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Introduction The role of ERCP to diagnose and manage biliopancreatic diseases is increasing since its inception with refinement of operator skill, technical advancement and better patient selection. The aim of the study was to explore common clinical and endoscopic characteristics, outcome, adverse events and safety profile of patients. Methods An observational study was conducted on patients undergoing ERCP in Department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of biliopancreatic diseases from April 2023 to March 2024 after taking approval from IRC-IOM. Patient demographics, clinical characteristics, ERCP findings and post procedure outcome data were collected and analyzed using SPSS version 26. Results A total of 200 patients were included with mean age 52.36±17.04 years and female:male ratio of ~3:2. Elective procedures were done in 182 (91%) patients and in 18 (9%) as urgent procedure (within 48 hours). The most common indications were choledocholithiasis (157, 78.5%) followed by benign biliary stricture (12, 6%). The most frequent papilla was type 1 papilla (normal variant) in 48% followed by type 3 papilla (protruding) in 30%. Difficult cannulation was encountered in 130 (51.5%) cases. Post ERCP pancreatitis (8, 4%) and hypoxia (9, 4.5%) were the most common procedure and anesthesia related adverse events respectively. Common therapeutic interventions included sphincterotomy (176, 88%), CBD stenting (154, 78.5%) and precut sphincterotomy (45, 22.5%). Conclusion ERCP was mostly done for benign diseases like CBD stone and benign biliary strictures. Common therapeutic procedures were sphincterotomy and CBD stenting. Complications related to procedure and anesthesia though occured, their rate was low. [ABSTRACT FROM AUTHOR]

Introduction: The risk for the occurrence of esophageal varices in a cirrhotic patient is assessed by two gold standard invasive tests: hepatic venous pressure gradient measurement and esophagogastroduodenoscopy. We aim to find the association between spleen and liver stiffness with the occurrence of esophageal varices in our settings. Methods: This was a prospective cross-sectional study. In the study duration of one year, 94 cirrhotic patients who met the inclusion and exclusion criteria were included. All patients were subjected to transient elastography for measuring liver and spleen stiffness and endoscopy. Results: Of 94 patients, only 77 (81.9%) had esophageal varices. The mean liver stiffness in patients with and without varices was 19.46±4.9SD kPa and 12.92±1.52 SD kPa respectively. The difference was statistically significant, p<0.001. The mean spleen stiffness in patients with and without varices was 22.26±4.6 SD kPa and 14.08±1.20 SD kPa respectively. The difference was statistically significant, p<0.001. The optimal cut-off value of liver and spleen to detect patients with any grade of esophageal varices was 14 and 16.15 kPa respectively. Conclusion: The stiffness of liver and spleen using transient elastography can be considered an equivalent method for screening cirrhotic patients for esophageal varices in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men. Methods Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded. Results A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score = 16. Conclusion ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score = 16. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Laparoscopic cholecystectomy is one of the common surgeries occurring worldwide and the gold standard for the management of gallstone disease. The non-absorbable surgical clips may slip and can migrate causing a variety of problems as such, choledocholithiasis., Case Presentation: The authors report a case of 43-year-old female who presented with the complaint epigastric pain. She had undergone cholecystectomy 7 years back for symptomatic cholelithiasis. Ultrasonography of the abdomen showed a dilated common bile duct following which endoscopic retrograde cholangiopancreatography was done. A single black-colored stone with the metal clip was retrieved., Clinical Discussion: Post-cholecystectomy clip migration should be considered as one of the differentials for choledocholithiasis. Ultrasonography of the abdomen shows the dilated common bile duct. Further management is done by endoscopic retrograde cholangiopancreatography., Conclusion: Surgical clips acting as nidus for choledocholithiasis is rare these days but should be considered as one of the differentials for pain abdomen., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Hepatocellular carcinoma is the most common primary liver cancer. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of hepatocellular carcinoma. Usually patients present at advanced stages where curative treatment is no longer possible. This study aimed to find the prevalence of hepatocellular carcinoma among patients with chronic liver disease in a tertiary care centre., Methods: This is a descriptive cross-sectional study conducted in a single tertiary care centre from March 2020 to August 2022. The study was done among inpatients of the Department of Gastroenterology after ethical approval from the Institutional Review Committee. A total population sampling method was used and data were collected using predetermined proformas. Point estimate at 95% Confidence Interval was calculated., Results: Among 1440 patients, hepatocellular carcinoma was seen in 54 (3.75%) (2.77-4.73, 95% Confidence Interval). At the time of diagnosis, 48 (88.89%) were symptomatic. The presenting symptoms were weight loss seen in 35 (64.81%) being the most common. Out of them, 37 (68.52%) consumed alcohol and 40 (74.07%) smoked cigarettes., Conclusions: Hepatocellular carcinoma is a notable concern. Alcohol-related liver cirrhosis is the most frequent condition encountered in patients with hepatocellular carcinoma in our setting.

Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre., Methods: A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated., Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women., Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings., Keywords: ascites; liver cirrhosis; prevalence.