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13C-Methacetine breath test: A new tool for monitoring hepatic function in cirrhotic patients before and after liver transplantation
OTHERCONTRIBUTIONS
DIGEST LIVER DIS 2DD1;33:A91-134
3
1 “C-METHACETINE BREATH TEST: A NEW TOOL FOR MONITORING HEPATIC FUNCTION IN CIRRHOTIC PATIENTS BEFORE AND AFTER LIVER TRANSPLANTATION. Alessandra Petrolad, Davide Festi, Giovanni DeBerardinis, Antonella Bonitatibus, Giuseppe Tisone, Dar+& Di Pnolo and Mario Angelico Chair of Gastroenterology, University of Rome Tor Vergata and University of Chiefi, and Liver Transplant Center. Tor Vergata University, Rome, Italy The ‘3C-metbacetme breath test is a simple and non invasive new diagnostic tool based on the use of a non expensi!,e. non toxic substance, exploring the microsomial hepatic function through [he release of “CO? in the breath. Aims. To assess the usefulness of “C-msracetine breath test to monitor the hepatic function in a group of cmhotic patients while in the waiting list for liver transolantation (OLTI and m the tirst six months follow& OLT. Method. ‘Twenty-eight ckrhotic patxnts (20 M, 8 F. 50flO yrs) listed for OLT and ten healthy comrols underwent a “Cmethacetine breath test every three months for a period of 12 to 24 weeks. Thirteen patients were transplanted and underwent ‘3C-methacetine breath test at the followme times afier OLT: I”-Znc week. I” m3’d-6’” month after OLT. “C-methacehne (75 mg) was given orally and the results were expressed as “C-Methocetine cumuIative percent of oxidation at 45 minutes+ Results. No adverse effects occurred The average “Cmethacetme cumulative percent oxidation was 1823% m healthy controls and 6.0+3.7% in cirrhotic patients at tmx of lisrmg, respectively. Most patxnts (74%) improved of at least one point of the Child-Pugh score wl$e m the waiting hst, which was associated with an increase in the “Cmethacetine percent oxidation (to 7.6f3 5%). The mean percent oxidation in the 13 patients studied either before and after OLT is shown below
Conclusions. The “C-methaceone breath test can be a useful new tool for monitorine the heoatx function of cirrhotic oanents listed for OLT and during theearly f&w-up aher surgery
PLASMA CITRULLINE TRANSPLANTATION IN HUMANS
AFTER
INTESTINAL
Pimni L’, Piazzi S*, Masetti M’, Paganelli F’, Bargossi A2, di Francesco F3, SC’, Cautero N’, Jovine E’, Miglioli M’, Pitma AD’ ‘Dpt of Internal Medicine and Gastroenterology, University of Bologna; ‘Centralized Analysis Laboratory St. Orsola-Malpighi Hospital, Bologna; ‘Dpt of General and Special Surgery, University of Modena. Italy Background and aim. Citrulline is an amino acid produced by enterocytes and metabolized into arginine by kidney. Plasma citmlline concentration (CIT) increases in patients with renal failure. In patients with short bowel syndrome (SBS), a direct correlation was showed between fasting plasma citrulline concentration and functioning small bowel length Aim of the present study was to evaluate CIT after intestinal transplantation (IT) in adult humans. Methods. CIT was evaluated in: 5 patients who underwent IT, 3 patients with SBS receiving home parent& nutrition (SBS-HPN), 7 patients with SBS on oral nutrition only (SBS-0) and 4 healthy adults (C). Patients with SBS had intestinal resection at least 2 year before the study. In the IT patients, both CIT and small bowel histology were evaluated on the following days after surgery: 1,3,6,9,12,15,30 @t I); l,3,6 (pt 2); 12,15,30,45,60 @t 3); 45,60,75 @t 4); 75 (Pt 5). Creatinine clearance (Cr Cl) was evaluated in all the subjects. Plasma amino acid were analyzed by chromatography. Data are reported as mean f SD. Results. CIT (pm&L) was 29 f 2 in C, 22 f 7 in SBS-0 and I2 f 6 in SBS-HPN. Cr Cl (mVmin) was 96 f I3 in C, 68 f 22 in SBS-0 and 84 i 30 in SBS-HPN. The table shows the results in IT Davs after IT 75 l-6 12-30 45-60 CIT 6?rl II *5 43f I3 60 + 23 92+28 79 i 22 22f IO Cr Cl 39+3 Small bowel histology showed a feature of mild rejection in IT-pt I on day I5 (CIT = 5). No rejection was observed in all the other cases. Conclusioor. In patients with IT, CIT progressively increased during the I” month aher surgery but was lower than that of healthy subjects and of HPNindependent SBS patients and was similar to that of HPN-dependent SBS patients. In the Zmdand the 3’d month after surgery, CIT appeared higher than controls probably because of the occurrence of mild renal failure.
2 FUNCTIONAL LIVER CHOLEDOCHOLlTHlASlS
TESTS
(FLT)
IN
DIAGNOSIS
OF
Lesinlao E. Lodi L. Rwca E, Rosa F U 0. MEDICINA 1’. Azienda 0spadali.m GUSTO ARSIZIO: Busto A. VA
Introduction: The diagnosis and treatment of choledocholithiasis needs of methods invasive and expensive. It becomes therefore necessary to select the patients with high probability of choledocholiiiasis for better cost-effediveness strataov. The simpler data used are the FLT. They stretch to reduce &r the onset of symptoms, however the clinical importance of this change is not dear. Aim: to estimate the clinical value of modification of FLT in time. Methods: from July 00 to December 01, 57 patients with suspicion of choledocholiiiasis underwent FLT at onset of symptoms and between the Zti and 4’ next days. The explored FLT were ALT. AST. ALP, GGT, and bilirubin. The change in time was expressed as per cent (%) fall. The final diagnosis was defined with EUS or ERCP. The statistical analysis has bean carried out with T-Student test. logistic regression and ROC curve. Rasults: The prevalence of choledccholithiasis was 43%. FLT decrease in time both in groups with CBD stones, and in that without. The FLT and their change do not correlate with the presence of CBD stones. The table show the ROC curve results of FLT change.
VIDEOTAPE ON ENDOCOPIC SUTURING WITH ENDOCMCH DEVICE FOR TREATMENT OF GERD Occhiuinti P, Montino F, O&lo M, Ballare M, Garello E. Saettone S, Del Piano M. Gastroenterologa. Azienda Ospedaliera “Maggiore della CaritB”, Novara In gastroesophageal reflux disease (GERD), the efficacy and safety of acute and long term medical therapy has been firmly established. The controversy today is around the real compliance and the cost effectiveness of medical management. The possible option to medical therapy of GERD is represented by surgical therapy (open or laparoscopic). Nevertheless, these procedures need for general anesthesia, long hospital stay, are expensive and can cause postoperative complications. The endoscopic procedures can offer an alternative to daily medication while avoiding the risks of surgery. These technique seems and easy to undo, no need for general anesthesia, cost effective, but will require technical improvements and larger studies with longer follow-up to demonstrate short and long term efficacy and safety. In the video tape we show the technique, indications, and contraindications of endoscopic gastroplasty with Endocinch Bard Device.
Condusions: FLT are not able to corractly discriminate the presence of CBD stows, neither at the onset of the symptoms, neither in the next days. Also. they change in time do not help in diagnosis. They can have only a low clinical impact.
A91
DIGEST LIVER DIS 2DD1;33:A91-134
3
1 “C-METHACETINE BREATH TEST: A NEW TOOL FOR MONITORING HEPATIC FUNCTION IN CIRRHOTIC PATIENTS BEFORE AND AFTER LIVER TRANSPLANTATION. Alessandra Petrolad, Davide Festi, Giovanni DeBerardinis, Antonella Bonitatibus, Giuseppe Tisone, Dar+& Di Pnolo and Mario Angelico Chair of Gastroenterology, University of Rome Tor Vergata and University of Chiefi, and Liver Transplant Center. Tor Vergata University, Rome, Italy The ‘3C-metbacetme breath test is a simple and non invasive new diagnostic tool based on the use of a non expensi!,e. non toxic substance, exploring the microsomial hepatic function through [he release of “CO? in the breath. Aims. To assess the usefulness of “C-msracetine breath test to monitor the hepatic function in a group of cmhotic patients while in the waiting list for liver transolantation (OLTI and m the tirst six months follow& OLT. Method. ‘Twenty-eight ckrhotic patxnts (20 M, 8 F. 50flO yrs) listed for OLT and ten healthy comrols underwent a “Cmethacetine breath test every three months for a period of 12 to 24 weeks. Thirteen patients were transplanted and underwent ‘3C-methacetine breath test at the followme times afier OLT: I”-Znc week. I” m3’d-6’” month after OLT. “C-methacehne (75 mg) was given orally and the results were expressed as “C-Methocetine cumuIative percent of oxidation at 45 minutes+ Results. No adverse effects occurred The average “Cmethacetme cumulative percent oxidation was 1823% m healthy controls and 6.0+3.7% in cirrhotic patients at tmx of lisrmg, respectively. Most patxnts (74%) improved of at least one point of the Child-Pugh score wl$e m the waiting hst, which was associated with an increase in the “Cmethacetine percent oxidation (to 7.6f3 5%). The mean percent oxidation in the 13 patients studied either before and after OLT is shown below
Conclusions. The “C-methaceone breath test can be a useful new tool for monitorine the heoatx function of cirrhotic oanents listed for OLT and during theearly f&w-up aher surgery
PLASMA CITRULLINE TRANSPLANTATION IN HUMANS
AFTER
INTESTINAL
Pimni L’, Piazzi S*, Masetti M’, Paganelli F’, Bargossi A2, di Francesco F3, SC’, Cautero N’, Jovine E’, Miglioli M’, Pitma AD’ ‘Dpt of Internal Medicine and Gastroenterology, University of Bologna; ‘Centralized Analysis Laboratory St. Orsola-Malpighi Hospital, Bologna; ‘Dpt of General and Special Surgery, University of Modena. Italy Background and aim. Citrulline is an amino acid produced by enterocytes and metabolized into arginine by kidney. Plasma citmlline concentration (CIT) increases in patients with renal failure. In patients with short bowel syndrome (SBS), a direct correlation was showed between fasting plasma citrulline concentration and functioning small bowel length Aim of the present study was to evaluate CIT after intestinal transplantation (IT) in adult humans. Methods. CIT was evaluated in: 5 patients who underwent IT, 3 patients with SBS receiving home parent& nutrition (SBS-HPN), 7 patients with SBS on oral nutrition only (SBS-0) and 4 healthy adults (C). Patients with SBS had intestinal resection at least 2 year before the study. In the IT patients, both CIT and small bowel histology were evaluated on the following days after surgery: 1,3,6,9,12,15,30 @t I); l,3,6 (pt 2); 12,15,30,45,60 @t 3); 45,60,75 @t 4); 75 (Pt 5). Creatinine clearance (Cr Cl) was evaluated in all the subjects. Plasma amino acid were analyzed by chromatography. Data are reported as mean f SD. Results. CIT (pm&L) was 29 f 2 in C, 22 f 7 in SBS-0 and I2 f 6 in SBS-HPN. Cr Cl (mVmin) was 96 f I3 in C, 68 f 22 in SBS-0 and 84 i 30 in SBS-HPN. The table shows the results in IT Davs after IT 75 l-6 12-30 45-60 CIT 6?rl II *5 43f I3 60 + 23 92+28 79 i 22 22f IO Cr Cl 39+3 Small bowel histology showed a feature of mild rejection in IT-pt I on day I5 (CIT = 5). No rejection was observed in all the other cases. Conclusioor. In patients with IT, CIT progressively increased during the I” month aher surgery but was lower than that of healthy subjects and of HPNindependent SBS patients and was similar to that of HPN-dependent SBS patients. In the Zmdand the 3’d month after surgery, CIT appeared higher than controls probably because of the occurrence of mild renal failure.
2 FUNCTIONAL LIVER CHOLEDOCHOLlTHlASlS
TESTS
(FLT)
IN
DIAGNOSIS
OF
Lesinlao E. Lodi L. Rwca E, Rosa F U 0. MEDICINA 1’. Azienda 0spadali.m GUSTO ARSIZIO: Busto A. VA
Introduction: The diagnosis and treatment of choledocholithiasis needs of methods invasive and expensive. It becomes therefore necessary to select the patients with high probability of choledocholiiiasis for better cost-effediveness strataov. The simpler data used are the FLT. They stretch to reduce &r the onset of symptoms, however the clinical importance of this change is not dear. Aim: to estimate the clinical value of modification of FLT in time. Methods: from July 00 to December 01, 57 patients with suspicion of choledocholiiiasis underwent FLT at onset of symptoms and between the Zti and 4’ next days. The explored FLT were ALT. AST. ALP, GGT, and bilirubin. The change in time was expressed as per cent (%) fall. The final diagnosis was defined with EUS or ERCP. The statistical analysis has bean carried out with T-Student test. logistic regression and ROC curve. Rasults: The prevalence of choledccholithiasis was 43%. FLT decrease in time both in groups with CBD stones, and in that without. The FLT and their change do not correlate with the presence of CBD stones. The table show the ROC curve results of FLT change.
VIDEOTAPE ON ENDOCOPIC SUTURING WITH ENDOCMCH DEVICE FOR TREATMENT OF GERD Occhiuinti P, Montino F, O&lo M, Ballare M, Garello E. Saettone S, Del Piano M. Gastroenterologa. Azienda Ospedaliera “Maggiore della CaritB”, Novara In gastroesophageal reflux disease (GERD), the efficacy and safety of acute and long term medical therapy has been firmly established. The controversy today is around the real compliance and the cost effectiveness of medical management. The possible option to medical therapy of GERD is represented by surgical therapy (open or laparoscopic). Nevertheless, these procedures need for general anesthesia, long hospital stay, are expensive and can cause postoperative complications. The endoscopic procedures can offer an alternative to daily medication while avoiding the risks of surgery. These technique seems and easy to undo, no need for general anesthesia, cost effective, but will require technical improvements and larger studies with longer follow-up to demonstrate short and long term efficacy and safety. In the video tape we show the technique, indications, and contraindications of endoscopic gastroplasty with Endocinch Bard Device.
Condusions: FLT are not able to corractly discriminate the presence of CBD stows, neither at the onset of the symptoms, neither in the next days. Also. they change in time do not help in diagnosis. They can have only a low clinical impact.
A91