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Background: Double Balloon Enteroscopy (DBE) is a standard method of assessing small bowel pathologies. It acts as a complimentary diagnostic tool in evaluating diseases of entire small bowel with varying diagnostic yields. These days, most of the advanced endoscopic centers provide DBE services. Here, we aimed to evaluate our initial experience in performing the DBE procedures in endoscopic unit of department of medical gastroenterology. Methods: Retrospective review of prospectively maintained medical records of all the patients undergoing DBE procedure over two years period (between Jan 2018- Dec 2020) were analyzed. The general demographics, indication, insertion routes, findings and any associated complications reported. Results: During study period, 50 DBE diagnostic procedures were performed. Youngest was 16years while oldest patient was 83years. Commonest indication was small bowel bleeding (28%, 14) fol­lowed by iron deficiency anemia in 24% (12). In 48% (24) complete procedure by both anterograde (oral) and retrograde (anal) route was performed. Commonest finding was small bowel ulcer in 16 patients followed by erosions (5) and diverticulum (5). Only in one patient, the vascular malforma­tion was revealed. Commonest procedure related complication was abdominal discomfort (50%) which resolved on its own. There was no major complication and no procedure related mortality. Conclusions: DBE is a safe diagnostic procedure in evaluating small bowel pathologies; the com­monest usefulness is in patients with either occult or overt SBB. However, the procedural complex­ity and long procedure times are still considered as obstacles in incorporating the DBE as routine services.

Portal hypertension results in various complications, gastroesophageal varices being one of them. Although less common than esophageal varices, gastric varices are difficult to obliterate and carry a higher mortality rate when bleeding occurs. They are less amenable to sclerotherapy, endoscopic variceal ligation. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) has been developed as a minimal invasive procedure to obliterate gastric varices. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of gastric varix, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. We report six cases where BRTO was done for gastric varices obliteration.

Introduction: As cites, a common entity in practice of gastroenterology is path physiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG as cites is often due to local peritoneal cause e.g. peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG as cites of uncertain etiology. Methods: Peritoneoscopy was prospectively performed in 12 patients with low SAAG as cites of unclear etiology. Patients with low SAAG as cites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results: Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion: Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG as cites of uncertain etiology.

Aim The aim of this study was to investigate the factors affecting health-related quality of life (HRQOL) in Nepalese patients with chronic liver disease (CLD). Methods In this study, HRQOL was measured with validated Nepali versions of the short-form 36 (SF-36) survey. Socioeconomic factors, etiology, laboratory parameters, disease severity, and self-rated health perceptions on HRQOL were recorded for analysis. Results Sixty CLD patients were enrolled in the study. The following HRQOL scores were obtained: physical functioning (PF) (34.4 ±26.7), role limitation due to physical health (RLPH) (7.5 ±17.8), role limitation due to emotional problems (RLEP) (27.7 ±38.2), energy or fatigue (E/F) (38.5 ±21.5), emotional well-being (EWB) (57.7 ±22.8), social functioning (SF) (55.2 ±23.5), pain (44.8 ±30.3), and general health (GH) (38.2 ±17). Employed status and higher annual family income had a positive impact on HRQOL. Ascites and abnormal upper gastrointestinal endoscopic findings were associated with poor health status perceptions. More severe disease (higher Child-Pugh class) was associated with lower HRQOL scores. A significant negative correlation between the model for end-stage liver disease (MELD) score and HRQOL domains was observed (p

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Objectives: The main objective of this study was to translate and validate the short form 36 (SF-36) health survey questionnaire into the Nepali language using a standard protocol to determine health-related quality of life (HRQoL) in patients with chronic liver disease (CLD). Methods: We conducted a cross-sectional study among 40 patients with CLD. A formal translation of SF-36 from English into the Nepali language was performed. Patients with CLD without other known co-morbidities were administered the Nepali version of SF-36. Cronbach's alpha and test-retest were performed for reliability analysis. Results: Cronbach's alpha of overall SF-36 score was 0.85, and the test-retest correlation coefficient was 0.78 (p

Introduction:A casual relation has been thought to exist between Helicobacter pylori infection and gastric cancer. The present study was carried out to find correlation between H. pylori and gastric carcinogenesis. Methods: A case control study was performed in the department of endoscopy, Tribhuvan University Teaching Hospital, between January 2008 and February 2009. All patients having carcinoma stomach on endoscopic evaluation later confirmed by histopathological examination were included. Total 50 healthy individuals, with no positive finding in endoscopy were included in control group. Results: Total 37 cases were analyzed. There were 23 (62.2%) males and 14 (37.8%) females. Majority were above 60 years (46%). Blood group A was commonest group found in patients with carcinoma stomach. Distal part, antrum, 20 (54%) was commonest location of tumor and Borrmann type three was commonest endoscopic type of tumor presentation. Majority of patients received triple therapy and H. pylori detection was low in those treated with triple therapy. Distal tumors were significantly associated with increased prevalence of H. pylori positivity. Total incidence of H. pylori in cases was 54% (20/37). In 15 (75%) cases, H. pylori could be detected by both ELISA and biopsy method. Incidence of H. pylori in controls was 64% (32/50). There was no statistically significant difference in H. pylori presence in cases and control. Conclusions: Our study couldn’t establish association between H. pylori and gastric cancer. More prospective trials can help find out correlation between combination of risk factors and gastric cancer. Keywords: helicobacter pylori; gastric cancer; risk factors.

Background: Ampullary tumors have been usually described together with other periampullary tumors. However, they have been found to behave differently in terms of their presentation, management, and perioperative outcomes. In this study, we try to analyze our experience in managing ampullary tumors in the tertiary level university teaching hospital. Materials and Methods: Retrospective review of the patients with ampullary tumors managed surgically over 10 years period (2004 January-2013 December) was carried out. Demographics, preoperative parameters, therapeutic procedures, postoperative morbidity and mortality were reviewed, and overall morbidity and mortality were compared with nonampullary group. Results: A total of 74 patients of ampullary tumors were managed over the study period. Jaundice was present in 65 (92.9%) patients at presentation. Pancreaticoduodenectomy (PD) was performed in 70 (66% of total PDs performed in the same period) cases while 4 patients had palliative bypass. There were no endoscopic resections and transduodenal ampullectomy in our series. On postoperative histology, two patients were found to have benign pathology. Postpancreatectomy fistula (30% vs. 11.1%) and other morbidities such as intra-abdominal collection and surgical site infection were higher in ampullary group. Mortality was comparable in both groups but overall mortality was higher than the published series. Conclusion: In tertiary centers of developing nations like ours, PD is still the main surgical procedure offered to the ampullary tumors. Ampullary tumors have higher perioperative morbidity than the nonampuallry group but have comparable mortality rates.