclusions: Majority of study participants have acceptable NIV practices. Signifi - cant variability of practice patterns exists in terms of preferred site of initiation andprotocol for initiation followed. NIV protocol should be created based on latest international guideline that is best applicable locally. Special ad hoc committee should be formed locally to negotiate high cost of equipment rental and make NIV easily available to most indigent patients.