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Effect of Biliary Drainage on Liver Stiffness in Patients with Malignant Extrahepatic Biliary Obstruction
hypodense lesions. Arterial phase revealed similar findings with no enhancement of lesion. Endoultrasonography (EUS) revealed multiple hypodense lesions of size 1–2 cm in left lobe of liver. Core biopsy revealed the tumour cell showing spindle shaped nuclei, dispersed chromatin, inconspicuous nucleoli and indistinct cytoplasm. Immunohistochemistry revealed the tumour cells to be strongly positive for reticulin, cytokeratin, CD34, vimentin, and negative for VWF, desmin, CEA, HMB-45 or S-100 protein. Malignant epitheloid hemangioendothelioma with splenic infiltration was thus diagnosed. Conclusion: EH with multifocal liver and spleen involvement as a primary presentation is extremely rare. Imaging modalities including CT and magnetic resonance imaging may not be able to differentiate it from other focal hepatic neoplasm. Liver biopsy was necessary for a definitive diagnosis. Corresponding author: Praveer Rai. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.128
EFFECT OF BILIARY DRAINAGE ON LIVER STIFFNESS IN PATIENTS WITH MALIGNANT EXTRAHEPATIC BILIARY OBSTRUCTION Kamlesh Kumar, Abhishek Deepak, Vivek Saraswat, T. Negi, Gaurav Pandey, Samir Mohindra Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Background: Liver stiffness measured (LS) with transient elastography (TE) is increased in the presence of liver fibrosis, inflammation, venous congestion and cholestasis. In malignant extrahepatic biliary obstruction (MEBO), LS maybe increased due to cholestasis,
cholangitis and liver fibrosis complicating biliary obstruction. Biliary stenting relieves cholestasis and cholangitis rapidly but liver fibrosis may persist longer, though no timeframe is established. The present study looks at LS changes in patients with MEBO before and after biliary drainage. Methods: Clinical, biochemical and imaging data of consecutive patients (n = 93) with MEBO planned for biliary drainage were recorded between July 2013 and July 2014. LS were measured in all patients using a Fibroscan (Echo Sens, Paris) with M probe, before and after biliary drainage. LS were also measured in 35 healthy volunteers. Results: MEBO was due to carcinoma gall bladder (n = 43), periampullary carcinoma (n = 23), cholangiocarcinoma (n = 14) and carcinoma pancreas (n = 13). Mean duration of jaundice before biliary decompression was 46.1 27.5 days and mean serum bilirubin before biliary decompression was 20.5 8.0 mg%. Mean LS was significantly higher in patients with MEBO than in healthy controls (24 12.1 vs. 5.7 1.6 kPa; P = 0.0001). The mean interval between two TE readings was 27.1 9.1 days. Marked reduction in LS was noted in 69 patients undergoing successful EBD (22.7 10.7 to 8.2 1.8 kPa; P = 0.0001); although it dropped to the normal range (<6.0 kPa) in only 5 patients. There was a positive but weak correlation of liver stiffness with serum bilirubin and duration of jaundice but a negative correlation with ALT levels. Conclusion: LS was increased in patients with MEBO and decreased but did not normalize after biliary drainage. Partial reduction in LS along with weak correlation between LS and serum bilirubin suggests that other factors may also be responsible for increased LS in MEBO. Corresponding author: Vivek Saraswat. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.129
Journal of Clinical and Experimental Hepatology | June/July 2015 | Vol. 5 | No. S2 | S57–S65
S65
Neoplasms
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
EFFECT OF BILIARY DRAINAGE ON LIVER STIFFNESS IN PATIENTS WITH MALIGNANT EXTRAHEPATIC BILIARY OBSTRUCTION Kamlesh Kumar, Abhishek Deepak, Vivek Saraswat, T. Negi, Gaurav Pandey, Samir Mohindra Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Background: Liver stiffness measured (LS) with transient elastography (TE) is increased in the presence of liver fibrosis, inflammation, venous congestion and cholestasis. In malignant extrahepatic biliary obstruction (MEBO), LS maybe increased due to cholestasis,
cholangitis and liver fibrosis complicating biliary obstruction. Biliary stenting relieves cholestasis and cholangitis rapidly but liver fibrosis may persist longer, though no timeframe is established. The present study looks at LS changes in patients with MEBO before and after biliary drainage. Methods: Clinical, biochemical and imaging data of consecutive patients (n = 93) with MEBO planned for biliary drainage were recorded between July 2013 and July 2014. LS were measured in all patients using a Fibroscan (Echo Sens, Paris) with M probe, before and after biliary drainage. LS were also measured in 35 healthy volunteers. Results: MEBO was due to carcinoma gall bladder (n = 43), periampullary carcinoma (n = 23), cholangiocarcinoma (n = 14) and carcinoma pancreas (n = 13). Mean duration of jaundice before biliary decompression was 46.1 27.5 days and mean serum bilirubin before biliary decompression was 20.5 8.0 mg%. Mean LS was significantly higher in patients with MEBO than in healthy controls (24 12.1 vs. 5.7 1.6 kPa; P = 0.0001). The mean interval between two TE readings was 27.1 9.1 days. Marked reduction in LS was noted in 69 patients undergoing successful EBD (22.7 10.7 to 8.2 1.8 kPa; P = 0.0001); although it dropped to the normal range (<6.0 kPa) in only 5 patients. There was a positive but weak correlation of liver stiffness with serum bilirubin and duration of jaundice but a negative correlation with ALT levels. Conclusion: LS was increased in patients with MEBO and decreased but did not normalize after biliary drainage. Partial reduction in LS along with weak correlation between LS and serum bilirubin suggests that other factors may also be responsible for increased LS in MEBO. Corresponding author: Vivek Saraswat. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.129
Journal of Clinical and Experimental Hepatology | June/July 2015 | Vol. 5 | No. S2 | S57–S65
S65
Neoplasms
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY