SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 36 SQUAMOUS CELL CARCINOMA AND END STAGE ACHALASIA: A CASE REPORT. Authors Dr Chandrakumarsing Anauth, Mr Frank Anderson 1 UKZN Background Achalasia is a rare motility disorder of the oesophagus characterized by absence of peristalsis and incomplete lower oesophageal sphincter (LES) relaxation. The association of achalasia and squamous cell cancer (SCC) is very rare with a mean incidence of less than 5% over a 10 year period. Case We present the case of a 48 year old male with no comorbidities who presented with progressive dysphagia for more than 1 year and was diagnosed with achalasia and associated para-oesophageal hernia. He subsequently underwent a Heller’s myotomy and repair of the hernia. However, his symptoms persisted after surgery. Multiple pneumatic balloon dilatations were done. About 6 months later during a follow up endoscopy for dilatation, a lesion was noted in the distal oesophagus which a biopsied and was reported as SCC insitu of the oesophagus. Repeat imaging demonstrated a sigmoid oesophagus and no features of metastatic disease. He subsequently underwent an oesophagectomy with colonic interposition graft. Conclusion There are no clear guidelines recommending screening and follow up of patients with achalasia with regards to malignancy. However with the high incidence of SCC in our population and the established association of achalasia and SCC, early detection is vital. METFORMIN’S ANTI-NEOPLASTIC EFFECT ON CLINICALLY STAGED IN VITRO PANCREAS CANCER CELLS Authors Dr Marguerite Barnard1, Prof Martin Brand 1 , Prof Raquel Duarte2 1 University Of Pretoria, 2 University of Witwatersrand Introduction Pancreas ductal adenocarcinoma (PDAC) accounts for more than 80% of all pancreatic cancers. Recently, diabetes mellitus (DM) has been linked as a common risk factor, with metformin, a first-line diabetic therapy agent, influencing various pathways such as various cellular pathways like the LKB1/AMPK pathway causing inhibition of cell division and promotion of apoptosis. This study investigated metformin’s apoptotic and anti-proliferative effect on clinically staged PDAC cells in vitro. Method A laboratory based in vitro study was conducted using HPDE (normal ductal epithelium), Panc-1 (early staged PDAC), Mia Paca-2 (intermediate) and CF PAC-1 (metastatic) cell lines. Experiments were conducted in triplicate, establishing seeding density, a IC50 for each cell line, cell proliferation assays, apoptosis and Ki67 index. Apoptosis was measured using Annexin V and Caspase 3 antibodies. Results The IC50’s established were HPDE 6.574mmol/L, Panc- 1 42.06mmol/L, MIAPaCa-2 1.196mmol/L and CFPAC-1 3.230mmol/L respectively. All cell lines showed a statistically significant stepwise decline in cell proliferation with increasing doses of metformin(p<0.05-0.0001). The proliferation assays and Ki67 indexes were significantly lower in metformin treated cells HPDE (61.23% vs. 74.57%, p<0.01), PANC-1 (37.60% vs. 62.97%, p<0.001), MIA PaCa-2 (33.40% vs. 42.17%, p< 0.01), CFPAC-1 (29.50% vs. 69.03%, p<0.0001). Most markers of apoptosis amongst all cell lines treated were statistically significant when treated with metformin compared to untreated cells. Conclusion This is the first study using clinically staged normal ductal and pancreatic cancer cells applying laboratory specific metformin IC50 for all of the experiments, including Ki67 measurement when treating pancreatic cancer cells. This study confirms metformin’s apoptotic and anti-proliferative effect on staged PDAC cell lines.. BILIARY ATRESIA AND FANCONI ANAEMIA: A RARE ASSOCIATION PRESENTING WITH SEVERE PANCYTOPAENIA. Author Dr Sarah Berkenfeld 1,2 , Professor Gita Naidu 1,2,3 , Dr Chrisitna Hajinicolaou 2,3 1 Wits Donald Gordon Medical Centre, 2 University of Witwatersrand, 3 Paediatrics & Child Health (Chris Hani Baragwanath Hospital) Introduction Biliary Atresia is a progressive inflammatory and fibro- obliterative disease of the intra and extrahepatic biliary tree resulting in biliary obstruction and neonatal cholestasis. The natural history of Biliary Atresia involves the evolution of portal hypertension and hypersplenism secondary to ongoing hepatic inflammation and progressive fibrosis. Hypersplenism causes mild to moderate pancytopaenia,. Severe pancytopaenia, particularly thrombocytopaenia is an uncommon complication and warrants further investigation. Case Report This case report describes a young female with Biliary Atresia (BA), post kasai portoenterosotomy, complicated by hepatic fibrosis and evolving pancytopaenia. Phenotypically, she had dysmorphic features with low set ears, microcephaly, a prominent forehead, triangular facies, a jejunal web and a left multicystic dysplastic kidney. Alagille syndrome was excluded based on liver histology and the failure to meet diagnostic criteria. No clear syndrome was identified at initial presentation. At 3 years, 9 months she presented with severe pancytopenia. Investigation revealed bone marrow aplasia. When re- examining her phenotypic features, Fanconi Anaemia (FA) was suggested. The diagnosis was confirmed by SAGES CONGRESS 2022 ABSTRACTS SAGES CONGRESS 2022 ABSTRACT eji l NF- eatment nset of its for the eir d atients eir py ribution ications 40.4 64.4 35.6 2:1 for was 79.4% t cases cal pared d and TREND IN PROC DURAL OUTCOMES AT ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Author Doctor Sayuri Naidu 1 , Doctor Frank Anderson 1 1 IALCH Introduction Endoscopic retrograde cholangiopancreatography (ERCP) has evolved largely into use for therapeutic purposes. This has bee assisted by advancement in other diagnostic modaliti s viz MRI and Endoscopic Ultrasou d. Failures at ERCP may be due to an inaccessible ampulla of Vater, failure to cannulate the ducts or in the intended therapy (viz failure to extract stones or deploy stents). There may be normal findings or an unnecessary procedure. Unnecessary ERCP should be limited as the complications of acute pancreatitis, perforation and bleeding may be fatal. Methods A retrospective review of electronic records of ERCP performed by a surgical team on a single day in week from 2011 to 2017 was performed. Demographic information, indications for ERCP, success and failure rates and non- therapeutic procedures were analyzed. Ethical approval was obtained from the UKZN ethics committee. Results All patients were referred from six regional hospitals. Six hundred and fifty procedures were reviewed from 2011 to 2017. The mean age in this population was 55 y ars with a standard deviation of 17 years. There wer 191 (29.9%) males and 447 (70.1%) females. Gallstones, 295(45%), bile d ct stricture, 167(26%), periampullary mass, 72(11%) and pseudocyst, 22(3%) were the commonest indications. The average cannulation rate over the period was 88.5% which improved to 92% when a pre-cut papillotomy was performed. There was failure to achieve therapeutic intent in an average 12(13%) and success in 67(72%) of patients. In an average 14(15%%) of patients there was no pathology at the time pf ERCP. Complications of ERCP were not an lyz d as patients were repatriated t their referring institutions and these were not routinely evaluated. Conclusion The cannulation rate when the ampulla was identified was simil r to other studies. However, greater than 10% of procedures which were unn cessary at the time of ERCP nd these should be further valuat nd limited. TUBERCULOUS LIVER ABSCESS. Author Dr Yonela Qub kile 1 1 Departme t of Ga troenterology, Nelson Mandela school of medicine, University of Kwa-Zulu Natal, Inkosi Albert Luthuli Central Hospital Introduction Tuberculosis (TB) is common in South Africa but tuberculous liver abscess (TLA) is extremely rare with a prevalence of 0.35%. Focal TB of the liver can be manifested by single or multiple tuberculous abscesses. These occur more frequently in immunocompromised