- Email: [email protected]
P491 NEEDLE-KNIFE FISTULOTOMY AS A RESCUE ACCESS OF THE COMMON BILE DUCT IN CIRRHOTIC PATIENTS: FEASIBILITY AND OUTCOME
POSTERS Results: Thirty-two patients were stratified as Overt HE, 19 patients had a positive PHES and 30 patients had an EEG consistent with HE. 1 H NMR spectroscopy could discriminate between patients and healthy controls (R2X = 0.77, R2Y = 0.45, Q2Y = 0.27, sensitivity 60%, specificity 100%). Patients with cirrhosis had higher glucose and lower hippurate levels. Urine NMR profiles discriminated patients with and without OHE, with less robust validity (R2X = 0.77, R2Y = 0.34, Q2Y = 0.19, sensitivity 80%, specificity 64%). Patients with OHE had higher histidine, citrate and creatinine levels. Urine NMR spectroscopy could not discriminate patients with abnormal PHES or EEG. Conclusions: Patients with cirrhosis have distinct urinary metabolic profiles compared to healthy controls and those with OHE have higher histidine, citrate and creatinine levels. 1 H NMR spectroscopy cannot discriminate patients with or without abnormal PHES or EEG. Mass spectrometry may be a more useful platform for biomarker discovery in MHE. P491 NEEDLE-KNIFE FISTULOTOMY AS A RESCUE ACCESS OF THE COMMON BILE DUCT IN CIRRHOTIC PATIENTS: FEASIBILITY AND OUTCOME Y. El-Naggar1 , M. Radwan2 , M. Emara3 . 1 Internal Medicine, 2 Faculty of Medicine, Zagazig University, 3 Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt E-mail: [email protected] Background and Aims: Cannulation of the common bile duct may require invasive procedures; such procedures may carry an increased risk of complications. the aim was to compare the safety and efficacy of the needle-knife fistulotomy with other techniques in cirrhotic patients after failure of the standard cannulation using the free hand needle knife. Methods: Group A: 15 patients who underwent a needle-knife fistulotomy using the needle-knife after failure of transpapillary wire-guided cannulation. Group B: 15 patients who underwent a precut using the standard pull sphincterotome after failure of transpapillary wire-guided cannulation. Group C: 20 patients who underwent a conventional transpapillary wire-guided cannulation without sphincterotomy. Group D: 20 patients who underwent a conventional transpapillary wire-guided cannulation with standard sphincterotomy. Results: Success rate of CBD cannulation and fair dye drainage was reported in 93.3% and 73.3%, 86.7% and 80%, 85% and 70%, 85% and 80% of patients in groups A, B, C and D respectively, with no statistically significant difference among the four groups. The only complication reported in group A was bleeding (three patients). No statistically significant difference among the four groups regarding post-procedural complications was noticed. Conclusions: Suprapapillary needle – knife fistulotomy can be used in cirrhotic patients when standard biliary cannulation proves to be difficult, it is associated with a high success rate and a low complication risk. P492 SALIENT FEATURES OF ACUTE ON CHRONIC LIVER FAILURE IN BANGLADESH; MAINLY ACUTE INSULT BY HEV AND COMPARATIVELY LOW MORTALITY M.A. Mahtab1 , S.M.F. Akbar2 , S. Rahman1 . 1 Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; 2 Medical Sciences, Toshiba General Hospital, Tokyo, Japan E-mail: [email protected] Background and Aims: ACLF, an intractable liver disease, manifesting as jaundice and coagulopathy, complicated by ascites and/or encephalopathy in patients with chronic liver diseases.
ACLF develops due to an acute insult in patients with chronic liver diseases (CLD). As the nature of CLD and acute insult may vary among localities, this study analyzed the clinical, biochemical, etiological aspects as well as prognosis of ACLF at Bangladesh. Methods: A total of 96 consecutive patients attending the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh who fulfilled all selection criteria of ACLF were enrolled. Results: The age of the patients was 42.2±14.7 years with a male predominance (77.0%). The most common etiology of CLD was HBV in 54 patients (65%), followed by NASH in 10 patients (10.4%). Most common cause of acute insult was HEV in 45 patients (47%). In 19 patients (19.8%), HBV flare was responsible for ACLF. Most of the patients presented with abdominal ascites (90 of 96 patients, 94%) and hepatic encephalopathy was seen in 30 patients (31.3%). Mean serum albumin, bilirubin, and INR were 12.90±8.11 mg/dl, 2.27±0.52 g/dl, and 2.32±0.72, respectively. Nineteen patients died within 90 days after hospital admission and 12 of them were due to acute insult by HEV. Conclusions: Apart from reports of other Asian countries in which acute insult was mainly caused by alcohol or flare of HBV, HEV induced acute insult in majority ACLF patients of this cohort. Constant monitoring of HBV-infected CLD patients are specially warranted during epidemic outbreaks of HEV at Bangladesh. P493 LIVER BIOPSY: THE NEEDLE GAUGE MATTERS E. Gigante1 , G. Anania1 , I. Luzzitelli1 , E. Pucci2 , E. Pilozzi2 , M. Rossi3 , G. Delle Fave1 , M. Marignani1 . 1 Digestive and Liver Diseases, 2 Pathology, 3 Radiology, St. Andrea Hospital, Faculty of Medicine and Psychology, University ‘Sapienza’, Roma, Italy E-mail: [email protected] Background and Aims: Liver biopsy (LB) is still one of the pivotal diagnostic tool for viral liver diseases, different procedures and devices are currently used. Our study was aimed to analyze the safety and the adequacy of LBs obtained by two different techniques. Methods: Medical files of consecutive patients underwent LB at our Unit from January 2004 to December 2010 to stage viral liver disease (HBV +/− HDV, HCV) were retrieved and data entered in a database. Patients were divided into two groups: one (G16) that underwent US-assisted procedure with a Menghini modified needle (16Gauge) and one (G18) that underwent US-guided procedure with a subcostal approach and a semiautomatic modified Menghini (18Gauge). The number of portal tracts present in each biopsy was assessed blindly by two pathologists. Results: Clinical and laboratory data were compared, as well as adverse events rate and samples characteristics. Table: Characteristics of patients Baseline characteristic
Team G16 (n = 110)
Team G18 (n = 32)
P-value
Male sex, % (number/total) Age, years, median (range) Platelets/mm3 , median (range)
62.7% (69/110) 49 (21–70)
40.6% (13/32) 52 (31–73)
p = 0.0409 p = 0.41
200,000 (78,000–797,000) 0.996 (0.86–1.2)
205,000 (65,000–394,000) 1.006 (0.87–1.31)
p = 0.62 p = 0.171
INR, median (range)
Complications occurred in 15 patients (9/110 G16 team vs 6/32 G18 team, p = 0.10), all classified as minor. Most samples were suitable for histological evaluation, with no difference among the two teams (95.5% G16 team vs. 90.7% G18 team, p = 0.378). The samples obtained by the G16 team had a higher mean number of portal tracts (G16 team 9.8±4.8 vs G18 team 7.8±4.3 (P = 0.0343) and a longer mean length of samples (G16 team 22±8.4 mm vs G18 team 16±6.8 mm) (P = 0.0013). Conclusions: Use of larger dimension needles allows to obtain better samples despite a similar rate of adverse events.
Journal of Hepatology 2014 vol. 60 | S215–S359
S233
ACLF develops due to an acute insult in patients with chronic liver diseases (CLD). As the nature of CLD and acute insult may vary among localities, this study analyzed the clinical, biochemical, etiological aspects as well as prognosis of ACLF at Bangladesh. Methods: A total of 96 consecutive patients attending the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh who fulfilled all selection criteria of ACLF were enrolled. Results: The age of the patients was 42.2±14.7 years with a male predominance (77.0%). The most common etiology of CLD was HBV in 54 patients (65%), followed by NASH in 10 patients (10.4%). Most common cause of acute insult was HEV in 45 patients (47%). In 19 patients (19.8%), HBV flare was responsible for ACLF. Most of the patients presented with abdominal ascites (90 of 96 patients, 94%) and hepatic encephalopathy was seen in 30 patients (31.3%). Mean serum albumin, bilirubin, and INR were 12.90±8.11 mg/dl, 2.27±0.52 g/dl, and 2.32±0.72, respectively. Nineteen patients died within 90 days after hospital admission and 12 of them were due to acute insult by HEV. Conclusions: Apart from reports of other Asian countries in which acute insult was mainly caused by alcohol or flare of HBV, HEV induced acute insult in majority ACLF patients of this cohort. Constant monitoring of HBV-infected CLD patients are specially warranted during epidemic outbreaks of HEV at Bangladesh. P493 LIVER BIOPSY: THE NEEDLE GAUGE MATTERS E. Gigante1 , G. Anania1 , I. Luzzitelli1 , E. Pucci2 , E. Pilozzi2 , M. Rossi3 , G. Delle Fave1 , M. Marignani1 . 1 Digestive and Liver Diseases, 2 Pathology, 3 Radiology, St. Andrea Hospital, Faculty of Medicine and Psychology, University ‘Sapienza’, Roma, Italy E-mail: [email protected] Background and Aims: Liver biopsy (LB) is still one of the pivotal diagnostic tool for viral liver diseases, different procedures and devices are currently used. Our study was aimed to analyze the safety and the adequacy of LBs obtained by two different techniques. Methods: Medical files of consecutive patients underwent LB at our Unit from January 2004 to December 2010 to stage viral liver disease (HBV +/− HDV, HCV) were retrieved and data entered in a database. Patients were divided into two groups: one (G16) that underwent US-assisted procedure with a Menghini modified needle (16Gauge) and one (G18) that underwent US-guided procedure with a subcostal approach and a semiautomatic modified Menghini (18Gauge). The number of portal tracts present in each biopsy was assessed blindly by two pathologists. Results: Clinical and laboratory data were compared, as well as adverse events rate and samples characteristics. Table: Characteristics of patients Baseline characteristic
Team G16 (n = 110)
Team G18 (n = 32)
P-value
Male sex, % (number/total) Age, years, median (range) Platelets/mm3 , median (range)
62.7% (69/110) 49 (21–70)
40.6% (13/32) 52 (31–73)
p = 0.0409 p = 0.41
200,000 (78,000–797,000) 0.996 (0.86–1.2)
205,000 (65,000–394,000) 1.006 (0.87–1.31)
p = 0.62 p = 0.171
INR, median (range)
Complications occurred in 15 patients (9/110 G16 team vs 6/32 G18 team, p = 0.10), all classified as minor. Most samples were suitable for histological evaluation, with no difference among the two teams (95.5% G16 team vs. 90.7% G18 team, p = 0.378). The samples obtained by the G16 team had a higher mean number of portal tracts (G16 team 9.8±4.8 vs G18 team 7.8±4.3 (P = 0.0343) and a longer mean length of samples (G16 team 22±8.4 mm vs G18 team 16±6.8 mm) (P = 0.0013). Conclusions: Use of larger dimension needles allows to obtain better samples despite a similar rate of adverse events.
Journal of Hepatology 2014 vol. 60 | S215–S359
S233