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Severe cholangitis is an urgent indication for endoscopic treatment, represented by endoscopic retrograde pancreatography (ERCP) and endoscopic sphincterotomy. It ensures good bile drainage, and improves patient morbidity and mortality. Materials and methods: This is a retrospective study carried out within our department between January 2010 and April 2018. All patients with severe cholangitis who benefited from therapeutic ERCP were enrolled. We analyzed the epidemiological data of the patients, the results of the ERCP, as well as the post-sphincterotomy mortality. We also performed multivariate analysis for predictive factors for mortality. Results: 88 patients were enrolled. The average age of the patients was 60.14 years [17-102 years], with a female predominance (n = 45, 51.1%). Twelve patients (13.6%) underwent a cholecystectomy. Almost 68, 18% patients (n = 60) had obstructive choledocholithiasis, fifteen patients (17,04%) had o cyst hydatic and 13 patients (14,77%) had tumor obstruction. Successful catheterization of the main bile duct was reported in 60 patients (68.18%), and failure in 28 cases (31.81%). The use of precut was performed in 28 cases (31.81%), which enabled successful access to main bile duct in 24 patients (85.71%). Failure of catheterization after a precut concerned 4 patients (14.28%): 3 patients (75%) benefited from a resumption of ERCP with success, and only one patient (25%) was proposed for surgery. fifty-five patients (91,66%) underwent stone evacuation (Figure 1). For 5 patients (8, 33%), failure of stone extraction was followed by successful surgery. Twenty-one patients benefited from successful implementation of a biliary prosthesis were objectified in 21 patients (25%). 5 patients (23.80%) failed. Among them, percutaneous drainage was done 4 patients (80%) and 1 patient (20%) was operated. The main post-ERCP complications were represented by: 5 cases (5.7%) of papillary bleeding, and 1 case of acute pancreatitis. The overall death rate was 11,36% (n=10). The course was marked by clinical and biological remission in the other patients with successful endoscopic drainage. The main predictors of mortality in multivariate analysis were impaired of consciousness upon admission (p = 0.023, OR=4, 5678 [2,678‑10, 7890]), and the presence of renal failure (p = 0.001, OR=6, 4809 [2,089‑15,781]). Conclusion: Endoscopic treatment is the gold standard for the treatment of severe cholangitis. Its results are satisfactory, with a lower mortality compared to surgical treatment with fewer hospitalizations.

Biliary lithiasis is a very frequent and benign pathology but can be the cause of rich and varied symptomatology as well as serious complications. Our study aims to estimate the prevalence and some risk factors of biliary lithiasis and especially to look for the correlation between this pathology and anthropometric measurements. Therefore, we conducted a campaign that included 1358 citizens to perform ultrasound screening for biliary lithiasis, hepatic steatosis, and hydatid cyst. In our study, the prevalence of biliary lithiasis was 19.2%. The average age was 47.7 years with a predominance of women, i.e. a percentage of 76.6%. The risk factors significantly associated with gallstones were abdominal obesity, male sex, and age below 40 years were protective factors, however, neither diabetes nor a history of hypercholesterolemia was associated with the risk of gallstones.

Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue around the duodenum. Usually diagnosed in the neonatal period, the annular pancreas can be responsible for intestinal obstruction in 1% of cases. In adults it is asymptomatic in 50% of cases, as it can be responsible for duodenal stenosis, pancreatitis, or duodenal or gastric ulcerations. We report two cases of duodenal stenosis secondary to an annular pancreas diagnosed in two adults in whom a surgical bypass was performed allowing resolution of symptoms.

Gastrointestinal stromal tumors are mesenchymal tumors that represent 0.1% to 0.3% of all malignant tumors. Their clinical presentation is nonspecific but presentation by massive hemorrhage with hemodynamic instability is rare. We report the cases of 02 young patients who presented a fulminant digestive hemorrhage with hemodynamic instability and whose endoscopic exploration did not reveal any obvious etiology. That’s why we involved interventional radiology and surgical team in order to localize and confirm the diagnosis of a hemorrhagic jejunal GIST and then to ensure the hemostasis by small bowel resection taking away the jejunal tumor.

Ulcerative gastrointestinal bleeding is the most frequent emergency in digestive endoscopy. Management is based on the initiation of an infusion of proton pump inhibitors as soon as the diagnosis is mentioned. Upper endoscopy should be performed as quickly as possible under the best technical conditions. Two combined techniques of endoscopic hemostasis, most often by injection of reduced adrenaline and placement of clips, allow hemostasis in most situations. In case of failure, a new endoscopy can be proposed. Surgery and interventional radiology have a place in second or even third line treatment. A retrospective study was carried out on 80 patients over an extended period from 2009 to 2019. Including all patients presented to the emergency department for upper gastrointestinal bleeding regardless of the mode of exteriorization and who were reinforced with endoscopic treatment. risk of surgery and death. The objective of our work is to evaluate the effectiveness of endoscopic management and to deduce the predictive factors of failure of endoscopic hemostasis.

Introduction: Primary biliary cholangitis (PBC), the new dominance of primary biliary cirrhosis, is a cholestatic disease of autoimmune etiology and represents the leading cause of intra-hepatic cholestasis. Treatment is mainly based on ursodeoxycholic acid. The biological response to treatment is the main predictor of survival without liver transplantation. The Globe-score has been recently validated as the main prognostic factor. Materials and methods: This is a retrospective study carried out in our department collating all cases of PBC followed in consultation. The aim of our work is to research the predictors of poor response to UDCA. Results: 46 patients were collected. The mean age of the patients was 58.82 years, with a predominance of women (n = 43, 93.5%). 34.78% of patients were in the stage of cirrhosis. Anti-M2 mitochondria antibodies were positive in 44 patients (95.65%). An overlap syndrome was found in 11 patients (23.9%). Treatment was based on UDCA combined with corticosteroid therapy and immunosuppressant for overlap syndrome. A biochemical response at 1 year of treatment according to the Paris II criteria was found in 47.8%. The average value of the globe score was 1.35. A score greater than 0.30 was objectified in 20 cases (43.47%). Nineteen cirrhotic patients (41.30%) had a globe score> 0.30. Factors associated with poor response to therapy were: stage of decompensated cirrhosis, elevated pre-therapy total bilirubin greater than 30 g / l and hypoalbunemia less than 35 g / l. The study of the correlation between Globe score and Paris II showed a strong and significant association with a correlation coefficient estimated at 67%. The Paris II score was significantly correlated with the response to treatment (p = 0.001). Conclusion: In accordance with the data in the literature, the globe-score and Paris II are two similar predictive means for evaluating the response at 1 year of treatment in Moroccan context. Keywords: Morocco, Predictors of response, Primary biliary cholangitis, Ursodeoxycholic acid

Backgound: Aorto-digestive fistulas remain a fatal disease entity often occurring after vascular surgeries. Eso-gastro-duodenal endoscopy is essential to explore the upper digestive bleeding. The negativity of morphological examinations should not exclude the diagnosis. Diagnosis has benefited in recent years from developments in cross-sectional imaging: computed tomography (CT) and magnetic resonance imaging (MRI). The severity of bleeding is linked to the vital consequences (mortality close to 50% up to 100% in the absence of treatment), functional (30% amputation), and to the underlying infection itself correlated with the attack of the stent and the anastomosis. Patients: We report three cases of aorto-digestive fistulas treated at The University Hospital Hassan II to show the challenging diagnosis and therapeutic of such rare causes of upper digestive bleeding. Results: three patients were admitted to the emergency endoscopy unit for upper digestive bleeding, 2 of them had a medical history of Behcet Disease and two had past aortic aneurism surgery. The couple’s upper endoscopy and CT scan angiography made the diagnosis. Unfortunately, 2 patients died from fatal bleeding. Conclusion: Aortodigestive fistula is an extremely serious complication of aortic aneurisms and a rare cause of gastrointestinal bleeding. This diagnosis should be considered in any patient presenting with digestive bleeding with vascular disease or previous history of vascular stent.

Gastric lymphomas are rare tumorsand accounts for only 3%. There are two groups of lymphomas:mucosa-associated lymphoid tissue (MALT) gastric lymphoma or diffuse large B-cell lymphoma. The management of this tumordepends on the histological grade and extension workup. It includes a clinical examination, radiological and endoscopic work-up including a total ileo-coloscopy in order to look for a synchronous intestinal localization.We report in this article the experience of our department concerning the interest of ileo-coloscopy in the assessment of gastric lymphoma extension. We included 87 patients followed for gastric lymphoma, 34 of whom underwent ileo-coloscopy preceded by thoracoabdomino-pelvic CT scan. Colonoscopy revealed an ulcerative colonic process in only 02 patients, whose CT scan also revealed a colonic thickening and the anatomopathological study was in favour of a colonic lymphoma.In the light of these results, is it not necessary to reconsider the interest of an invasive procedure in the work-up of gastric lymphoma with a normal abdominal scan? &nbsp

Les carcinomes annexiels sont rares et représentent moins de 1% des carcinomes cutanées. Le carcinome scléreux des glandes sudorales a été décrit pour la première fois en 1982 par Goldsteinet al.Nous rapportons un nouveau cas de localisation inhabituelle péri. Il s´agit d´une patiente de 33 ans, présentait une lésion cutanée péri-anale, d´aspect rétracté. L´analyse histologique de la biopsie cutanée péri-lésionnelle, l´immunohistochimie, la négativité des investigations cliniques, radiologiques et endoscopiques nous ont permis de poser le diagnostic du carcinome scléreux eccrine. Il s´agit d´une entité rare, de localisation habituelle faciale, d´évolution lente mais agressive. Elle pose le problème de diagnostic différentiel avec des tumeurs bénignes et malignes d´où l´enjeu pour le pathologiste de savoir évoquer ce carcinome devant toute lésion cutanée d´aspect scléreux et infiltrant, d´évolution lente et dans un contexte de conservation de l´état général et d´absence d´histoire néoplasique, et de ne pas hésiter à demander de nouvelles biopsies profondes si doute.

Ulcerative gastrointestinal bleeding is the most frequent emergency in digestive endoscopy. Management is based on the initiation of an infusion of proton pump inhibitors as soon as the diagnosis is mentioned. Upper endoscopy should be performed as quickly as possible under the best technical conditions. Two combined techniques of endoscopic hemostasis, most often by injection of reduced adrenaline and placement of clips, allow hemostasis in most situations. In case of failure, a new endoscopy can be proposed. Surgery and interventional radiology have a place in second or even third line treatment. A retrospective study was carried out on 80 patients over an extended period from 2009 to 2019. Including all patients presented to the emergency department for upper gastrointestinal bleeding regardless of the mode of exteriorization and who were reinforced with endoscopic treatment. risk of surgery and death. The objective of our work is to evaluate the effectiveness of endoscopic management and to deduce the predictive factors of failure of endoscopic hemostasis. &nbsp

Endoscopic ultrasound (EUS) is a method of exploration of the digestive system that combines two techniques: endoscopy and ultrasound. EUS has several applications in digestive pathology. Echo-endoscopic biopsy (EEB) of pancreatic masses is a technique that allows fine needle aspiration to obtain material for cytohistological analysis. It is indicated each time a histological examination can have a diagnostic and/or therapeutic interest.For that we realized a retrospective study between January 2017 and December 2020. All patients referred to the department for a bilio-pancreatic echo-endoscopy in the framework of a pancreatic tumor were included in the study. We collected 90 patients who met our inclusion criteria. We recorded the patients demographics, pathologic history, symptoms, and ultrasound, CT, and EUS. During the echo-endoscopic examination, we always tried to specify some essential data according to the international recommendations, depending on the pathology (benign or malignant). &nbsp

Anti-TNFα have revolutionized the management of chronic inflammatory rheumatic and intestinal diseases however, they are at high risk of reactivation of latent tuberculosis. These are most often extra-pulmonary tuberculosis and disseminated forms which occur during the first year and which can be avoided by screening and prophylactic treatment. The aim of this publication is to describe the epidemiological, clinical, biological, radiological and evolving data of patients having triggered tuberculosis under anti TNFα treatment followed at the Hassan II hospital center (CHU) in Fez during the period between January 2012 and January 2021. During this period, we collected 130 patients under anti TNF alpha of which 84.5% of patients are on Infliximab 15.5% on Adalimumab. Active tuberculosis occurred in 4.6% of patients whose mean age is 35.5 years and the sex ration is 5H / 1F. The duration of onset is on average after 5 sessions of anti TNF alpha. A phtysio assessment was carried out in all our patients before starting the anti TNF α, 2 of which were IDR positive completed by quantifying it which came back positive in a single patient. &nbsp

A-TNF inhibitors are increasingly used in various inflammatory disorders. Multiple side effects have been reported in recent years, particularly peripheral neuropathies. We report a case of axonal neuropathy occurring after the start of treatment with Infliximab. This is a 47 years old patient, followed for Crohn’s disease requiring treatment with Infliximab. Twenty-two weeks later, the patient presented a grade 4 of axonal neuropathy. We concluded to a medicinal sensitive neuropathy after elimination of other etiologies. Given the severity of the neurological symptoms, we decided to change the therapeutic class.

Liver hydatid cyst is a parasitic disease that is endemic in Morocco. Its gravity is essentially due to its complications, such as Intrabiliary rupture. The aim of our study was to evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the management of intrabiliary rupture of hydatid disease of the liver. Materials and Methods: This is a retrospective study in the department of Gastroenterology in the University Hospital Hassan II of Fez over a period of 12 years from March 2005 to October 2017. All patients admitted for hepatic hydatid disease and who received ERCP were included. We analyzed the success rate of catheterization of the common bile duct (CBD), the successful clearance of the bile duct and the complications. Results: 2860 patients had received therapeutic ERCP, 151 patients (5.3%) had hepatic hydatid disease, 112 of which had intrabiliary disruption of hepatic hydatid and 39 patients were admitted for sphincteromy for reversal of the flow after surgery of hydatid cyst. The average age of our patients was 41 years old [12 - 85]. The sex ratio F/H = was 1.12. 74% (N = 112) patients were admitted to a table cholangitis and 26% of cases were operated for KHF fistulized in the bile ducts with persistence of a large biliary flow in post-operative (39 cases). The success of initial catheterization of the commun bile duct was achieved for 138 patients (91%) or obtained secondarily after precut for 13 patients. The evacuation of hydatid membranes was carried out in 51% of them (N = 78); twenty two (14.5%) patients had one or more calculations with or without hydatid membranes. A case of gastrointestinal bleeding post ERCP was observed. All the patients followed evolved well in the long term except for two patients who presented in few months after the first ERCP severe cholangitis which required the use of a second ERCP with successful evacuation of membranes. Conclusion: In our study, endoscopic management of hydatid cyst remains a dominant position, with a very satisfactory success rate and an acceptable rate of morbidity and mortality.

Portal thrombosis (PT) is a rare condition of heterogeneous etiologies. The aim of our work is to study the epidemiological and etiological profile of portal thrombosis in non cirrhotic patients through the experience of our department. Patients and Methods: This is a retrospective study over a 9-year period (January 2009-July 2018), 54 cases of PT in non cirrhotic patients were collected in the department of Hepato-Gastro-Enterology of the HASSAN II Fez Hospital, 73 cases of PT were excluded among cirrhotic patients. Results: We collected 54 cases of PT cases; the average age was 45 years, with an F/M ratio of 1.42. PT was revealed by abdominal pain in 20 cases, complications of portal hypertension in 24 cases, and ultrasound discovery in 10 asymptomatic cases. Main underlying causes of PT were: A proteine S deficiency in 7 cases, Acute pancreatitis in 5 cases, colonic cancer in 4 cases, pancreatic cancer in 4 cases, Hydatic liver Echinococcoses (3 cases), anti phospholipid syndrom (3 cases), myeloproliferative syndrom (2 cases) and jak mutation 2 in 1 case, non identified etiology was reported in 20 cases (37%). Treatment was based on anticoagulation, treatment of portal hypertension complications, and etiological treatment in cases where etiological diagnosis was certainly posed. Conclusion: PT is a rare but serious condition, according to our study neoplastic causes are predominant followed by protein S deficiency. Etiological investigations have to be wide and early treatment is the best option to avoid extension and complication.

SARS-CoV-2 infection is a major concern and a new threat to immunocompromised patients. Patients with chronic inflammatory bowel diseases (IBDs) are at increased risk of infections, in particular when they have active disease and are on immunosuppressive treatment. The purpose of this study was to assess the clinical, biological and radiological features of three patients with COVID-19 associated with chronic IBD as well as their management and outcomes. The study was conducted at the Hassan II University Teaching Hospital in Fes, Morocco over a 3-month period. We assessed all patients with disease onset. All patients had mild symptoms or were asymptomatic. No changes or delays in treatment regimens occurred and none of patients developed severe COVID-19. Reverse transcription polymerase chain reaction (RT-PCR) test results were positive in all patients. Radiological examinations were conducted. Chest scanner showed ground-glass opacities in one case. Treatment was based on hydroxychloroquine with azithromycin. Outcome was good in all cases. This preliminary report suggests that patients with chronic IBD aren’t at higher risk of developing COVID-19 compared to the general population.

The transarterial chemoembolization (TACE) is a firstline therapeutic option for advanced hepatocellular carcinoma (HCC). Their indications are clearly defined by learned societies but the challenge is to determine the optimal number of TACE sessions that will benefit patients before switching to other therapies. For this reason, the Assessment for Retreatment with Transarterial chemoembolization (ART) score has been developed. The objective of our work is to show the prognostic value of the ART score before the second TACE.This is a retrospective and prospective study of patients with hepatocellular carcinoma on cirrhosis liver who received a TACE between January 2012 to July 2019. The diagnosis of HCC was made according to the non-invasive criteria of EASL with the use of histology for doubtful cases. The ART score was calculated after the first chemoembolization. Patients were divided into 2groups: group A with an ART score between 0 and 1.5 and group B with a score =2.5.During the study period, 58 patients with HCC on cirrhosis liver received a TACE: 55.17% had an ART score between 0 - 1.5 before the second session and 44.8% had an ART score =2,5. Both groups were comparable regarding age, circumstances of discovery and Child's score. The size of the HCC as well as the value of the AFP was further increased in the group B. We observed a significant difference in the radiological response, the Child score and aspartate transaminase rate between the two groups after the first TACE. The overall survival rate at 3 years was 81% in group A versus 19% in group B.The ART score has an independent prognostic value and should be taken into account in the therapeutic strategy before the second TACE.

La pancreatite auto-immune a IgG4, connue sous le nom de pancreatite auto-immune de type 1 (PAI de type 1), est la manifestation pancreatique dune maladie systemique a IgG4 appelee maladie fibrosclerosante a IgG4. Elle se manifeste par une atteinte multiorganique, mais surtout pancreatique, avec une elevation des IgG4 serique dans plus de 80% des cas. Sur le plan histologique latteinte se traduit par un infiltrat lymphoplasmocytaire dense de lorgane atteint avec positivite des IgG4 en immuno- histochimie, dune fibrose dorgane et des veinulites obliterantes. Mais vu la difficulte dobtenir des prelèvements biopsiques pancreatiques adaptes, le diagnostic de PAI de type 1 peut être retenu sur une combinaison de critères cliniques, radiologiques et serologiques. Dans sa forme pseudotumorale, la PAI est parfois difficile a distinguer dun cancer. Compte tenu de sa bonne reponse aux corticoïdes, un diagnostic minutieux permettrait deviter une chirurgie lourde et inutile. Nous rapportons ici un cas de PAI de type 1, retenu sur des critères cliniques, serologique et radiologiques, et levolution sous traitement. &nbsp

La maladie à IgG4 encore appelée polyexocrinopathie auto-immune à IgG4 est une nouvelle entité où s´inscrit la PAI de type 1. Elle peut toucher différents organes (système nerveux central, les glandes salivaires, la thyroïde, les poumons, le pancréas, les voies biliaires, le foie, le tube digestif, les reins, la prostate…) avec des symptômes relatifs à l´organe atteint. Elle est plus fréquente chez l´homme de plus de 50 ans. Son incidence et sa prévalence sont mal connues car c´est une maladie peu fréquente. Elle est a priori plus fréquente en Asie et ne représente que 20 à 30% des PAI en occident. Son diagnostic est histologique caractérisé par la présence, dans un contexte d´élévation sérique des IgG4 dans plus de 80% des cas, d´un infiltrat lymphoplasmocytaire dense de l´organe atteint avec positivité des IgG4 en immuno- histochimie, d´une fibrose d´organe et des veinulites oblitérantes. Elle est sensible à la corticothérapie avec un risque de rechute à l´arrêt de la corticothérapie qui n´est pas négligeable et qui conduit alors à l´utilisation d´immunomodulateurs, principalement: les thiopurines (Azathioprine ou le 6-mercaptopurine), le méthotrexate et de façon plus récente le rituximab qui peut être utilisé également comme traitement d´induction. Grâce aux avancées récentes, des critères histologiques et cliniques précis sont maintenant connus permettant de limiter les prises en charge inadaptées telle que la chirurgie. Cependant, de nombreuses lacunes persistent dans nos connaissances: sur la physiopathologie, l´identification de biomarqueurs spécifiques autres que les IgG4, l´histoire naturelle de la maladie et l´évaluation du risque de cancer à long terme, les performances des outils diagnostiques comme la biopsie pancréatique sous échoendoscopie. De même, une prise en charge consensuelle internationale reste à définir dans les phases initiales de la maladie et en cas de rechute. L´objectif de cette étude est de rapporter 3 cas de ML-IgG4 en se basant sur les critères cliniques et radiologiques, la réponse thérapeutique.

International Journal of Advanced Research (IJAR)

Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005-2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 - 70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency that requires a multidisciplinary approach; medical treatment is the basis of initial treatment; but surgery must always be indicated at the right time avoiding increasing the death rate, this rate is important in our series.