SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 33 ABSTRACT CORNER Conclusion A South African protocol for the management of perforated peptic ulcers, recognizing that most patients don’t return for follow-up gastroscopy, should be developed. Essentially an intra-operatively biopsy should be performed in view of the low patient follow-up rate, however the biopsy specimen must be optimal to improve the diagnostic rate of malignancy and H. pylori. ABSTRACT 3: Gallbladder disease: A review of cholecystectomy specimens in South Africa Author Dr Zafar Khan Background Studies suggest that the rate gallstone disease in Africa is low. Our hypothesis is that gallstone disease in Africa has increased due to urbanization and its associated increases in body mass index (BMI). Methods An audit of cholecystectomies done in South Africa by reviewing gallbladder specimens processed by the South African National Health Laboratory Service (NHLS) from 2004 and 2014 was done. The NHLS services 82.5% of SA’s population. Descriptive analysis was performed with comparison done. Urbanization ratios were obtained from Statistics South Africa and BMI data from previously published studies. Results 33467 cholecystectomy specimens were analysed. There was a 92% absolute increase in cholecystectomies during the study period (Pearson r 0.94; p < 0.01) with the overall cholecystectomy rate increasing by 65% from 8.36 to 13.81 per 100000 population. 85% of cholecystectomies were in females, who were significantly younger than males. The data was divided into two equal time periods and compared. During period 2 there was 28,8% increase in cholecystectomies and patients were significantly younger (46.9 vs 48.2 years; p = < 0.0001). The Northern Cape was the only province to show a decline in the cholecystectomy rate in period 2 and was also the only province to record a decline in urbanization ratios. Population based studies in SA have demonstrated a clear association between urbanization and increases in BMI. Interpretation This nationwide African study demonstrates a significant increase in cholecystectomies for younger patients with gallstone disease. A positive relationship between urbanization and cholecystectomy rates has been demonstrated. Urbanization associated increases in BMI is the likely cause for gallstone disease in this low risk population. ABSTRACT 4: Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy in Laparoscopic Bariatric Surgery, a Meta-Analysis Author Dr Sarah Nietz Background Laparoscopic bariatric surgery is an effective long-term treatment modality for morbid obesity and its associated complications. Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure, however sleeve gastrectomy (SG) has gained popularity as a stand-alone weight loss procedure. This meta-analysis was undertaken to determine whether SG is as effective as RYGB. Methods Randomized controlled trials comparing adults undergoing laparoscopic RYGB or SG for treatment of morbid obesity were compared in a fixed-effect meta- analysis model. Outcomes included procedure-related morbidity and mortality; measures of weight loss; improvement of diabetes and dyslipidaemia; and change in gut hormone levels. Dichotomous outcomes were analyzed using odds ratios and continuous data using mean differences. Heterogeneity was assessed using the I2 test. Results Eight RCTs with 520 participants were included. There was no statistical difference between the two procedures regarding morbidity, reoperation, rehospitalization, parameters of weight loss and diabetes resolution after 12 months follow-up. RYGB significantly improved dyslipidaemia and lowered leptin levels. SG lowered fasting ghrelin levels. There was no difference in peptide YY levels. No mortalities were reported. Conclusions SG and RYGB are equivalent bariatric procedures except that RYGB has a superior resolution of dyslipidaemia and lower leptin levels, and SG resulted in lower ghrelin levels. ABSTRACT 5: Efficacy of epidermal growth factor receptor blockade in early pancreatic ductal adenocarcinoma. Author Dr Helgard Marais Summary of the thesis Treatment of pancreatic ductal adenocarcinoma (PDAC) is far from satisfactory. Despite advances being made the five-year overall survival has only improved from 2.8% in the period 1978-1983 to 5.1% in the period 2001-2007. The poor prognosis is a combination of vague symptomatology leading to late presentation, the cancers’ aggressive nature and complex mutational landscape, and poor response to treatment modalities. Epidermal Growth Factor Receptors (EGFR) regulates a diverse array of cellular functions. These include growth, survival, cell migration and differentiation and is overexpressed in 30%-89% of PDACs, being linked to larger tumour size, worse clinical stage, and a reduced overall survival. The aim of this study was to assess and compare the extent of apoptosis, using ki-67 index, caspase-3 and Annexin-V assays, in early and metastatic PDAC cell lines when treated with EGFR targeted treatment (Erbitux) and