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PERCUTANEOUS LASER ABLATION FOR PALLIATIVE TREATMENT OF NEUROENDOCRINE LIVER METASTASES
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 (HCC) is poorly defined. We aimed at defining risk and natural history of HCC developing in patients with HDV. Material and methods: 299 consecutive anti-HDV positive patients (230 males, mean age 30yrs, 272 [91%] anti-HBe positive), followed for 233 months (range 8-518). Infection was of unknown origin in 222 (74%). Cirrhosis was either histologically or clinically diagnosed in 186. All patients were under surveillance for HCC with US every 6 months. HDV was defined by serum IgM anti-HDV, HDV-RNA by PCR and/or HDV antigen detection. Results: HCC developed in 60 cirrhotics (39 Child A, 17 child B, 4 child C), after 86 months (range 3-432) from diagnosis of cirrhosis (annual rates: 0.9%). 55 (92%) patients were anti-HBe positive, 5 (8%) anti-HCV positive, HCV-RNA negative. HBV-DNA and/or IgMantiHBc were repeatedly positive in 27 (45%), HDV replication was present in 46 (77%). 22 patients (37%) had a past history of IFN treatment, 15 (25%) of corticosteroids, 4 (6%) of nucleoside analogues and 19 (32%) were never treated. Alcohol consumption was higher than 40 gr/day in 18 (30%). HCC was detected as a single nodule in 28 patients (47%, 24 with maximum diameter <3cm), two nodules in 15 patients (25%, <3cm in 11), 3 nodules in 8 (13%, <3 cm in 5) and >3 nodules in 9 (15%). Portal thrombosis was diagnosed in 6 (10%). 12 patients (20%) underwent OLT. Independent risk factors for HCC were IFN treatment (OR 2.18; 95% CI 1.10-4.32) and HBV replication (OR 5.15; 95% CI 2.57-10.32). After 45 months (range 3-204) from HCC diagnosis, 34 patients are still alive (57%), 1 (1%) was lost to follow-up and 25 (42%) died of liver failure (n=17, HCC (n=5), primary non function (n=2), metastasis from other cancer (n=1). Conclusions: Chronic hepatitis delta is a long-lasting disease with a substantial risk of developing into HCC. HCC risk is higher in the presence of HBV replication. # F. Cirrhosis & its complications 1. Natural history
P.76 DOES THE DEGREE OF PORTAL HYPERTENSION CORRELATE WITH THE SEVERITY OF LIVER CIRRHOSIS? L. Bellis, R. Guarisco, O. Dell’Unto, F. Paglia, L. Spilabotti, C. Puoti Marino Gen. Hospital, Roma Background and aim: Portal hypertension (PH) is the main complication of liver cirrhosis. It is not at yet known whether the degree of portal hypertension (PH) correlates with the severity of underlying liver disease. Material and methods: 59 cirrhotic patients with PH (47 males) were studied. The etiology of cirrhosis was HCV-related in 34 cases and alcoholic in 25. 16 patients belonged to Child Pugh class A, 19 to class B and 24 to class C. The degree of PHG was assessed according to the 4th Baveno International Consensus Workshop, Esophageal Varices (EV) were classified according to the Italian Liver Cirrhosis Project, and gastric varices (GV) to Sarin et al (10). Hepatic venous pressures were measured in the occluded and then in the free positions. The hepatic venous pressure gradient (HVPG) was calculated by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Pressure measurements were performed by triplicate in each case. Results were given as arithmetic means of the 3 determinations. Results: Mean HVPG levels were 19.0±5.1 mmHg (range 12.5-36.5 mm Hg). HVPG values did not differ between the 34 patients with HCV cirrhosis (19.4±6.0 mmHg, range 12.0-36.5 mmHg) and the 25 subjects with alcoholic cirrhosis (18.5±3.5 mmHg, range 12.5-27.0 mmHg, p = 0.51). The mean HVPG values were 18±2 mmHg among patients in Child Pugh Class A, 21±4 mmHg in those in Class B and 19±5 mmHg in patients belonging to Child Class C (N.S.). 10 patients had F1 EV (19%), 25 had F2 EV (43%) and 18 had F3 EV (30%). Further, 12/53 patients (23%) had gastric varices (GV), and 41/53 (77%) showed endoscopic features of portal hypertensive gastropathy.
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HVPG levels were 20.5±6.3 mmHg in patients with F1 EV, 17.9±3.8 mmHg in those with F2 varices and 20.7±5.2 mmHg in patients with F3 varices (p = 0.16). The size of EV did not differ between patients with viral or alcoholic cirrhosis, nor the prevalence of large varices was different according to the etiology of the disease (p = 0.90). Conclusions: In our series of patients, the degree of PH did not differ according to the severity of cirrhosis, evaluated through the Child Pugh classification. Further, our data seem to indicate that the severity of PH does not differ according to the size of esophageal varices. # F. Cirrhosis & its complications 2. Portal hypertension
P.77 ENDOSCOPIC VARICEAL LIGATION FOR PROPHYLAXIS OF ESOPHAGEAL VARICEAL BLEEDING: TECHNICAL ASPECTS AND OUTCOME S. Silvano ∗ , I. Potenza, W. Debernardi Venon, C. Alessandria, M. Bruno, A. Musso, C. Barletti, G. Saracco, M. Rizzetto Molinette Hospital, Torino Background and aim: Endoscopic variceal ligation (EVL) is effective in the prevention of variceal rebleeding and is indicated in the prevention of first variceal bleeding in patients with high-risk varices. However, technical aspects and procedural-related outcomes remain controversial. Material and methods: All cirrhotics with esophageal varices treated between January 2006 and November 2007 who have reached variceal obliteration and with a follow-up after obliteration > 12 months, were retrospectively analysed for technical aspects (number of sessions and bands, procedure times) and outcomes as endoscopic complications, rebleeding, variceal recurrence. Results: Among a total of 208 patients treated with EVL, 103 patients (Child A/B/C, 30/60/13) were included. Fourty-seven patients had EVL for primary prophylaxis of variceal bleeding. Mean number of sessions to obliteration and mean number of bands for each session were 2.8 (1 – 7) and 5 (2 – 7), respectively. The overall proportion of patients with variceal recurrence after obliteration was 28.8%. Outcome was similar in patients treated for prevention of first variceal bleeding and in patients treated for prevention of variceal rebleeding. The placement of > 5 bands per session was not associated with higher endoscopic complications (19.6% vs 17.8%, p = ns). Scars of previous ligation were seen in patients with an interval between endoscopic sessions > 20 days or < 20 days in 15% and 42%, respectively (p < 0.05). Once obliteration was obtained, variceal recurrence occurred in 21% of patients within 3 months and in 39% within 6 months, without any variceal bleeding. The usage of beta-blockers did not reduce the time to obliteration of varices. Conclusions: In our population endoscopic variceal ligation is a safe technical approach. An interval between endoscopic sessions > 20 days reduces procedural-related complications. An earlier control postobliteration does not change the outcomes and the therapeutic strategy. The therapy with beta-blockers did not influence the endoscopic procedure. # F. Cirrhosis & its complications 2. Portal hypertension
P.78 PERCUTANEOUS LASER ABLATION FOR PALLIATIVE TREATMENT OF NEUROENDOCRINE LIVER METASTASES S. Nasoni ∗ , C.M. Pacella, A. Petrolati, E. Papini, Z. Rossi Ospedale Regina Apostolorum, Albano Laziale, Roma Background and aim: Liver metastases occur in about 25–90% of patients with neuroendocrine tumours (NET). NET usually run a rather indolent course but the 5-year survival is reported to be about 40%
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Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
in patients with liver metastases versus 75–99% in subjects that are free of hepatic lesions. The most effective management and timing of treatment for patients with surgically unresectable metastases remains still unsettled. Purpose: To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable and progressive NET hepatic metastases. Material and methods: Twelve patients (7 male; 5 female; median age 53 [range 24-79]) with NET hepatic metastases and progressive disease under medical treatment underwent PLA. Primary tumors were localized in the pancreas and intestine in 4 and 3 patients respectively, whereas five patients had a lung endocrine carcinoma. The lesions treated with PLA were 16, and the number of treatments was 21. The median diameter of metastases was 3,5 cm (range 1,5-12) at baseline. Nine of twelve patients had symptoms related to either hormone secretion or mass effect. PLA was performed under ultrasound (US) guidance according to the previously described technique. The efficacy of treatment was assessed by means of CT and contrast-enhanced US examination 24 hours after PLA. Clinical and CT controls were performed every 3 months. Results: The mean follow-up post PLA was 23 months (range 2-72). The 10 hepatic tumors with a size = 4.0 cm appeared completely ablated by PLA treatment, while largest metastasis (with a diameter ranging from 5,5 to 12 cm) showed an over 60% ablation. Most patients (88%) reported symptom relief. Progression-free mean survival after PLA was 15 months (range 2-48). No major complications were observed during and after the procedures Conclusions: PLA is a feasible and well tolerated procedure for the palliative treatment of unresectable neuroendocrine hepatic tumors. In the present series most patients showed an improvement of their performance status and a long progression-free survival. Further controlled studies on a larger number of patients are required to evaluate the impact of PLA on the overall survival. # F. Cirrhosis & its complications 5. Others
P.79 CTLA4 AND MMP1 POLYMORPHISMS DISTRIBUTION IN PRIMARY BILIARY CIRRHOSIS RAPIDLY EVOLVING TO LIVER FAILURE A. Paziale, M. Cicilano, P. Pazienza, E. Tarabra, G. Actis, G. Tappero, E. Borghesio, L. Framarin, F. Castellino, N. Leone, F. Rosina ∗ , M. Ayoubi Presidio Sanitario Gradenigo, Torino Background and aim: Primary Biliary Cirrhosis (PBC) is an immunemediated disease with variable prognosis: some patients experience a non progressive course, others develop liver failure (LF) through parenchyma substitution by fibrotic tissue. Cytotoxic T lymphocytes associated antigen 4 (CTL-4) plays an inhibitory role in regulating lymphocytes function. The loss of CTLA-4 function is responsible for loss of lymphocyte tolerance. The G allele at position +49 of exon 1 of the CTLA-4 gene affects the CTLA-4 function. MMP1 gene encodes matrix metalloproteinase 1, the polymorphism (1G/2G) in the promoter results in transcriptional upregulation leading to increased degradation of Type VII collagen, a substrate of MMP1, possibly slowing down liver fibrogenesis. Material and methods: 79 patients selected according to the “extreme phenotype” criteria from 162 prospectively followed PBC patients were assigned to: group A) 47 pts without disease progression during a 10 years follow-up, group B) 32 patients who within the same period developed LF and died or underwent liver transplantation. CTLA-4 (+49 A/G) and MMP1 -1607(1G/2G) genetic polymorphisms were evaluated by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) on PBMC in group A and on PBMC or explanted livers tissue in group B patients.
Results: No statistically significant MMP1 and CTLA4 genotype distribution were observed between rapidly progressive and indolent phenotypes. Conclusions: Genetic polymorphisms of CTLA-4 and MMP-1, two genes involved in immune-regulation and homeostasis of connective tissue, do not play a role in modulating the natural history of PBC. # F. Cirrhosis & its complications 5. Others
P.80 PERCUTANEOUS LASER ABLATION FOR EARLY-STAGE HEPATOCELLULAR CARCINOMA IN SO-CALLED HIGHRISK LOCATIONS: A RETROSPECTIVE COMPARISON WITH NO HIGH-RISK LOCATIONS LESIONS FOR SAFETY, EFFECTIVENESS AND LONG-TERM OUTCOME A. Petrolati ∗ , Z. Rossi, S. Nasoni, C.M. Pacella Ospedale Regina Apostolorum, Albano Laziale, Roma Background and aim: Laser ablation (LA) is an effective and safe treatment that can improve the survival of patients with early HCC. To our knowledge however, no study has focused on the analysis of lesions location predicting outcome. The aim is to evaluate retrospectively the safety and efficacy and long-term outcome of laser ablation in cirrhotic patients with hepatocellular carcinoma (HCC) located at high-risk sites. Material and methods: One hundred sixty-four cirrhotic patients with hearly-stage HCC (< 5cm in diameter) received LA treatments from 1996 to 2008. One hundred-six patients (mean age 69-yrs), have 116 lesions in high-risk locations, defined as less than 5 mm from vital structures (group1). The other 58 patients (mean age 68-yrs), had 66 lesions whose location was not considered technically difficult (group 2). The completeness of ablation was assessed by contrast-enhanced dynamic CT scan 24-48h and three months after LA. During follow-up all patients with complete ablation were monitored by dynamic CT scan every six months. Complete ablation, complications and local tumor progression were analyzed with regard to the location of each nodule. The data were compared using the chi-square test and the Mann-Whitney test. Results: The overall complete response rate was 92% in the group 1 and 95% in the group 2. The median follow-up was 29 months (range 0.1-144), and 35 months (range 6-138), respectively. In the group 1 the median overall survival was 42 months (95% CI, 32-50 mounths), the 3-, and 5-year cumulative survival rates were 60% e 37%, respectively. In the group 2 the median overall survival was 43 months (95% CI, 37-53 months), the 3-, and 5-year cumulative survival rates were 70% e 33%, respectively. The local recurrence rate was 19% and 18% in the group 1 and the group 2, respectively. Early complications was significantly different between two groups 47% (55/116 lesions) vs 26% (17/66 lesions) (P=0.05). Late complications rate occurred in the hard-to-treat group was 6%. One LA-related death was observed in patients with lesions in high-risk locations. Conclusions: Our data show that the location did not affect the outcome of patients with early HCC. # F. Cirrhosis & its complications 5. Others
P.81 ROLE OF TRANSJUGULAR PORTOSYSTEMIC STENT SHUNT (TIPS) IN PATIENTS WITH ACUTE ALCOHOLIC HEPATITIS (AAH) AND HEPATO-RENAL SYNDROME (HRS) G. Testino ∗ , C. Ferro, E. Andorno, P. Borro, A.O. Ancarani, A. Sumberaz San Martino Hospital, Genova Background and aim: In severe steatohepatitis or in end stage alcoholic liver disease (with or without steatohepatitis) HRS is a common
P.76 DOES THE DEGREE OF PORTAL HYPERTENSION CORRELATE WITH THE SEVERITY OF LIVER CIRRHOSIS? L. Bellis, R. Guarisco, O. Dell’Unto, F. Paglia, L. Spilabotti, C. Puoti Marino Gen. Hospital, Roma Background and aim: Portal hypertension (PH) is the main complication of liver cirrhosis. It is not at yet known whether the degree of portal hypertension (PH) correlates with the severity of underlying liver disease. Material and methods: 59 cirrhotic patients with PH (47 males) were studied. The etiology of cirrhosis was HCV-related in 34 cases and alcoholic in 25. 16 patients belonged to Child Pugh class A, 19 to class B and 24 to class C. The degree of PHG was assessed according to the 4th Baveno International Consensus Workshop, Esophageal Varices (EV) were classified according to the Italian Liver Cirrhosis Project, and gastric varices (GV) to Sarin et al (10). Hepatic venous pressures were measured in the occluded and then in the free positions. The hepatic venous pressure gradient (HVPG) was calculated by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Pressure measurements were performed by triplicate in each case. Results were given as arithmetic means of the 3 determinations. Results: Mean HVPG levels were 19.0±5.1 mmHg (range 12.5-36.5 mm Hg). HVPG values did not differ between the 34 patients with HCV cirrhosis (19.4±6.0 mmHg, range 12.0-36.5 mmHg) and the 25 subjects with alcoholic cirrhosis (18.5±3.5 mmHg, range 12.5-27.0 mmHg, p = 0.51). The mean HVPG values were 18±2 mmHg among patients in Child Pugh Class A, 21±4 mmHg in those in Class B and 19±5 mmHg in patients belonging to Child Class C (N.S.). 10 patients had F1 EV (19%), 25 had F2 EV (43%) and 18 had F3 EV (30%). Further, 12/53 patients (23%) had gastric varices (GV), and 41/53 (77%) showed endoscopic features of portal hypertensive gastropathy.
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HVPG levels were 20.5±6.3 mmHg in patients with F1 EV, 17.9±3.8 mmHg in those with F2 varices and 20.7±5.2 mmHg in patients with F3 varices (p = 0.16). The size of EV did not differ between patients with viral or alcoholic cirrhosis, nor the prevalence of large varices was different according to the etiology of the disease (p = 0.90). Conclusions: In our series of patients, the degree of PH did not differ according to the severity of cirrhosis, evaluated through the Child Pugh classification. Further, our data seem to indicate that the severity of PH does not differ according to the size of esophageal varices. # F. Cirrhosis & its complications 2. Portal hypertension
P.77 ENDOSCOPIC VARICEAL LIGATION FOR PROPHYLAXIS OF ESOPHAGEAL VARICEAL BLEEDING: TECHNICAL ASPECTS AND OUTCOME S. Silvano ∗ , I. Potenza, W. Debernardi Venon, C. Alessandria, M. Bruno, A. Musso, C. Barletti, G. Saracco, M. Rizzetto Molinette Hospital, Torino Background and aim: Endoscopic variceal ligation (EVL) is effective in the prevention of variceal rebleeding and is indicated in the prevention of first variceal bleeding in patients with high-risk varices. However, technical aspects and procedural-related outcomes remain controversial. Material and methods: All cirrhotics with esophageal varices treated between January 2006 and November 2007 who have reached variceal obliteration and with a follow-up after obliteration > 12 months, were retrospectively analysed for technical aspects (number of sessions and bands, procedure times) and outcomes as endoscopic complications, rebleeding, variceal recurrence. Results: Among a total of 208 patients treated with EVL, 103 patients (Child A/B/C, 30/60/13) were included. Fourty-seven patients had EVL for primary prophylaxis of variceal bleeding. Mean number of sessions to obliteration and mean number of bands for each session were 2.8 (1 – 7) and 5 (2 – 7), respectively. The overall proportion of patients with variceal recurrence after obliteration was 28.8%. Outcome was similar in patients treated for prevention of first variceal bleeding and in patients treated for prevention of variceal rebleeding. The placement of > 5 bands per session was not associated with higher endoscopic complications (19.6% vs 17.8%, p = ns). Scars of previous ligation were seen in patients with an interval between endoscopic sessions > 20 days or < 20 days in 15% and 42%, respectively (p < 0.05). Once obliteration was obtained, variceal recurrence occurred in 21% of patients within 3 months and in 39% within 6 months, without any variceal bleeding. The usage of beta-blockers did not reduce the time to obliteration of varices. Conclusions: In our population endoscopic variceal ligation is a safe technical approach. An interval between endoscopic sessions > 20 days reduces procedural-related complications. An earlier control postobliteration does not change the outcomes and the therapeutic strategy. The therapy with beta-blockers did not influence the endoscopic procedure. # F. Cirrhosis & its complications 2. Portal hypertension
P.78 PERCUTANEOUS LASER ABLATION FOR PALLIATIVE TREATMENT OF NEUROENDOCRINE LIVER METASTASES S. Nasoni ∗ , C.M. Pacella, A. Petrolati, E. Papini, Z. Rossi Ospedale Regina Apostolorum, Albano Laziale, Roma Background and aim: Liver metastases occur in about 25–90% of patients with neuroendocrine tumours (NET). NET usually run a rather indolent course but the 5-year survival is reported to be about 40%
S104
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
in patients with liver metastases versus 75–99% in subjects that are free of hepatic lesions. The most effective management and timing of treatment for patients with surgically unresectable metastases remains still unsettled. Purpose: To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable and progressive NET hepatic metastases. Material and methods: Twelve patients (7 male; 5 female; median age 53 [range 24-79]) with NET hepatic metastases and progressive disease under medical treatment underwent PLA. Primary tumors were localized in the pancreas and intestine in 4 and 3 patients respectively, whereas five patients had a lung endocrine carcinoma. The lesions treated with PLA were 16, and the number of treatments was 21. The median diameter of metastases was 3,5 cm (range 1,5-12) at baseline. Nine of twelve patients had symptoms related to either hormone secretion or mass effect. PLA was performed under ultrasound (US) guidance according to the previously described technique. The efficacy of treatment was assessed by means of CT and contrast-enhanced US examination 24 hours after PLA. Clinical and CT controls were performed every 3 months. Results: The mean follow-up post PLA was 23 months (range 2-72). The 10 hepatic tumors with a size = 4.0 cm appeared completely ablated by PLA treatment, while largest metastasis (with a diameter ranging from 5,5 to 12 cm) showed an over 60% ablation. Most patients (88%) reported symptom relief. Progression-free mean survival after PLA was 15 months (range 2-48). No major complications were observed during and after the procedures Conclusions: PLA is a feasible and well tolerated procedure for the palliative treatment of unresectable neuroendocrine hepatic tumors. In the present series most patients showed an improvement of their performance status and a long progression-free survival. Further controlled studies on a larger number of patients are required to evaluate the impact of PLA on the overall survival. # F. Cirrhosis & its complications 5. Others
P.79 CTLA4 AND MMP1 POLYMORPHISMS DISTRIBUTION IN PRIMARY BILIARY CIRRHOSIS RAPIDLY EVOLVING TO LIVER FAILURE A. Paziale, M. Cicilano, P. Pazienza, E. Tarabra, G. Actis, G. Tappero, E. Borghesio, L. Framarin, F. Castellino, N. Leone, F. Rosina ∗ , M. Ayoubi Presidio Sanitario Gradenigo, Torino Background and aim: Primary Biliary Cirrhosis (PBC) is an immunemediated disease with variable prognosis: some patients experience a non progressive course, others develop liver failure (LF) through parenchyma substitution by fibrotic tissue. Cytotoxic T lymphocytes associated antigen 4 (CTL-4) plays an inhibitory role in regulating lymphocytes function. The loss of CTLA-4 function is responsible for loss of lymphocyte tolerance. The G allele at position +49 of exon 1 of the CTLA-4 gene affects the CTLA-4 function. MMP1 gene encodes matrix metalloproteinase 1, the polymorphism (1G/2G) in the promoter results in transcriptional upregulation leading to increased degradation of Type VII collagen, a substrate of MMP1, possibly slowing down liver fibrogenesis. Material and methods: 79 patients selected according to the “extreme phenotype” criteria from 162 prospectively followed PBC patients were assigned to: group A) 47 pts without disease progression during a 10 years follow-up, group B) 32 patients who within the same period developed LF and died or underwent liver transplantation. CTLA-4 (+49 A/G) and MMP1 -1607(1G/2G) genetic polymorphisms were evaluated by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) on PBMC in group A and on PBMC or explanted livers tissue in group B patients.
Results: No statistically significant MMP1 and CTLA4 genotype distribution were observed between rapidly progressive and indolent phenotypes. Conclusions: Genetic polymorphisms of CTLA-4 and MMP-1, two genes involved in immune-regulation and homeostasis of connective tissue, do not play a role in modulating the natural history of PBC. # F. Cirrhosis & its complications 5. Others
P.80 PERCUTANEOUS LASER ABLATION FOR EARLY-STAGE HEPATOCELLULAR CARCINOMA IN SO-CALLED HIGHRISK LOCATIONS: A RETROSPECTIVE COMPARISON WITH NO HIGH-RISK LOCATIONS LESIONS FOR SAFETY, EFFECTIVENESS AND LONG-TERM OUTCOME A. Petrolati ∗ , Z. Rossi, S. Nasoni, C.M. Pacella Ospedale Regina Apostolorum, Albano Laziale, Roma Background and aim: Laser ablation (LA) is an effective and safe treatment that can improve the survival of patients with early HCC. To our knowledge however, no study has focused on the analysis of lesions location predicting outcome. The aim is to evaluate retrospectively the safety and efficacy and long-term outcome of laser ablation in cirrhotic patients with hepatocellular carcinoma (HCC) located at high-risk sites. Material and methods: One hundred sixty-four cirrhotic patients with hearly-stage HCC (< 5cm in diameter) received LA treatments from 1996 to 2008. One hundred-six patients (mean age 69-yrs), have 116 lesions in high-risk locations, defined as less than 5 mm from vital structures (group1). The other 58 patients (mean age 68-yrs), had 66 lesions whose location was not considered technically difficult (group 2). The completeness of ablation was assessed by contrast-enhanced dynamic CT scan 24-48h and three months after LA. During follow-up all patients with complete ablation were monitored by dynamic CT scan every six months. Complete ablation, complications and local tumor progression were analyzed with regard to the location of each nodule. The data were compared using the chi-square test and the Mann-Whitney test. Results: The overall complete response rate was 92% in the group 1 and 95% in the group 2. The median follow-up was 29 months (range 0.1-144), and 35 months (range 6-138), respectively. In the group 1 the median overall survival was 42 months (95% CI, 32-50 mounths), the 3-, and 5-year cumulative survival rates were 60% e 37%, respectively. In the group 2 the median overall survival was 43 months (95% CI, 37-53 months), the 3-, and 5-year cumulative survival rates were 70% e 33%, respectively. The local recurrence rate was 19% and 18% in the group 1 and the group 2, respectively. Early complications was significantly different between two groups 47% (55/116 lesions) vs 26% (17/66 lesions) (P=0.05). Late complications rate occurred in the hard-to-treat group was 6%. One LA-related death was observed in patients with lesions in high-risk locations. Conclusions: Our data show that the location did not affect the outcome of patients with early HCC. # F. Cirrhosis & its complications 5. Others
P.81 ROLE OF TRANSJUGULAR PORTOSYSTEMIC STENT SHUNT (TIPS) IN PATIENTS WITH ACUTE ALCOHOLIC HEPATITIS (AAH) AND HEPATO-RENAL SYNDROME (HRS) G. Testino ∗ , C. Ferro, E. Andorno, P. Borro, A.O. Ancarani, A. Sumberaz San Martino Hospital, Genova Background and aim: In severe steatohepatitis or in end stage alcoholic liver disease (with or without steatohepatitis) HRS is a common