- Email: [email protected]
O15 EFFECTS OF THE FXR AGONIST OBETICHOLIC ACID ON HEPATIC VENOUS PRESSURE GRADIENT (HVPG) IN ALCOHOLIC CIRRHOSIS: A PROOF OF CONCEPT PHASE 2A STUDY
ORAL PRESENTATIONS AEs resulted in SMV withdrawal. SAEs possibly related to SMV were infrequent (1.1%). No fatal AEs occurred. Conclusions: Simeprevir confers clinical benefit and is generally well tolerated in European HCV genotype 1-infected patients. Acknowledgements: This study was supported by Janssen Research and Development, Beerse, Belgium. O14 USE OF SOFOSBUVIR/LEDIPASVIR FIXED DOSE COMBINATION FOR TREATMENT OF HCV GENOTYPE-1 IN PATIENTS COINFECTED WITH HIV A. Osinusi1,2 , K. Townsend1 , A. Nelson1 , A. Kohli3,4 , C. Gross3 , M.A. Polis1 , P.S. Pang5 , W.T. Symonds5 , R. Talwani2 , M.M. Sajadi2 , J. Hogan6 , D. Benator7 , M. Subramanian5 , J. Mchutchison5 , H. Masur4 , S. Kottilil1 , for the NIAID ERADICATE Study Team. 1 Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, 2 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, 3 Frederick National Laboratory for Cancer Research, Funded by the NCI Contract No. HHSN261200800001E, Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc., Frederick, 4 Critical Care Medicine Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, 5 Gilead Sciences, Foster City, CA, 6 Unity Health Care Inc, 7 Infectious Diseases Section, Washington, DC Veteran Affairs Medical Center and George Washington University Medical Center, Washington, DC, United States E-mail: [email protected] Background and Aims: The combination of sofosbuvir (SOF) with ribavirin (RBV) in HIV/HCV coinfected patients results in high SVR rates. However, anemia, which occurred in up to 20% of patients, along with relapse, continues to remain a challenge. We describe the safety and efficacy of a RBV-free regimen of SOF and Ledipasvir (LDV) in HIV/HCV coinfected patients. Methods: Fifty HCV, genotype-1, treatment naïve subjects, with stable HIV disease, received SOF/LDV (400 mg/90 mg respectively) once daily for 12 weeks in two different groups (A: antiretroviral therapy (ARV)-naïve, HIV long-term nonprogressors and B: patients on permitted ART namely TDF, FTC, EFV, RPV, RALT with HIV suppression). Serial measurements of safety parameters, virologic and host correlates were performed.
Figure: Early HCV viral decline with SOV/LDV treatment in HIV/HCV coinfected patients.
Results: Baseline demographics were similar between groups except for baseline HIV viral Load and CD4 count (p < 0.05). Virologic decline was rapid with a mean HCV Log10 RNA decline of 3.9 (±0.73) in ARV naïve and 4.13 (±0.46) in ARV subjects by day 7. In ARV naïve subjects who have completed treatment (n = 8), SVR 4 is 100% (SVR12 will be presented). In ARV treated subjects, 100% achieved viral suppression by 4 weeks with continued viral suppression (SVR 4
data will be presented). There were 2 cases of grade 1 anemia, no serious adverse events (SAEs) or discontinuations due to adverse events (AEs). Table: Baseline demographics Baseline characteristic
No. (%) or Median (IQR) ARV naïve
ARV
Age Black Male BMI – median (IQR) Fib. 3–4 Genotype 1a Log HCV VL at baseline HIV baseline VL
59.0 (54.0–62.0) 8 (73) 6 (55) 25.9 (21.8–27.4) 3 (28) 8 (73) 6.1 (5.3–6.9) 4 (36) 0.81 (0.67–0.98) 772 (528.5–962.0)
52.5 (48.8–56.5) 8 (80) 9 (90) 23.3 (21.8–30.0) 2 (25) 5 (50) 6.2 (5.3–6.5) 10 (100) 0.91 (0.83–1.2) 590.5 (284.5–647.8)
Conclusions: In HIV/HCV coinfected patients, a 12-week regimen of SOF/LDV elicited rapid and complete HCV suppression on treatment, was well tolerated, and was safe and efficacious, mirroring rates observed in HCV monoinfected patients.
Parallel Session: PORTAL HYPERTENSION: CIRRHOSIS BLEEDING, HEPATORENAL ASCITES
O15 EFFECTS OF THE FXR AGONIST OBETICHOLIC ACID ON HEPATIC VENOUS PRESSURE GRADIENT (HVPG) IN ALCOHOLIC CIRRHOSIS: A PROOF OF CONCEPT PHASE 2A STUDY R. Mookerjee1 , M. Rosselli1 , G. Pieri1 , T. Beecher-Jones2 , R. Hooshmand-Rad2 , M. Chouhan1 , G. Mehta1 , R. Jalan1 , D. Shapiro3 . 1 UCL Institute for Liver & Digestive Health, Royal Free London NHS Foundation Trust and University College London Medical School, London, United Kingdom; 2 Intercept Pharmaceuticals, 3 UCL Institute for Liver & Digestive Health, Royal Free London NHS Foundation Trust and University College London Medical School, San Diego, CA, United States E-mail: [email protected] Background and Aims: Cirrhosis related portal hypertension causes significant morbidity and mortality. Our previous study in BDL rats showed 5 days of FXR agonist obeticholic acid (OCA) therapy, reduces portal pressure by increasing eNOS activity. This proofof-concept study evaluated short-term OCA treatment to assess tolerance and HVPG response. Methods: 25 alcoholic cirrhosis patients (17 male; mean age 53 yrs) with portal hypertension received OCA 10 mg or 25 mg orally for 7–12 days. For each dose, n = 4 patients were assessed for safety/tolerance; then n = 8, (HVPG ≥ 12 mmHg) evaluated for HVPG changes. A positive response was defined as HVPG reduction <12 mmHg or >15% from baseline. Results: OCA was generally well tolerated. Pruritus was the most common AE (principally 25 mg dose). One patient had a lacunar infarct at dosing, considered unrelated to drug, and was excluded. There were no changes in liver or renal biochemistry, or inflammatory cytokines. 9/16 patients undergoing haemodynamic assessment responded [HVPG reduction 16 to 11.6 mmHg (28%)]; across all sixteen patients mean HVPG reduction was nonsignificant [16 to 13.8 mmHg (18%), p = 0.07]. Amongst nonresponders, HVPG increased in two patients, and did not change in five. MAP did not change significantly from baseline (88 to
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ORAL PRESENTATIONS 93 mmHg, p = 0.2). In six patients, liver blood flow was discerned with a median increase of 25% (range: 5–65%). Conclusions: Short-term OCA therapy was generally well tolerated and significantly lowered HVPG in more than 50% evaluated patients, with no deleterious impact on MAP, warranting further larger, placebo controlled studies, and evaluation of the mechanism for portal pressure lowering. O16 DOES ACUTE HEMODYNAMIC RESPONSE TO CARVEDILOL IN HEPATIC VENOUS PRESSURE GRADIENT PREDICT MORBIDITY AND MORTALITY IN CIRRHOSIS? PROSPECTIVE STUDY V.V. Kirnake, A.K. Arora, A. Kumar, P. Sharma. Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India E-mail: [email protected] Background and Aims: Portal hypertension leads to most complication of cirrhosis. Most complications are ameliorated by beta-blockers. Acute hemodynamic response is a recent modality of determining HVPG response. Aims: We aimed to assess the acute effect of Carvedilol on HVPG and its impact on outcome in cirrhotics over a 6-month period. Methods: Patients requiring beta-blocker therapy were subjected to HVPG measurement. After HVPG they were given Tab. Carvedilol 25 mg and repeat HVPG performed after one hour. Acute responders (defined as a HVPG <12 mmHg or a 10% decrease from baseline)were given carvedilol. Rest patients were categorized as non-responders. Both groups were followed for 6 months. Repeat HVPG was done in acute responders after 6 month. All complications were noted at the end of 6 month. Results: Out of 69 patients, 49 (71%) patients showed acute reduction in HVPG of >10%. There were no baseline differences between two groups. On follow-up, complications like ascites and hepatic encephalopathy were significantly less common in acute responder group (p < 0.001). However, there was no statistically significant difference in mortality between 2 groups (p > 0.05). Repeat HVPG after a median period of 6 months performed in 41 of 49 patients in the acute responder group. Out of 41 patients 35 (85%) patients were still responders (long term responders) and 6 (15%) patient were non long term responders. Conclusions: Determination of acute response to carvedilol is a convenient and rapid way to identify responders. It is an excellent prognostic marker as acute responders develop less complications. O17 IMPACT OF ANTICOAGULANT THERAPY ON UPPER GASTROINTESTINAL BLEEDING (UGI) IN PATIENTS WITH LIVER CIRRHOSIS. RESULTS FROM A RETROSPECTIVE MULTICENTRIC CASE–CONTROL STUDY ´ Puente3 , M. Casas4 , C. Vinaixa5 , F. Cerini1 , J. Mart´ınez Gonzalez2 , A. 5 6 9 M. Berenguer , C. Villanueva , S. Augustin7 , E. Llop8 , R. Banares ˜ , 1 A. Albillos2 , J. Bosch1 , V. Hernandez-Gea ´ , J.C. Garcia-Pagan1 . 1 Barcelona Hepatic Hemodynamic Laboratory. Liver Unit, Hospital Cl´ınic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, 2 Department of Gastroenterology, Hospital Universitario Ram´ on y Cajal, IRYCIS, CIBERehd, University of Alcala’, Madrid, 3 Department of Gastroenterology, Hospital Universitario Marques de Valdecilla., Santander, 4 Department of Gastroenterology, Parc Taul´ı Hospital, Sabadell, 5 Liver Transplantation and Hepatology Unit, La Fe Hospital and CIBERehd, Valencia, 6 Department of Gastroenterology, Hospital Sant Pau, 7 Liver Unit – Department of Internal Medicine, Vall d’Hebron Hospital, Institut de Recerca, Universitat Aut` onoma de Barcelona and CIBERehd, Barcelona, 8 Department of Gastroenterology, Hospital Universitario Puerta de Hierro-Majadahonda, 9 Department of Gastroenterology, Gregorio Mara˜ no ´n Hospital, Madrid, Spain E-mail: [email protected]
thrombotic risk and anticoagulation therapy (AT) is most frequently used in LC pts. Variceal bleeding is a severe complication of LC. It is unknown if AT may impact the outcome of UGIB in these pts. Methods: 52 pts on AT with UGIB were enrolled in the study. Portal vein thrombosis (PVT) and other reasons were the indication for AT in 14 and 38 pts respectively. 104 pts with LC and UGIB not under AT were matched, for severity of LC, age, sex, source of UGIB and SOFA score, as controls. Results: There were no differences between groups except for INR/MELD. UGIB was attributed to portal hypertension (PH) in 63% of pts (gastroesophageal varices in 56%) and peptic/vascular lesions in 37%. 17% of Pts experienced 5-days-failure being independent predictors age and presence of PVT, but not AT. There were no differences between pts with/without AT in needs for rescue therapies, ICU admission, transfusions, hospital stay and 6wmortality. 11% of pts had 6w-mortality. These patients had worse Child, MELD, MELD-XI, SOFA and use of AT for other reason than PVT (21% vs 7% in PVT and 8% in non-AT; p = 0.03) than survivors. Independent predictors of 6-weeks-mortality were SOFA score and use of PVT for other reason than PVT. Conclusions: Our study suggests that factors that impact the outcome of UGIB in pts under AT, are the degree of liver failure and comorbidity, but not AT itself. O18 RANDOMIZED STUDY OF ENDOSCOPIC BAND LIGATION AND ARGON PLASMA COAGULATION IN THE TREATMENT OF GASTRIC ANTRAL AND FUNDAL VASCULAR ECTASIA M. Elhendawy1 , S. Mosaad1 , W. Elkhalawany1 , M. Enaba2 , L. Abo-Ali1 , A.A. Elfert1 . 1 Tropical Medicine, 2 Internal Medicine, Tanta University, Tanta, Egypt E-mail: [email protected] Background and Aims: Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent gastrointestinal hemorrhage in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method to decrease hemorrhage in patients with GAVE, but this requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) has recently been found as useful treatment for GAVE, and a good alternative for APC, and in refractory cases. The aim of our randomized study is to evaluate the safety and efficacy of EBL versus APC in the treatment of GAVE. Methods: 88 cirrhotic patients with GAVE have been randomized to either treatment with EBL or APC in biweekly sessions until complete endoscopic obliteration, then followed up for 6 months with monthly hemoglobin level. Results: We have found 13 (29.5%) patients in the EBL group and 9 (20.5%) patients in the APC group with similar lesions around the gastric cardia; we named gastric fundal vascular ectasia (GFVE). EBL has significantly decreased the number of sessions required for complete obliteration of lesions to 2.98 in comparison to 3.48 sessions in the APC group (p < 0.05). Also, hemoglobin has increased significantly in both groups after obliteration, but with insignificant difference between both groups. However, EBL group has consumed significantly less blood transfusion than the APC group (p < 0.05). Conclusions: EBL is more effective and has comparable safety to APC in the treatment of GAVE and GFVE in cirrhotic patients. Also, a significantly less blood transfusion is needed in patients treated with EBL.
Background and Aims: Recent studies have shown that LC is actually an acquired hypercoagulable state with increased S8
Journal of Hepatology 2014 vol. 60 | S1–S22
Figure: Early HCV viral decline with SOV/LDV treatment in HIV/HCV coinfected patients.
Results: Baseline demographics were similar between groups except for baseline HIV viral Load and CD4 count (p < 0.05). Virologic decline was rapid with a mean HCV Log10 RNA decline of 3.9 (±0.73) in ARV naïve and 4.13 (±0.46) in ARV subjects by day 7. In ARV naïve subjects who have completed treatment (n = 8), SVR 4 is 100% (SVR12 will be presented). In ARV treated subjects, 100% achieved viral suppression by 4 weeks with continued viral suppression (SVR 4
data will be presented). There were 2 cases of grade 1 anemia, no serious adverse events (SAEs) or discontinuations due to adverse events (AEs). Table: Baseline demographics Baseline characteristic
No. (%) or Median (IQR) ARV naïve
ARV
Age Black Male BMI – median (IQR) Fib. 3–4 Genotype 1a Log HCV VL at baseline HIV baseline VL
59.0 (54.0–62.0) 8 (73) 6 (55) 25.9 (21.8–27.4) 3 (28) 8 (73) 6.1 (5.3–6.9) 4 (36) 0.81 (0.67–0.98) 772 (528.5–962.0)
52.5 (48.8–56.5) 8 (80) 9 (90) 23.3 (21.8–30.0) 2 (25) 5 (50) 6.2 (5.3–6.5) 10 (100) 0.91 (0.83–1.2) 590.5 (284.5–647.8)
Conclusions: In HIV/HCV coinfected patients, a 12-week regimen of SOF/LDV elicited rapid and complete HCV suppression on treatment, was well tolerated, and was safe and efficacious, mirroring rates observed in HCV monoinfected patients.
Parallel Session: PORTAL HYPERTENSION: CIRRHOSIS BLEEDING, HEPATORENAL ASCITES
O15 EFFECTS OF THE FXR AGONIST OBETICHOLIC ACID ON HEPATIC VENOUS PRESSURE GRADIENT (HVPG) IN ALCOHOLIC CIRRHOSIS: A PROOF OF CONCEPT PHASE 2A STUDY R. Mookerjee1 , M. Rosselli1 , G. Pieri1 , T. Beecher-Jones2 , R. Hooshmand-Rad2 , M. Chouhan1 , G. Mehta1 , R. Jalan1 , D. Shapiro3 . 1 UCL Institute for Liver & Digestive Health, Royal Free London NHS Foundation Trust and University College London Medical School, London, United Kingdom; 2 Intercept Pharmaceuticals, 3 UCL Institute for Liver & Digestive Health, Royal Free London NHS Foundation Trust and University College London Medical School, San Diego, CA, United States E-mail: [email protected] Background and Aims: Cirrhosis related portal hypertension causes significant morbidity and mortality. Our previous study in BDL rats showed 5 days of FXR agonist obeticholic acid (OCA) therapy, reduces portal pressure by increasing eNOS activity. This proofof-concept study evaluated short-term OCA treatment to assess tolerance and HVPG response. Methods: 25 alcoholic cirrhosis patients (17 male; mean age 53 yrs) with portal hypertension received OCA 10 mg or 25 mg orally for 7–12 days. For each dose, n = 4 patients were assessed for safety/tolerance; then n = 8, (HVPG ≥ 12 mmHg) evaluated for HVPG changes. A positive response was defined as HVPG reduction <12 mmHg or >15% from baseline. Results: OCA was generally well tolerated. Pruritus was the most common AE (principally 25 mg dose). One patient had a lacunar infarct at dosing, considered unrelated to drug, and was excluded. There were no changes in liver or renal biochemistry, or inflammatory cytokines. 9/16 patients undergoing haemodynamic assessment responded [HVPG reduction 16 to 11.6 mmHg (28%)]; across all sixteen patients mean HVPG reduction was nonsignificant [16 to 13.8 mmHg (18%), p = 0.07]. Amongst nonresponders, HVPG increased in two patients, and did not change in five. MAP did not change significantly from baseline (88 to
Journal of Hepatology 2014 vol. 60 | S1–S22
S7
ORAL PRESENTATIONS 93 mmHg, p = 0.2). In six patients, liver blood flow was discerned with a median increase of 25% (range: 5–65%). Conclusions: Short-term OCA therapy was generally well tolerated and significantly lowered HVPG in more than 50% evaluated patients, with no deleterious impact on MAP, warranting further larger, placebo controlled studies, and evaluation of the mechanism for portal pressure lowering. O16 DOES ACUTE HEMODYNAMIC RESPONSE TO CARVEDILOL IN HEPATIC VENOUS PRESSURE GRADIENT PREDICT MORBIDITY AND MORTALITY IN CIRRHOSIS? PROSPECTIVE STUDY V.V. Kirnake, A.K. Arora, A. Kumar, P. Sharma. Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India E-mail: [email protected] Background and Aims: Portal hypertension leads to most complication of cirrhosis. Most complications are ameliorated by beta-blockers. Acute hemodynamic response is a recent modality of determining HVPG response. Aims: We aimed to assess the acute effect of Carvedilol on HVPG and its impact on outcome in cirrhotics over a 6-month period. Methods: Patients requiring beta-blocker therapy were subjected to HVPG measurement. After HVPG they were given Tab. Carvedilol 25 mg and repeat HVPG performed after one hour. Acute responders (defined as a HVPG <12 mmHg or a 10% decrease from baseline)were given carvedilol. Rest patients were categorized as non-responders. Both groups were followed for 6 months. Repeat HVPG was done in acute responders after 6 month. All complications were noted at the end of 6 month. Results: Out of 69 patients, 49 (71%) patients showed acute reduction in HVPG of >10%. There were no baseline differences between two groups. On follow-up, complications like ascites and hepatic encephalopathy were significantly less common in acute responder group (p < 0.001). However, there was no statistically significant difference in mortality between 2 groups (p > 0.05). Repeat HVPG after a median period of 6 months performed in 41 of 49 patients in the acute responder group. Out of 41 patients 35 (85%) patients were still responders (long term responders) and 6 (15%) patient were non long term responders. Conclusions: Determination of acute response to carvedilol is a convenient and rapid way to identify responders. It is an excellent prognostic marker as acute responders develop less complications. O17 IMPACT OF ANTICOAGULANT THERAPY ON UPPER GASTROINTESTINAL BLEEDING (UGI) IN PATIENTS WITH LIVER CIRRHOSIS. RESULTS FROM A RETROSPECTIVE MULTICENTRIC CASE–CONTROL STUDY ´ Puente3 , M. Casas4 , C. Vinaixa5 , F. Cerini1 , J. Mart´ınez Gonzalez2 , A. 5 6 9 M. Berenguer , C. Villanueva , S. Augustin7 , E. Llop8 , R. Banares ˜ , 1 A. Albillos2 , J. Bosch1 , V. Hernandez-Gea ´ , J.C. Garcia-Pagan1 . 1 Barcelona Hepatic Hemodynamic Laboratory. Liver Unit, Hospital Cl´ınic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, 2 Department of Gastroenterology, Hospital Universitario Ram´ on y Cajal, IRYCIS, CIBERehd, University of Alcala’, Madrid, 3 Department of Gastroenterology, Hospital Universitario Marques de Valdecilla., Santander, 4 Department of Gastroenterology, Parc Taul´ı Hospital, Sabadell, 5 Liver Transplantation and Hepatology Unit, La Fe Hospital and CIBERehd, Valencia, 6 Department of Gastroenterology, Hospital Sant Pau, 7 Liver Unit – Department of Internal Medicine, Vall d’Hebron Hospital, Institut de Recerca, Universitat Aut` onoma de Barcelona and CIBERehd, Barcelona, 8 Department of Gastroenterology, Hospital Universitario Puerta de Hierro-Majadahonda, 9 Department of Gastroenterology, Gregorio Mara˜ no ´n Hospital, Madrid, Spain E-mail: [email protected]
thrombotic risk and anticoagulation therapy (AT) is most frequently used in LC pts. Variceal bleeding is a severe complication of LC. It is unknown if AT may impact the outcome of UGIB in these pts. Methods: 52 pts on AT with UGIB were enrolled in the study. Portal vein thrombosis (PVT) and other reasons were the indication for AT in 14 and 38 pts respectively. 104 pts with LC and UGIB not under AT were matched, for severity of LC, age, sex, source of UGIB and SOFA score, as controls. Results: There were no differences between groups except for INR/MELD. UGIB was attributed to portal hypertension (PH) in 63% of pts (gastroesophageal varices in 56%) and peptic/vascular lesions in 37%. 17% of Pts experienced 5-days-failure being independent predictors age and presence of PVT, but not AT. There were no differences between pts with/without AT in needs for rescue therapies, ICU admission, transfusions, hospital stay and 6wmortality. 11% of pts had 6w-mortality. These patients had worse Child, MELD, MELD-XI, SOFA and use of AT for other reason than PVT (21% vs 7% in PVT and 8% in non-AT; p = 0.03) than survivors. Independent predictors of 6-weeks-mortality were SOFA score and use of PVT for other reason than PVT. Conclusions: Our study suggests that factors that impact the outcome of UGIB in pts under AT, are the degree of liver failure and comorbidity, but not AT itself. O18 RANDOMIZED STUDY OF ENDOSCOPIC BAND LIGATION AND ARGON PLASMA COAGULATION IN THE TREATMENT OF GASTRIC ANTRAL AND FUNDAL VASCULAR ECTASIA M. Elhendawy1 , S. Mosaad1 , W. Elkhalawany1 , M. Enaba2 , L. Abo-Ali1 , A.A. Elfert1 . 1 Tropical Medicine, 2 Internal Medicine, Tanta University, Tanta, Egypt E-mail: [email protected] Background and Aims: Gastric antral vascular ectasia (GAVE) is characterized by mucosal and submucosal vascular ectasia causing recurrent gastrointestinal hemorrhage in patients with cirrhosis. Treatment with argon plasma coagulation (APC) is an effective and safe method to decrease hemorrhage in patients with GAVE, but this requires multiple sessions of endoscopic therapy. Endoscopic band ligation (EBL) has recently been found as useful treatment for GAVE, and a good alternative for APC, and in refractory cases. The aim of our randomized study is to evaluate the safety and efficacy of EBL versus APC in the treatment of GAVE. Methods: 88 cirrhotic patients with GAVE have been randomized to either treatment with EBL or APC in biweekly sessions until complete endoscopic obliteration, then followed up for 6 months with monthly hemoglobin level. Results: We have found 13 (29.5%) patients in the EBL group and 9 (20.5%) patients in the APC group with similar lesions around the gastric cardia; we named gastric fundal vascular ectasia (GFVE). EBL has significantly decreased the number of sessions required for complete obliteration of lesions to 2.98 in comparison to 3.48 sessions in the APC group (p < 0.05). Also, hemoglobin has increased significantly in both groups after obliteration, but with insignificant difference between both groups. However, EBL group has consumed significantly less blood transfusion than the APC group (p < 0.05). Conclusions: EBL is more effective and has comparable safety to APC in the treatment of GAVE and GFVE in cirrhotic patients. Also, a significantly less blood transfusion is needed in patients treated with EBL.
Background and Aims: Recent studies have shown that LC is actually an acquired hypercoagulable state with increased S8
Journal of Hepatology 2014 vol. 60 | S1–S22