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Short-course Somatostatin Versus Terlipressin Infusion in Combination With Endoscopic Variceal Ligation for the Prevention of Early Esophageal Variceal Rebleeding: A Real-world, Prospective Cohort Study
e104 Abstracts
and IR play a role in the development and progression of coronary artery disease. CIMT are valuable in the diagnosis of subclinical early atherosclerosis. OBJECTIVES: 1] To study the extent of subclinical atherosclerosis in UC patients by measuring CIMT 2] To study the correlation between CIMT, serum homocystiene level and homeostasis model assessment of insulin resistance (HOMA-IR) in UC. METHODS: We studied 60 UC patients and 60 healthy matched controls. Patients with known risk factors for atherosclerosis were excluded from the study. Fasting blood glucose, lipid profile, insulin resistance (HOMA-IR), ESR, serum Vitamin B12 level and Homocysteine levels were measured in all subjects. CIMT was measured using B-mode duplex imaging study. RESULT: Ulcerative colitis patients had significantly higher CIMT than controls (P < .05). ESR, fasting insulin, HOMA-IR and serum homocysteine levels were also significantly higher in UC patients (P < .05). Pearson correlation coefficient showed significant correlations between: 1) CIMT and age, duration of UC, HOMA-IR and homocysteine level (P < .05); 2) Serum homocysteine and duration of UC, fasting insulin level, HOMA-IR and CIMT (P < .01); 3) HOMA-IR and age, duration of UC, serum homocysteine and CIMT (P < .01). Multiregression models showed that serum homocysteine affects CIMT and duration of UC independently; age and duration of UC affects HOMA-IR independently. CONCLUSIONS: Higher CMT indicates subclinical atherosclerosis in UC patients. Age, duration of UC, HOMA-IR, and homocysteine levels were important factors associated with increased CIMT.
Short-course Somatostatin Versus Terlipressin Infusion in Combination With Endoscopic Variceal Ligation for the Prevention of Early Esophageal Variceal Rebleeding: A Real-world, Prospective Cohort Study Yoen-Young Chuah, Huay-Min Wang, and Ping-I. Hsu BACKGROUND: Once acute esophageal variceal bleeding (EVB) is successfully controlled, rebleeding may occur in approximately 2-thirds of patients if further preventive measures are not taken. Endoscopic variceal ligation (EVL) is recommended in patients who present with EVB and is best used in combination with vasoactive drugs. The aim of this prospective cohort study was designed to assess the efficacy and safety of somatostatin, compared with terlipressin in cirrhotic patients who have acute EVB and received EVL in realworld clinical practice. METHODS: From April 2010 through April 2014, cirrhotic patients with significant upper gastrointestinal bleeding were screened (n ¼ 352). Eligible patients with acute EVB were non-randomly assigned to receive early administration of somatostatin (group S) or terlipressin (group T) infusion, followed by EVL. A decision to use vasoactive drugs depended on the physician’s favorite. In group S,
Clinical Gastroenterology and Hepatology Vol. 13, No. 7
somatostatin (250 mg) by intravenous bolus followed by 250 mg/hour was continued for 3 days. In group T, terlipressin was started with 2mg bolus injection and followed by 1 mg infusion every 6 hours for 3 days. Administration of non-selective b-blockers were considered to start on day 5. Elective EVL was undertaken at interval of 2-4 weeks. Follow-up was for 42 days. RESULTS: A total of 150 patients were enrolled; 49 in group S and 109 in group T. Major prescription decisions for vasoactive drugs depended on convenient administration (77.1%) in group T and safety profile (73.2%) in group S. The baseline and endoscopic characteristics of the treatment groups were comparable. Only one patient in each study group was defined as failure to control acute EVB (within 48 h). Very early rebleeding within 49-120 h occurred in one patient in groups S and T (P ¼ .469). Four patients (10.0%) in group S and 14 patient (13.0%) in group T have EV rebleeding episodes within 3-42 days (P ¼ .781). No significant differences were observed in 6-week survival (9.8% vs 12.8%), blood transfusion and hospital stay. Overall complications were compatible in groups S and T, whereas patients in group S have a trend of increasing cases of renal failure and flush, and patients in group T have a trend of increasing episodes of hypertension and hyponatremia. CONCLUSIONS: Short-course somatostatin infusion was similarly effective to short-course terlipressin infusion in preventing against early esophageal variceal rebleeding and in reducing mortality. Medication considerations for vasoactive drugs mainly depended on convenient administration and safety profile in real-world clinical practice. Study of Scar Recurrence in Incidental Gallbladder Cancer N. Akhtar, S. Gupta, S. Misra, and V. Kumar BACKGROUND: Incidental gallbladder cancer (IGBC) is defined as GBC diagnosed intra-operatively or after cholecystectomy done for benign gallbladder disease. Laparoscopic cholecystectomy (LC) in patients with GBC has been associated with an increased incidence of peritoneal metastasis and port site recurrences. Similar high incidence of scar site recurrence after open cholecystectomy in IGBC is not a commonly reported phenomenon with only a few anecdotal case reports. METHODS: Records of all GBC patients registered between 2008 and 2012 were analyzed retrospectively. GBC patients with scar site/port site metastasis were reviewed for their clinical presentation, time elapsed between initial cholecystectomy and presentation with scar site recurrence, radiological imaging, treatment received and disease outcome. RESULTS: Of 337 patients of GBC, 30.56% (n ¼ 103) presented with diagnosis of IGBC. 15/103 cases of IGBC had radiologically and cytologically proven scar site/ port site metastasis ([open and laparoscopic cholycystectomy] [n ¼ 11 and 4 respectively]). The most
and IR play a role in the development and progression of coronary artery disease. CIMT are valuable in the diagnosis of subclinical early atherosclerosis. OBJECTIVES: 1] To study the extent of subclinical atherosclerosis in UC patients by measuring CIMT 2] To study the correlation between CIMT, serum homocystiene level and homeostasis model assessment of insulin resistance (HOMA-IR) in UC. METHODS: We studied 60 UC patients and 60 healthy matched controls. Patients with known risk factors for atherosclerosis were excluded from the study. Fasting blood glucose, lipid profile, insulin resistance (HOMA-IR), ESR, serum Vitamin B12 level and Homocysteine levels were measured in all subjects. CIMT was measured using B-mode duplex imaging study. RESULT: Ulcerative colitis patients had significantly higher CIMT than controls (P < .05). ESR, fasting insulin, HOMA-IR and serum homocysteine levels were also significantly higher in UC patients (P < .05). Pearson correlation coefficient showed significant correlations between: 1) CIMT and age, duration of UC, HOMA-IR and homocysteine level (P < .05); 2) Serum homocysteine and duration of UC, fasting insulin level, HOMA-IR and CIMT (P < .01); 3) HOMA-IR and age, duration of UC, serum homocysteine and CIMT (P < .01). Multiregression models showed that serum homocysteine affects CIMT and duration of UC independently; age and duration of UC affects HOMA-IR independently. CONCLUSIONS: Higher CMT indicates subclinical atherosclerosis in UC patients. Age, duration of UC, HOMA-IR, and homocysteine levels were important factors associated with increased CIMT.
Short-course Somatostatin Versus Terlipressin Infusion in Combination With Endoscopic Variceal Ligation for the Prevention of Early Esophageal Variceal Rebleeding: A Real-world, Prospective Cohort Study Yoen-Young Chuah, Huay-Min Wang, and Ping-I. Hsu BACKGROUND: Once acute esophageal variceal bleeding (EVB) is successfully controlled, rebleeding may occur in approximately 2-thirds of patients if further preventive measures are not taken. Endoscopic variceal ligation (EVL) is recommended in patients who present with EVB and is best used in combination with vasoactive drugs. The aim of this prospective cohort study was designed to assess the efficacy and safety of somatostatin, compared with terlipressin in cirrhotic patients who have acute EVB and received EVL in realworld clinical practice. METHODS: From April 2010 through April 2014, cirrhotic patients with significant upper gastrointestinal bleeding were screened (n ¼ 352). Eligible patients with acute EVB were non-randomly assigned to receive early administration of somatostatin (group S) or terlipressin (group T) infusion, followed by EVL. A decision to use vasoactive drugs depended on the physician’s favorite. In group S,
Clinical Gastroenterology and Hepatology Vol. 13, No. 7
somatostatin (250 mg) by intravenous bolus followed by 250 mg/hour was continued for 3 days. In group T, terlipressin was started with 2mg bolus injection and followed by 1 mg infusion every 6 hours for 3 days. Administration of non-selective b-blockers were considered to start on day 5. Elective EVL was undertaken at interval of 2-4 weeks. Follow-up was for 42 days. RESULTS: A total of 150 patients were enrolled; 49 in group S and 109 in group T. Major prescription decisions for vasoactive drugs depended on convenient administration (77.1%) in group T and safety profile (73.2%) in group S. The baseline and endoscopic characteristics of the treatment groups were comparable. Only one patient in each study group was defined as failure to control acute EVB (within 48 h). Very early rebleeding within 49-120 h occurred in one patient in groups S and T (P ¼ .469). Four patients (10.0%) in group S and 14 patient (13.0%) in group T have EV rebleeding episodes within 3-42 days (P ¼ .781). No significant differences were observed in 6-week survival (9.8% vs 12.8%), blood transfusion and hospital stay. Overall complications were compatible in groups S and T, whereas patients in group S have a trend of increasing cases of renal failure and flush, and patients in group T have a trend of increasing episodes of hypertension and hyponatremia. CONCLUSIONS: Short-course somatostatin infusion was similarly effective to short-course terlipressin infusion in preventing against early esophageal variceal rebleeding and in reducing mortality. Medication considerations for vasoactive drugs mainly depended on convenient administration and safety profile in real-world clinical practice. Study of Scar Recurrence in Incidental Gallbladder Cancer N. Akhtar, S. Gupta, S. Misra, and V. Kumar BACKGROUND: Incidental gallbladder cancer (IGBC) is defined as GBC diagnosed intra-operatively or after cholecystectomy done for benign gallbladder disease. Laparoscopic cholecystectomy (LC) in patients with GBC has been associated with an increased incidence of peritoneal metastasis and port site recurrences. Similar high incidence of scar site recurrence after open cholecystectomy in IGBC is not a commonly reported phenomenon with only a few anecdotal case reports. METHODS: Records of all GBC patients registered between 2008 and 2012 were analyzed retrospectively. GBC patients with scar site/port site metastasis were reviewed for their clinical presentation, time elapsed between initial cholecystectomy and presentation with scar site recurrence, radiological imaging, treatment received and disease outcome. RESULTS: Of 337 patients of GBC, 30.56% (n ¼ 103) presented with diagnosis of IGBC. 15/103 cases of IGBC had radiologically and cytologically proven scar site/ port site metastasis ([open and laparoscopic cholycystectomy] [n ¼ 11 and 4 respectively]). The most