South African Gastroenterology Review - latest Issue

Wow! A year like none other. COVID-19 has really changed the practice of medicine across the globe and has not left South Africa untouched. Telephonic consults, disruption to endoscopy lists, changes in attendance at outpatients have severely affected our members and many have incurred significant financial losses. The effect of decreasing health care to our patients will have a long lasting effect in particular when we think of cancer treatment and screening. COVID-19 has also enhanced our society’s engagement via electronic platforms with numerous electronic webinars. SAGES in conjunction with the Gastro Foundation held a very successful virtual congress this year with over 400 registrations including international attendees. A big thank you to Karin Fenton and Eastern Sun and all the speakers in hosting such an amazing event.

Locally advanced hepatocellular carcinoma includes the presence of portal tumor thrombosis. The prognosis and treatment options for these patients are limited. Radiation therapy allows portal recanalization and the combination of other treatments such as TACE or even surgery. There are different modalities of radiotherapy including conventional radiotherapy, 3DRT, IMRT or VMAT. SBRT allows high doses of radiation to be delivered to the tumor while limiting the dose to the nearby healthy tissues. This allows high doses of radiation to be delivered to the tumor in a few sessions with low side effects. This study aims to review the role of radiation therapy in hepatocellular carcinoma with portal tumour thrombosis, specifically the role of SBRT.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide and management of this disease remains challenging in many cases. For patients with Barcelona Clinic Liver Cancer (BCLC) advanced stage (C) disease, systemic therapy with Sorafenib has been the standard of care with median overall survival (OS) rates of less than one year. Patients presenting with portal vein tumour thrombosis (PVT) are considered to have a particularly dismal survival. For select patients, various loco-regional therapies may improve outcomes and even aid in downstaging to surgical resection or liver transplant. We present a case report of an adult male patient with a unilobar HCC with lobar portal vein invasion who underwent transarterial radioembolization (TARE) as a downstaging procedure. The patient had complete radiological response and then underwent a liver transplant. Complete pathological response was confirmed in the liver explant. At time of writing, almost 4 years following diagnosis, this patient was still alive with no evidence of recurrence. Patient selection is key when deciding on the optimal management of HCC and multidisciplinary team (MDT) involvement is encouraged.

We are presenting a clinical case of a 35 year old man that was referred to our outpatient department by his neurology team. He was known to them with myasthenia gravis diagnosed in 2017. The myasthenia gravis was paraneoplastic, associated with a thymoma for which he had required a thymectomy in late 2017. He was on maintenance with an anticholinesterase inhibitor, and immunosuppression with prednisone and azathioprine.

Background: Epidermolysis bullosa acquisita (EBA) is a rare type of autoimmune bullous skin disease causing inflammation of the skin and mucous membranes. Dysphagia in these patients is usually due to repetitive food bolus trauma of the fragile oesophagus leading to a stricture. Case presentation: Herein we describe a case of a benign oesophageal stricture in a man with EBA requiring multiple oesophageal dilatations to treat his dysphagia. Conclusion: To the best of our knowledge, EBA with an oesophageal stricture has not been previously reported in South Africa. This case highlights effective management of this complex condition.

Gastrocutaneous fistula (GCF) are rare but serious post-operative complication, usually as a result of previous surgery to the alimentary tract. The most well described conditions etiologically related to GCFs include breakdown of gastroenteric anastomosis, disruption of gastric suture lines following bariatric surgery, chronic inflammatory disease, failure of gastrostomy tract healing, and others. We report a 47-year-old female who developed a Gastrocutaneous fistula secondary to gastric inflammation and ulceration.

The first G-ECHO session was held on Thursday 3 September 2020 with an invited lecture from Peter Malfertheiner. Since then we have had weekly interactive webinars, starting with a lecture on a key topic, followed by case discussions. Our online audience has grown each week and the sub - specialties rotate each week and include GI Endoscopy, IBD, Patient Blood Management (PBM) with Pathology the most recent addition. In 2021 a multidisciplinary program on the screening and treatment of Liver cancer in sub Saharan Africa is planned.