SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 32 ABSTRACT CORNER This section is dedicated to publishing abstracts from successful MMed’s, MSc’s, MPhil’s and PhD’s do with gastro-enterology. The aim is to provide a platform to show research activities taking place in our academic centers. ABSTRACT 1: Surgical portosystemic shunts versus devascularisation procedures for prevention variceal rebleeding due to hepatosplenic schistosomiasis Author Dr Chikwendu Ede Background Surgical interventions such as shunts and devascularisation procedures are effective therapies to prevent variceal rebleeding in people with hepatosplenic schistosomiasis. As this disease is prevalent in low income countries, the impact of eco-social factors result in poor compliance with non-surgical therapies that require repeated sessions and long-term follow-up. Therefore, this review is timely. Objectives To determine whether surgical portosystemic shunts have better outcomes compared with oesophagogastric devascularisation procedures in the prevention of variceal rebleeding due to schistosomal portal hypertension. Methodology: This meta-analysis was conducted by using standards expected by The Cochrane Collaboration. All randomised clinical trials comparing surgical portosystemic shunts with oesophagogastric devascularisation with or without splenectomy in the prevention of variceal rebleeding due to hepatosplenic schistosomiasis were selected. The risk of bias were assessed according to domains and risk of random errors with Trial Sequential Analysis. The quality of evidence was assessed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group approach. Results Two trials that met the inclusion criteria of this review were selected. An analysis of 115 participants, 57 who received distal splenorenal shunt and 58 who received devascularisation procedure is presented. The trials were assessed at high risk of bias. There is no difference in overall mortality between distal splenorenal shunt versus devascularisation, risk ratio (RR) is 1.40, (95% confidence interval (CI) 0.32 to 6.15), downgraded to very low quality due to overall risk of bias, imprecision and publication bias. Variceal rebleeding following devascularisation is statistically significant (RR is 0.23, 95% CI 0.05 to 1.01), very low quality evidence due to bias, imprecision, and publication bias. The number of participants needed to treat with distal splenorenal shunt to achieve benefit (NNTB) is 8. Serious adverse events reported as procedure specific include: portal vein thrombosis, haemolysis, ascites and shunt dysfunction. There was no report on quality of life. Distal splenorenal shunt (DSRS) is associated with a statistically significant post procedure encephalopathy (RR 8.10, 95% CI 1.04 to 62.83), downgraded to very low quality due to overall risk of bias, imprecision, and publication bias. Outcomes of proximal splenorenal shunt compared to devascularisation was reported by a single trial, therefore no meta-analysis was computed for this comparison, nor subgroup of proximal splenorenal shunt compared to distal splenorenal shunt. Conclusion Available evidence seems to suggest that distal splenorenal shunt is better than devascularisation for the prevention of variceal rebleeding due to hepatosplenic schistosomiasis, but this is at the cost of significant encephalopathy. The review author is cautious to make this conclusion because overall evidence is very low quality and only few trials with small sample size are available. Further randomised clinical trials with adequate sample size and good methodological quality are needed. ABSTRACT 2: Do perforated gastric ulcers require routine intra- operative biopsy? Author Dr Meryl Oyomno Background The recommendation that perforated peptic ulcers have an intraoperative biopsy is suggested to diagnose occult malignancy. However, there is also a recommendation for routine postoperative outpatient follow-up gastroscopy to examine and biopsy the ulcer. In view of the low incidence of malignancy (<1%) and the changing epidemiology of perforated gastric ulcers evidenced by an increased incidence in patients younger than the typical age group for gastric cancer (60-79 years), the question is raised: is it really necessary to biopsy gastric ulcers intra-operatively at the time of repair? Objectives To determine the malignancy rate of perforated peptic ulcers, as well as the demographics and potential risk factors for the perforated ulcers. Methods A two-year retrospective study (1st January 2010 to 31st December 2011) was carried out in three public university affiliated hospitals in Johannesburg. Results During the two-year period, 171 patients underwent operative management of perforated ulcers. Most were young (20 – 39 years) with a median age of 42 years. 54.4% of the ulcers were gastric ulcers and intra- operative biopsy was performed in 72% of cases. Of these, only 25 (26.88 %) were optimal biopsies. Most (97.62%) of the suboptimal biopsies were deemed so, as no mucosa was represented on the biopsy specimen. 90.2% of the biopsies were benign and 2.4% malignant. Only one case of H. pylori infection was noted. A non- attendance rate of 72% for follow-up gastroscopy was noted.