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A Comparison of Albumin vs Albumin Combined With Terlipressin for Treating Hepatorenal Syndrome: An Evidence Based Case Report
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Abstracts
Clinical Gastroenterology and Hepatology Vol. 15, No. 1
was 1,3% including hemothorax, hematoma and pleural effusion. CONCLUSION: RFA is a safe and effective therapy for HCC patients. Factors correlated with survival were etiologies, mRECIST response and number of tumors. Hepatocellular carcinoma frequency Ablation (RFA)
Keywords:
(HCC);
Radio-
Conflicts of interest: The authors disclose no conflicts.
Endoscopy in the Centenarians: Is it Worth the Trouble? Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Endoscopy in the very elderly is generally considered risk prone. Centenarians are people who are 100 years of age. Little is known about endoscopy in the centenarians. This retrospective study aimed to explore this. METHODS: A retrospective study analysing endoscopy in centenarians presenting to a University Hospital from 01/2005 to 01/2015 was undertaken. Endoscopy reports were retrieved from the Hospital’s Endoscopy Reporting tool and patients’ details were confirmed using the Trust’s patient database. RESULTS: 11 procedures (7 Gastroscopies, 3 sigmoidoscopies and 1 Colonoscopy) were undertaken in 10 patients (4 male and 6 female). Age: 101 to 119 years. Mean 105.2 years. 7 (Caucasians), 2 (Indians) and 1 (Afro-Caribbean). 72% (urgent basis). 70% (inpatients) and majority were undertaken by Consultants (82%). Indications included Dysphagia (36.3%), Melena (27.2%), Rectal Bleeding (27.2%) and previous Cancer (9%). Procedural yield (81.8%) and endoscopic intervention performed in 2 cases (Duodenal ulcer injected with adrenaline and hemorrhoids banded). 2 procedures were performed under sedation (midazolam). 100% completion rate without immediate complications. CONCLUSION: To the best of the author’s knowledge this is the only study analysing endoscopic practice in centenarians. While the sample size is small it demonstrates that endoscopy can be performed safely and diagnostic yield is high. A patients’ age should not be the sole factor when deciding suitability for endoscopic procedures. Larger studies are required to gain a better understanding of endoscopic suitability for patients in this age group. Conflicts of interest: The authors disclose no conflicts.
Haemostasis After Endoscopic Intervention in Upper Gastrointestinal Bleeding: A Retrospective Study Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Acute
Upper Gastrointestinal Bleeding (AUGIB) is a medical emergency with 10% mortality rate.
European Society of Gastrointestinal Endoscopy (ESGE) 2015 guidance advises dual modalities of treatment in non-variceal bleeding. This retrospective audit looks at endoscopic practice at a tertiary hospital. METHODS: The Endoscopy Reporting Tool was used to select patients who had underwent endoscopic intervention (EI) after presenting with haematemesis and/or malena from 09/2012 to 08/2013. Endoscopy report were analysed for operator, pathology, modality of treatment, haemostasis, repeat endoscopy, nature of bleeding, adrenaline injected and stigmata of bleeding. RESULTS: Out of 969 patients, 168(17.3%) required EI. 107 (64%) were performed by Consultant Gastroenterologists, 55 (33%) Specialist Registrars and 6(3%) Other professionals. Varices (31%), Duodenal Ulcers (30%), Gastric Ulcers (14%) and Mallory Weiss Tears (5%) were the main causes of bleeding. In 71 (42%) the lesion was oozing, 6 (3.5%) cases were spurting. 61 (55%) of non-variceal bleeds had a visible vessel, 43 (39%) adherent clot and 9 (8%) pigmented bases. 58% received Dual Therapy and 42% monotherapy. 6 (5.4%) received mechanical therapy only. Haemostasis was achieved in all but 3 cases. 26 (15.5%) underwent repeat endoscopy; 11 (6.5%) required repeat EI. 23% of the non-variceal bleeds had 5mls adrenaline injected, 46% 6-10mls and 26% > 11mls. CONCLUSION: Peptic ulcers and Oesophageal Varices remain the leading causes of AUGIB. Around 1/6 patients with AUGIB require EI. Dual modalities of EI were under utilised and should be advocated in line with ESGE guidance. Conflicts of interest: The authors disclose no conflicts.
A Comparison of Albumin vs Albumin Combined With Terlipressin for Treating Hepatorenal Syndrome: An Evidence Based Case Report Emilina Faradila Cornain and Irsan Hasan 1
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, and 2Hepatobiliary Division of the Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia BACKGROUND: Type 1 Hepatorenal syndrome (HRS) is an
acute deterioration of the circulatory, renal and hepatic function characterized by rapid, progressive renal impairment with doubling of serum creatinine level > 2.5 mg/dL in less than two weeks.1,2 About 18% of patients with cirrhosis develop hepatorenal syndrome after a year.3 Intravenous albumin was the therapy of choice as it increases total plasma volume and cardiac output. It was revealed that vasoconstrictors and albumin may improve patient’s renal function. The rationale of adding vasoconstrictors needs to be based on evidence. The aim of this study is to determine whether the combination of albumin and terlipressin compared to albumin alone were able to improve renal function in patients with type 1 HRS.
January 2017 METHODS: A literature search was performed through PubMed and Cochrane Library. Studies were screened and met accordingly based on inclusion and exclusion criteria. A total of eight studies were selected and critically appraised for its validity, importance and applicability. RESULTS: All studies showed that the concomitant use of vasoconstrictor agent was able to significantly enhance the therapeutic effects of albumin and increases renal function. CONCLUSION: Terlipressin may improve renal function in patients with type 1 HRS. Whether the evidence is strong enough to support the intervention for clinical practice could be debated due to the results of the trial sequential analyses. However, the outcome measures assessed are objective, which reduces the risk of bias. Keywords: type 1 hepatorenal syndrome, terlipressin, renal
function References
1. Gluud LL, Christensen K, Christensen E, A K. Systematic review of randomized trals on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010;51:576–584. 2. Arroyo V, Fernandez J, P G. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis 2008;28:81–95. 3. Martin-Llahi M, Pepin MN, Guevara M, Diaz F, A T. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008;134:1352–1359. Conflicts of interest: The authors disclose no conflicts.
Performance of a Score for Advanced Proximal Colorectal Neoplasia in a Chinese Population Jason Liwen Huang,1 Ping Chen,2 Xiaoqin Yuan,2 Yunlin Wu,2 Harry Haoxiang Wang,3 and Martin Chisang Wong1 1
JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China, 2Ruijin Hospital North, Shanghai Jiaotong University, Shanghai, China, and 3School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China BACKGROUND: Subjects at higher risk for advanced prox-
imal neoplasia (APN) are more suited to receive colonoscopy as a primary colorectal cancer screening tool. A 7-point index based on age, gender, and distal findings at sigmoidoscopy has been proposed to predict the risk for APN.1 Despite good internal validation, few studies have been performed to externally validate the index. We aim to evaluate its external validity and discriminatory capability in Chinese screening participants. METHODS: Age, gender, and colonoscopic findings were prospectively collected in a hospital-based endoscopy unit in Shanghai, China (2013-2015). The cumulative
Abstracts
e33
score from each subject derived from the index was categorized into low, intermediate, or high risk, and rates of APN were assessed accordingly. We used the area under curve (AUC) to evaluate index performance and binary regression models to assess the predictive value for APN. RESULTS: Among 5833 subjects, 151 (2.6%) had APNs. Rates of APN in low, intermediate and high risk subgroup were 0.6%, 1.6% and 6.3%, respectively (p<0.001). The model’s AUC was 0.724 (95% CI 0.685-0.763). Age, gender and distal finding were all independent predictors of APN. When compared with the subjects in the low risk group, those in the intermediate (adjusted odds ratio [aOR] ¼2.52, 95% CI 1.29-4.93) and high risk (aOR¼10.49, 95% CI 5.61-19.62) group were significantly more likely to have APN detected. CONCLUSION: The model based on age, gender and distal finding has good performance to predict APN in a Chinese population. The current findings supported its use to tailor endoscopy-based screening (249 words) Reference 1. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD,
Ransohoff DF. Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 2003;139: 959–965. Conflicts of interest: The authors disclose no conflicts.
Association Mining of Mutational Landscape in Four Clinical Stages across 11 Cancer Types Wangxiong Hu and Shu Zheng Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China BACKGROUND: Cancer is driven largely by somatic ‘driver mutations’ that accumulate in the genome. So far, hundreds of cancer driver genes have been annotated in Catalogue of Somatic Mutations in Cancer (COSMIC), although insightful, underlying interaction of these driver genes in specific cancer genome remains unclear. METHODS: Here we used Apriori algorithm to find frequent mutational gene sets (FMGSs) with point mutations and small insertions/deletions from 4,904 tumors across 11 cancer types as part of the TCGA (The Cancer Genome Atlas) Pan-Cancer effort and then mine the hidden association rules (ARs) within these FMGSs. RESULTS AND CONCLUSION: We found that well-known cancer driver genes such as APC, PIK3CA, PTEN, and TP53 were often co-occurred with other driver genes and FMGSs size peak at an itemset size of 4w5 genes. Moreover, the number and constitution of FMGS and ARs differed greatly among different cancers and stages. By extension, endocrine-related cancers such as breast carcinoma, ovarian cystadenocarcinoma, and thyroid carcinoma were bare of FMGS and ARs, while cancers contact directly with external environments such as
Abstracts
Clinical Gastroenterology and Hepatology Vol. 15, No. 1
was 1,3% including hemothorax, hematoma and pleural effusion. CONCLUSION: RFA is a safe and effective therapy for HCC patients. Factors correlated with survival were etiologies, mRECIST response and number of tumors. Hepatocellular carcinoma frequency Ablation (RFA)
Keywords:
(HCC);
Radio-
Conflicts of interest: The authors disclose no conflicts.
Endoscopy in the Centenarians: Is it Worth the Trouble? Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Endoscopy in the very elderly is generally considered risk prone. Centenarians are people who are 100 years of age. Little is known about endoscopy in the centenarians. This retrospective study aimed to explore this. METHODS: A retrospective study analysing endoscopy in centenarians presenting to a University Hospital from 01/2005 to 01/2015 was undertaken. Endoscopy reports were retrieved from the Hospital’s Endoscopy Reporting tool and patients’ details were confirmed using the Trust’s patient database. RESULTS: 11 procedures (7 Gastroscopies, 3 sigmoidoscopies and 1 Colonoscopy) were undertaken in 10 patients (4 male and 6 female). Age: 101 to 119 years. Mean 105.2 years. 7 (Caucasians), 2 (Indians) and 1 (Afro-Caribbean). 72% (urgent basis). 70% (inpatients) and majority were undertaken by Consultants (82%). Indications included Dysphagia (36.3%), Melena (27.2%), Rectal Bleeding (27.2%) and previous Cancer (9%). Procedural yield (81.8%) and endoscopic intervention performed in 2 cases (Duodenal ulcer injected with adrenaline and hemorrhoids banded). 2 procedures were performed under sedation (midazolam). 100% completion rate without immediate complications. CONCLUSION: To the best of the author’s knowledge this is the only study analysing endoscopic practice in centenarians. While the sample size is small it demonstrates that endoscopy can be performed safely and diagnostic yield is high. A patients’ age should not be the sole factor when deciding suitability for endoscopic procedures. Larger studies are required to gain a better understanding of endoscopic suitability for patients in this age group. Conflicts of interest: The authors disclose no conflicts.
Haemostasis After Endoscopic Intervention in Upper Gastrointestinal Bleeding: A Retrospective Study Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Acute
Upper Gastrointestinal Bleeding (AUGIB) is a medical emergency with 10% mortality rate.
European Society of Gastrointestinal Endoscopy (ESGE) 2015 guidance advises dual modalities of treatment in non-variceal bleeding. This retrospective audit looks at endoscopic practice at a tertiary hospital. METHODS: The Endoscopy Reporting Tool was used to select patients who had underwent endoscopic intervention (EI) after presenting with haematemesis and/or malena from 09/2012 to 08/2013. Endoscopy report were analysed for operator, pathology, modality of treatment, haemostasis, repeat endoscopy, nature of bleeding, adrenaline injected and stigmata of bleeding. RESULTS: Out of 969 patients, 168(17.3%) required EI. 107 (64%) were performed by Consultant Gastroenterologists, 55 (33%) Specialist Registrars and 6(3%) Other professionals. Varices (31%), Duodenal Ulcers (30%), Gastric Ulcers (14%) and Mallory Weiss Tears (5%) were the main causes of bleeding. In 71 (42%) the lesion was oozing, 6 (3.5%) cases were spurting. 61 (55%) of non-variceal bleeds had a visible vessel, 43 (39%) adherent clot and 9 (8%) pigmented bases. 58% received Dual Therapy and 42% monotherapy. 6 (5.4%) received mechanical therapy only. Haemostasis was achieved in all but 3 cases. 26 (15.5%) underwent repeat endoscopy; 11 (6.5%) required repeat EI. 23% of the non-variceal bleeds had 5mls adrenaline injected, 46% 6-10mls and 26% > 11mls. CONCLUSION: Peptic ulcers and Oesophageal Varices remain the leading causes of AUGIB. Around 1/6 patients with AUGIB require EI. Dual modalities of EI were under utilised and should be advocated in line with ESGE guidance. Conflicts of interest: The authors disclose no conflicts.
A Comparison of Albumin vs Albumin Combined With Terlipressin for Treating Hepatorenal Syndrome: An Evidence Based Case Report Emilina Faradila Cornain and Irsan Hasan 1
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, and 2Hepatobiliary Division of the Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia BACKGROUND: Type 1 Hepatorenal syndrome (HRS) is an
acute deterioration of the circulatory, renal and hepatic function characterized by rapid, progressive renal impairment with doubling of serum creatinine level > 2.5 mg/dL in less than two weeks.1,2 About 18% of patients with cirrhosis develop hepatorenal syndrome after a year.3 Intravenous albumin was the therapy of choice as it increases total plasma volume and cardiac output. It was revealed that vasoconstrictors and albumin may improve patient’s renal function. The rationale of adding vasoconstrictors needs to be based on evidence. The aim of this study is to determine whether the combination of albumin and terlipressin compared to albumin alone were able to improve renal function in patients with type 1 HRS.
January 2017 METHODS: A literature search was performed through PubMed and Cochrane Library. Studies were screened and met accordingly based on inclusion and exclusion criteria. A total of eight studies were selected and critically appraised for its validity, importance and applicability. RESULTS: All studies showed that the concomitant use of vasoconstrictor agent was able to significantly enhance the therapeutic effects of albumin and increases renal function. CONCLUSION: Terlipressin may improve renal function in patients with type 1 HRS. Whether the evidence is strong enough to support the intervention for clinical practice could be debated due to the results of the trial sequential analyses. However, the outcome measures assessed are objective, which reduces the risk of bias. Keywords: type 1 hepatorenal syndrome, terlipressin, renal
function References
1. Gluud LL, Christensen K, Christensen E, A K. Systematic review of randomized trals on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010;51:576–584. 2. Arroyo V, Fernandez J, P G. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis 2008;28:81–95. 3. Martin-Llahi M, Pepin MN, Guevara M, Diaz F, A T. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008;134:1352–1359. Conflicts of interest: The authors disclose no conflicts.
Performance of a Score for Advanced Proximal Colorectal Neoplasia in a Chinese Population Jason Liwen Huang,1 Ping Chen,2 Xiaoqin Yuan,2 Yunlin Wu,2 Harry Haoxiang Wang,3 and Martin Chisang Wong1 1
JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China, 2Ruijin Hospital North, Shanghai Jiaotong University, Shanghai, China, and 3School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China BACKGROUND: Subjects at higher risk for advanced prox-
imal neoplasia (APN) are more suited to receive colonoscopy as a primary colorectal cancer screening tool. A 7-point index based on age, gender, and distal findings at sigmoidoscopy has been proposed to predict the risk for APN.1 Despite good internal validation, few studies have been performed to externally validate the index. We aim to evaluate its external validity and discriminatory capability in Chinese screening participants. METHODS: Age, gender, and colonoscopic findings were prospectively collected in a hospital-based endoscopy unit in Shanghai, China (2013-2015). The cumulative
Abstracts
e33
score from each subject derived from the index was categorized into low, intermediate, or high risk, and rates of APN were assessed accordingly. We used the area under curve (AUC) to evaluate index performance and binary regression models to assess the predictive value for APN. RESULTS: Among 5833 subjects, 151 (2.6%) had APNs. Rates of APN in low, intermediate and high risk subgroup were 0.6%, 1.6% and 6.3%, respectively (p<0.001). The model’s AUC was 0.724 (95% CI 0.685-0.763). Age, gender and distal finding were all independent predictors of APN. When compared with the subjects in the low risk group, those in the intermediate (adjusted odds ratio [aOR] ¼2.52, 95% CI 1.29-4.93) and high risk (aOR¼10.49, 95% CI 5.61-19.62) group were significantly more likely to have APN detected. CONCLUSION: The model based on age, gender and distal finding has good performance to predict APN in a Chinese population. The current findings supported its use to tailor endoscopy-based screening (249 words) Reference 1. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD,
Ransohoff DF. Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 2003;139: 959–965. Conflicts of interest: The authors disclose no conflicts.
Association Mining of Mutational Landscape in Four Clinical Stages across 11 Cancer Types Wangxiong Hu and Shu Zheng Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China BACKGROUND: Cancer is driven largely by somatic ‘driver mutations’ that accumulate in the genome. So far, hundreds of cancer driver genes have been annotated in Catalogue of Somatic Mutations in Cancer (COSMIC), although insightful, underlying interaction of these driver genes in specific cancer genome remains unclear. METHODS: Here we used Apriori algorithm to find frequent mutational gene sets (FMGSs) with point mutations and small insertions/deletions from 4,904 tumors across 11 cancer types as part of the TCGA (The Cancer Genome Atlas) Pan-Cancer effort and then mine the hidden association rules (ARs) within these FMGSs. RESULTS AND CONCLUSION: We found that well-known cancer driver genes such as APC, PIK3CA, PTEN, and TP53 were often co-occurred with other driver genes and FMGSs size peak at an itemset size of 4w5 genes. Moreover, the number and constitution of FMGS and ARs differed greatly among different cancers and stages. By extension, endocrine-related cancers such as breast carcinoma, ovarian cystadenocarcinoma, and thyroid carcinoma were bare of FMGS and ARs, while cancers contact directly with external environments such as