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Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions

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World Journal of Gastroenterology 2007年第29期13卷 3962-3966页

作者： abdulrahman m aljebreen Joseph Romagnuolo Rafael Perini Francis Sutherland Division of Gastroenterology Department of Medicine King Saud University Riyadh Saudi Arabia medical University of South Carolina Digestive Disease Center Charleston South Carolina United States Division of Gastroenterology University of Calgary Calgary Alberta Canada Department of General Surgery University of Calgary Calgary Alberta Canada

AIm: To assess the diagnostic accuracy of endoscopic ultrasound (EUS), fluid tumor markers and cytology in distinguishing benign from (pre)malignant pancreatic cystic lesions. mETHODS: 46 consecutive patients, referred to a gastroenterologist and surgeon for a symptomatic or incidental pancreatic cyst, were reviewed. EUS, cytology, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) levels were compared with the final diagnosis, based on surgical pathology and/or imaging follow-up of at least 12 mo. Cysts were classified as benign (pseudocyst, serous cystadenoma) or malignant/ pre-malignant (mucinous cystic neoplasm). Receiver- operator characteristics (ROC) curve analysis was performed. RESULTS: The mean age was 56 years; 29% were male and median cyst diameter was 3 cm. Final outcome was obtained in 41 (89%) patients. Twenty-three (56%) of these 41 had surgical pathology. Twenty-three (56%) had benign lesions and 18 (44%) had malignant/pre- malignant lesions. Sensitivity, specificity and positive and negative predictive value of EUS alone to distinguish benign from malignant/premalignant pancreatic cystic lesions were 50%, 56%, 36% and 54% and for cytology were 71%, 96%, 92% and 85%, respectively. The corresponding values for the ROC-derived ideal cutoffswere 75%, 90%, 75%, 90% for CA 19-9 (> 37 U/mL) and 70%, 85%, 79% and 78% for CEA (> 3.1 ng/mL). Subgroup analysis of those with surgical pathology yielded almost identical performance and cutoffs. CONCLUSION: Cytology and cyst fluid tumor marker analysis is a very useful tool in distinguishing benign from (pre)malignant pancreatic cystic lesions.

关键词： Endoscopic ultrasound Carcinoembryonic antigen CA 19-9 Pancreatic cystic lesions Fine needle aspiration

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Clinical epidemiology of ulcerative colitis in Arabs based on the montréal classification

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World Journal of Gastroenterology 2014年第46期20卷 17525-17531页

作者： Othman R Alharbi Nahla A Azzam Ahmed S Almalki majid A Almadi Khalid A Alswat Nazia Sadaf abdulrahman m aljebreen Gastroenterology Division King Khalid University Hospital King Saud University Riyadh 11461Saudi Arabia Gastroenterology Division Riyadh Military HospitalRiyadh 11461Saudi Arabia Gastroenterology Division the Mc Gill University Health Center montréal General Hospital Mc Gill UniversityMontréal H3A 1W9Canada

AIm:To determine the clinical,epidemiological and phenotypic characteristics of ulcerative colitis(UC)in Saudi Arabia by studying the largest cohort of Arab UC ***:Data from UC patients attending gastroenterology clinics in four tertiary care centers in three cities between September 2009 and September 2013were entered into a validated web-based registry,inflammatory bowel disease information system(IBDIS).The IBDIS database covers numerous aspects of inflammatory bowel *** characteristics,disease phenotype and behavior,age at diagnosis,course of the disease,and extraintestinal manifestations were ***:Among 394 UC patients,males comprised51.0%and females 49.0%.According to the montréal classification of age,the major chunk of our patients belonged to the A2 category for age of diagnosis at17-40 years(68.4%),while 24.2%belonged to the A3category for age of diagnosis at>40 *** to the same classification,a majority of patients had extensive UC(42.7%),35.3%had left-sided colitis and29.2%had only ***,51.3%were in remission,16.6%had mild UC,23.4%had moderate UC and 8.6%had severe *** relapse occurred in17.4%patients,infrequent relapse in 77%and 4.8%had chronic disease.A majority(85.2%)of patients was steroid *** regard to extraintestinal manifestations,arthritis was present in 16.4%,osteopenia in 31.4%,osteoporosis in 17.1%and cutaneous involvement in 7.0%.CONCLUSION:The majority of UC cases were young people(17-40 years),with a male *** the disease course was found to be similar to that reported in Western countries,more similarities were found with Asian countries with regards to the extent of the disease and response to steroid therapy.

关键词： Ulcerative colitis Inflammatory bowel disease information system Saudi Arabia Epidemiology

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Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

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World Journal of Gastrointestinal Surgery 2013年第12期5卷 337-340页

作者： majid A Almadi Fahad Bamihriz abdulrahman m aljebreen Gastroenterology Division King Khalid University Hospital King Saud University Gastroenterology Division the McGill University Health Center Montreal General Hospital McGill University Surgery Division King Khalid University Hospital King Saud University

Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents(SEmS) in the management of the leak. Seven weeks after the insertion of the initial SEmS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwenta computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEmS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEmS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.

关键词： Stents Esophagus Leak Surgery Complication Aortoesophageal fistula Endoscopy Bariatric surgery Sleeve gastrectomy

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Epidemiology and outcome of Crohn's disease in a teaching hospital in Riyadh

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World Journal of Gastroenterology 2004年第9期10卷 1341-1344页

作者： Abdullah S.AI-Ghamdi Ibrahim A.AI-mofleh Rashed S.AIRashed Saleh m.AI-Amri abdulrahman m.aljebreen Reda EI-Badawi Arthur C.Isnani Gastroenterology Division Department of Medicine (38)King Khalid University HospitalRiyadhKingdom of Saudi Arabia King Khalid University Hospital College of Medicine and Research Center (74)PO Box 2925RiyadhKingdom of Saudi Arabia

AIm: To know the epidemiology and outcome of Crohn's disease at King Khalid University Hospital, Riyadh, Saudi Arabia and to compare the results from other world ***: A retrospective analysis of patients seen for 20 years (between 1983 and 2002). Individual case records were reviewed with regard to history, clinical, findings from colonoscopy, biopsies, small bowel enema, computerized tomography scan, treatment and ***: Seventy-seven patients with Crohn's disease were revisited, 13% presented the disease in the first 10 years and 87% over the last 10 years. Thirty-three patients (42.9%) were males and 44 (57.1%) were females. Age ranged from 11-70 years (mean of 25.3+11.3 years). Ninety-two (92%) were Saudi. The mean duration of symptoms was 26+34.7 mo. The mean annual incidence of the disease over the first 10 years was 0.32:100 000 and 1.66:100 000 over the last 10 years with a total mean annual incidence of 0.94:100 000 over the last 20 years. The chief clinical features included abdominal pain, diarrhea, weight loss,anorexia, rectal bleeding and palpable mass. Colonoscopic findings were abnormal in 58 patients (76%) showing mostly ulcerations and inflammation of the colon. Eighty nine percent of patients showed nonspecific inflammation with chronic inflammatory cells and half of these patients revealed the presence of granulomas and granulations on bowel biopsies. Similarly, 69 (89%) of small bowel enema results revealed ulcerations (49%), narrowing of the bowel lumen (42%), mucosal thickening (35%) and cobblestone appearance (35%). CT scan showed abnormality in 68 (88%) of patients with features of thickened loops (66%) and lymphadenopathy (37%). Seventy-eight percent of patients had small and large bowel disease, 16% had small bowel involvement and only 6% had colitis alone. Of the total 55 (71%) patients treated with steroids at some point in their disease history, a satisfactory response to therapy was seen in 28 patients (51%) w

关键词： Hospitals, Teaching Adolescent Adult Aged Child Comparative Study Crohn Disease Female Humans male middle Aged Retrospective Studies Saudi Arabia Treatment Outcome

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Sedated vs unsedated colonoscopy:A prospective study

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World Journal of Gastroenterology 2014年第17期20卷 5113-5118页

作者： abdulrahman m aljebreen majid A Almadi Felix W Leung Gastroenterology Division King Khalid University HospitalKing Saud UniversityRiyadh 11461Saudi Arabia Gastroenterology Division McGill University Health Center mcGill University MontrealQuebec H3G 1A4Canada Research and medical Services Sepulveda Ambulatory Care CenterVeterans Affairs Greater Los Angeles Healthcare Systemand David Geffen School of Medicine at UCLALos AngelesCaliforniaCA 91343United States

AIm:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the ***:Consecutive patients who underwent colonoscopies over a 2-year period were invited to *** patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was *** details were *** patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were ***:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,Pmpletion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,Pmoreover,the average patient pain score(3.4 vs 5.7,Pms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing *** option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.

关键词： Sedation Colonoscopy Unsedated Screening Endoscopy

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Resolution of an esophageal leak and posterior gastric wall necrosis with esophageal self-expandable metal stents

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World Journal of Gastroenterology 2013年第40期19卷 6931-6933页

作者： majid A Almadi abdulrahman m aljebreen Fahad Bamihriz Division of Gastroenterology King Khalid University Hospital King Saud University Riyadh 11461Saudi Arabia Division of Gastroenterology The McGill University Health Center montreal General Hospital McGill UniversityMontrealH3G 1A4Canada Division of Surgery King Khalid University HospitalKing Saud UniversityRiyadh 11461Saudi Arabia

The use of weight reduction surgeries has increased over the years with a higher proportion of these surgeries being sleeve gastrectomies,this has been associated with some complications including staple line *** report a 32-year-old male who had undergone a laparoscopic gastric band surgery and subsequently a laparoscopic sleeve gastrectomy,this was complicated by both an staple line leak at the gastroesophageal junction as well as a large(> 4 cm) posterior gastric wall defect due to gastric wall necrosis. We used two co-axially inserted self-expandable stents(SEmS) in the management of this patient,5 stents were used over repeated endoscopy sessions and 20 wk. Both defects had resolved without the need for surgical *** is the first reported case were SEmS are used for both a staple line leak as well as a gastric wall *** also review the literature on the use of SEmS in the management of leaks post weight reduction surgeries.

关键词： Stents Self-expandable metal stents Laparoscopic sleeve gastrectomy Staple line leak Esophageal leak Gastric necrosis

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Biochemical and radiological predictors of malignant biliary strictures

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World Journal of Gastroenterology 2004年第10期10卷 1504-1507页

作者： Ibrahim A.AI-mofleh abdulrahman m.aljebreen Saleh m.AlAmri Rashed S.AJ-Rashed Faleh Z.Al-Faleh Hussein m.AJ-Freihi Ayman A.Abdo Arthur C.Isnani Gastroenterology Division department of Medicine (38)King Khalid University HospitalRiyadhKingdom of Saudi Arabia King Khalid University Hospital College of Medicine and Research Center (74)PO Box 2925Riyadh 11461Kingdom of Saudi Arabia

AIm: Differentiation of benign biliary strictures (BBS) from malignant biliary strictures (mBS) remains difficult despite improvement in imaging and endoscopic techniques. The aim of this study was to identify the clinical, biochemical and or radiological predictors of malignant biliary ***: We retrospectively reviewed all charts of patients who had biliary strictures (BS) on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) in case of unsuccessful ERCP from march 1998 to August 2002. Patient characteristics, clinical features, biochemical, radiological and biopsy results were all recorded. Stricture etiology was determined based on cytology,biopsy or clinical follow-up. A receiver operator characteristic (ROC) curve was constructed to determine the optimal laboratory diagnostic criterion threshold in predicting ***: One hundred twenty six patients with biliary strictures were enrolled, of which 72 were malignant. The mean age for BBS was 53 years compared to 62.4 years for mBS (P=0.0006). Distal bile duct stricture was mainly due to a malignant process 48.6% vs 9% (P=0.001). Alkaline phosphates and AST levels were more significantly elevated in mBS (P=0.0002). ROC curve showed that a bilirubin level of 84 μmol/L or more was the most predictive of mBS with a sensitivity of 98.6%, specificity of 59.3% and a positive likelihood ratio of 2.42 (95% CI=0.649-0.810). Proximal biliary dilatation was more frequently encountered in mBS compared to BBS, 73.8% vs39.5% (P=0.0001). majority of BBS (87%) and mBS (78%) were managed ***: A serum bilirubin level of 84 μmol/L or greater is the best predictor of mBS. Older age, proximal biliary dilatation, higher levels of bilirubin, alkaline phosphatase, ALT and AST are all associated with mBS. ERCP is necessary to diagnose and treat benign and malignant biliary strictures.

关键词： Biliary Tract Diseases Biliary Tract Neoplasms Constriction, Pathologic Predictive Value of Tests Age Factors Bilirubin Cholangiography Cholangiopancreatography, Endoscopic Retrograde Humans middle Aged ROC Curve Retrospective Studies Sensitivity and Specificity

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Seroprevalence of celiac disease among healthy adolescents in Saudi Arabia

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World Journal of Gastroenterology 2013年第15期19卷 2374-2378页

作者： abdulrahman m aljebreen majid A Almadi Alwaleed Alhammad Faleh Z Al Faleh Gastroenterology Division King Khalid University HospitalKing Saud University Gastroenterology Division McGill University Health CenterMontreal General HospitalMcGill University Immunology Unit Department of PathologyKing Saud University

AIm: To identify the seroprevalence of celiac disease among healthy Saudi adolescents. mETHODS: Between December 2007 and January 2008, healthy students from the 10th to 12th grades were randomly selected from three regions in Saudi Arabia. These regions included the following: (1) Aseer region, with a student population of 25512; (2) madinah, with a student population of 23852; and (3) Al-Qaseem, with a student population of 16067. Demographic data were recorded, and a venous blood sample (5-10 mL) was taken from each student. The blood samples were tested for immunoglobulin A and immunoglobulin G endomysial antibodies (EmA) by indirect ***: In total, 1167 students (614 males and 553 females) from these three regions were randomly selected. The majority of the study population was classified as lower middle class (82.7%). There were 26 (2.2%) students who had a positive anti-EmA test, including 17 females (3.1%) and 9 males (1.5%). Al-Qaseem region had the highest celiac disease prevalence among the three studied regions in Saudi Arabia (3.1%). The prevalence by region was as follows: Aseer 2.1% (10/479), madinah 1.8% (8/436), and Al-Qaseem 3.2% (8/252). The prevalence in madinah was significantly lower than the prevalence in Aseer and Al-Qaseem (P=0.02). CONCLUSION: Our data suggest celiac disease prevalence might be one of the highest in the world. Further studies are needed to determine the real prevalence.

关键词： Celiac disease Saudi Arabia Prevalence Antiendomysial antibody Epidemiology

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Complications and survival in patients undergoing colonic stenting for malignant obstruction

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World Journal of Gastroenterology 2013年第41期19卷 7138-7145页

作者： majid A Almadi Nahla Azzam Othman Alharbi Alabbas H mohammed Nazia Sadaf abdulrahman m aljebreen Division of Gastroenterology King Khalid University HospitalKing Saud UniversityRiyadh 11461Saudi Arabia Division of Gastroenterology The McGill University Health CenterMontreal General HospitalMcGill UniversityMontrealH3G 1A4Canada

AIm:To investigate whether predicting patients that might be at a higher risk for complications might serve to improve the selection of patients undergoing colonic ***:A retrospective review of consecutive patients who underwent an attempted self-expandable metal stent(SEmS)insertion for malignant colonic obstruction between November 2006 and march *** patients were either referred for preoperative colonic decompression with the intent of a single surgical procedure,or for palliation of the malignant colorectal obstruction for unresectable ***’s test orχ2test was performed on categorical variables,and the t test for continuous *** and multivariable logistic regression were used to examine the association between independent variables and the presence of complications from SEmS ***:SEmS insertion was attempted in 73 *** comprised 55.71%and the mean age was 67.41±12.41 *** these,65.15%underwent subsequent surgery,while 34.85%received SEmS as palliation for advanced *** tumors were only4.76%.The majority of patients had stageⅣdisease(63.83%),while the remainder had stageⅢ(36.17%).SEmS were successfully inserted in 93.85%(95%CI:87.85%-99.85%).Perforations occurred in 4.10%,SEmS migration in 8.21%,and stent re-occlusion from ingrowth occurred in 2.74%of *** mean duration of follow up for the patients was 13.52±17.48 mo(range 0-73 mo).None of the variables:age,sex,time between the onset of symptoms to SEmS insertion,time between SEmS insertion and surgery,length of the stenosis,location of the stenosis,albumin level,or receiving neoadjuvant chemotherapy,could predict the development of complications from either SEmS insertion nor prolonged ***:None of the variables could predict the development of complications or *** studies are required to identify patients who would benefit the most from SEmS.

关键词： Colonic obstruction Colorectal cancer Palliative interventions Self-expanding metal stent Colonic stents Enteric stenting Emergency surgery Complications Endoscopy

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Prevalence and clinical features of colonic diverticulosis in a middle Eastern population

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World Journal of Gastrointestinal Endoscopy 2013年第8期5卷 391-397页

作者： Nahla Azzam abdulrahman m aljebreen Othman Alharbi majid A Almadi Division of Gastroenterology Department of Medicine King Khalid University Hospital King Saud University Division of Gastroenterology the McGill University Health Center Montreal General Hospital McGill University

AIm: To determine the prevalence, location, associations and clinical features of colonic-diverticulosis and its role as a cause of lower-gastroenterology-bleeding. mETHODS: We retrospectively reviewed the medical records of 3649 consecutive patients who under-went a colonoscopy for all indications between 2007 and 2011 at King Khalid University Hospital, Riyadh, Saudi Arabia. The demographic data were collected retrospectively through the hospital's information system, electronic file system, endoscopic e-reports, and manual review of the files by two research assistants. The demographic information included the age, sex, comorbidities and indication for the colonoscopy. The association among colonic polyps, comorbidities and diverticular disease was also ***: A total of 270 patients out of 3649 were diagnosed with colonic diverticulosis, with a prevalence of 7.4%. The mean age was 60.82 years ± 0.833, (range 12-110). Females comprised 38.89% (95%CI: 33-44.7) of the study population. The major symp-toms were rectal bleeding in 33.6%, abdominal pain in 19.3%, constipation in 12.8% and anemia in 6%. Diverticula were predominantly left-sided (sigmoid and descending colon) in 62%, right-sided in 13% and in multiple locations in 25%. There was an association between the presence of diverticulosis and adenomatous polyps (Pvalue mellitus (P-value most common cause of lower gastrointestinal bleeding, in 33.6% (95%CI: 27.7-39.4), after internal hemor-rhoids, in 44.6% (95%CI: 40.3-48.9). On multivariable logistic regression, hypertension (OR = 2.30; 95%CI: 1.29-4.10), rectal bleeding (OR = 2.57; 95%CI: 1.50-4.38), and per year increment in age (OR = 1.05; 95%CI: 1.03-1.07) were associated with diverticulosis but not with bleeding diverticular disease. Limitations: A small proportion of the patients included had colo-noscopies performed as a screening ***

关键词： Colonic diverticulosis Diverticular disease Saudi Arabia Prevalence Lower gastrointestinal bleeding Epidemiology

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