Volume 78 - 2015 - Fasc.3 - Original articles
Percutaneous radiofrequency ablation for hepatocellular carcinoma located in the caudate lobe of the liver
Aim : This study aimed to evaluate the effectiveness and safety of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) located in the caudate lobe of the liver.
Patients and methods : Between 2012 April and 2014 February, 142 patients with HCC meeting the Milan criteria were enrolled in this study. Of these patients, nine patients had HCC located in the caudate lobe (caudate group). Six of the nine cases were located in the Spiegel lobe, two cases were located in the paracaval portion and one case was located in the caudate process. We evaluated the local recurrence rate and RFA-related complications in the cau- date group and non-caudate group.
Results : The local recurrence rate in the caudate group was 12.5% at 1 year and 12.5% at 2 years, while the local recurrence rate in the non-caudate group was 14.9% at 1 year and 29.0% at 2 years ; there were no significant differences between the groups. No complications were observed in the caudate group, and minor complications were observed in six patients (4.5%) in the non- caudate group. No major complications or mortalities were observed in either group, and the complication rates were not significantly different between the groups (P = 1).
Conclusions : RFA for HCC in the caudate lobe and the non- caudate lobe has equivalent effectiveness and safety. RFA is a promising treatment option for HCC arising in the caudate lobe. (Acta gastroenterol. belg., 2015, 78, 267-273).
Persisting signs of disease activity at Magnetic Resonance Enterocolonography predict clinical relapse and disease progression in quiescent Crohn's disease
Introduction : Deep remission including clinical remission and tissue healing has been advocated as the therapeutic target in Crohn's disease. Yet, the definition of deep remission remains un- clear.
The aim of this study was to assess the persisting lesions at mag- netic resonance enterocolonography (MREC) in clinically quies- cent Crohn's disease as well as their relapse predictive value.
Methods : we performed a prospective monocentre cohort study. We included patients with clinical remission. At baseline, these pa- tients had blood tests, the measurement of fecal calprotectin and underwent a MREC. They were then followed up clinically for a minimum of 1 year. A relapse was defined by a HBI > 4 with an increase of at least 3 points. Correlations between clinical, demo- graphic, biological parameters and MREC signs were assessed as well as the time-to-relapse predictive value of the studied variables.
Results : Twenty seven patients were recruited. Fourteen out of 27 had persisting disease activity at MREC. MREC signs only part- ly correlated with biomarkers. Ten out of 27 patients relapsed over a median follow up of 25 months. In univariate analysis, relative contrast enhancement of the most affected segment (HR : 2.56 ; P=0.046), ulcers (HR: 12.5; P=0.039), fistulas (HR: 14.1; P = 0.009) and target sign (HR : 3.63 ; P = 0.049) were associated with relapse. In multivariate analysis, fistula was the only one.
Conclusions: Half of the patients with clinically quiescent Crohn's disease had persisting signs of disease activity at MREC. These signs predicted time-to-relapse. (Acta gastroenterol. belg., 2015, 78, 274-281).
Bifidobacterium lactis B94 plus inulin for Treatment of Helicobacter pylori infection in children : does it increase eradication rate and patient compliance ?
The aim of this study is to investigate the effects of Bifidobacte- rium lactis B94 and inulin (synbiotic) treatment on eradication rate and patient compliance in subjects treated for symptomatic H. py- lori infection. Patients with symptomatic H. pylori infection were divided into two groups. One group was treated with standard tri- ple therapy (lansoprazole, amoxicillin, and clarithromycin) and B. lactis B94 (5 × 109 CFU/dose) plus inulin (900 mg) twice daily for seven days. The control group was treated with standard triple therapy and placebo. The side effects and eradication rates were evaluated at the end of the study. Ninety-three patients with H. py- lori infection were treated with either synbiotic plus triple therapy (n = 47) or placebo plus triple therapy (n = 46). The infection erad- ication rates were not significantly different between the synbiotic and placebo groups [intent-to-treat (ITT), 80.8% and 67.3%, p=0.13, respectively; per-protocol (PP), 86.3% and 81.5%, p = 0.55, respectively]. The drug side effects were significantly higher in the placebo group than in the synbiotic group (63% and 17%, respectively, p < 0.01). Although no intolerable adverse side effects were observed in the synbiotic group, intolerable adverse side effects were observed in 13% of the placebo group (p = 0.01). Our results suggest that twice daily 5 × 109 CFU/dose B. lactis B94 plus 900 mg inulin treatment did not have a direct positive effect on the H. pylori eradication rate. However, this treatment had signifi- cantly reduced side effects and indirectly increased eradication rates by increasing patient compliance. (Acta gastroenterol. belg., 2015, 78, 282-286).
Prevalence of advanced histologic features in diminutive colon polyps
Background/Aims: Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps.
Patients/Methods : The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retro- spectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size : diminutive (= 5 mm), small (6-9 mm), and large (= 10 mm).
Relationship of percutaneous endoscopic gastrostomy-related mortality and morbidity rates and effectiveness with advancing age
Background and aims : Percutaneous endoscopic gastrostomy (PEG) is insertion of a tube to stomach through abdominal wall for provision of nutrition in patients who couldn't be fed by oral route. In the present study, it was aimed to evaluate PEG procedures performed in our facility regarding indication, complication and effectiveness and to determine whether these characteristics have a relationship with advancing age.
Material and method : In this descriptive study, we reviewed clinical and endoscopic records of 300 patients who underwent PEG procedure between May 2009 and December 2011. The pa- tients were divided into 2 groups(group 1 > 75, group 2 < 75 years). All patients were retrospectively reviewed regarding demographic data, indications, biochemical parameters (Hemoglobin, total protein and albumin) at baseline and 3 months after procedure, complications and mortality.
Budd-Chiari syndrome : reassessment of a step-wise treatment strategy
Background and study aims : The Budd-Chiari syndrome is a rare disorder characterized by hepatic venous outflow obstruction. A step-wise management was recently proposed. The aim of this study is to reassess our treatment approach and long-term outcome.
Patients and methods : The data of 37 Budd-Chiari patients, seen in our unit, were critically analyzed and compared with the ENVIE (European Network For Vascular Disorders of the Liver) data.
Results : Most patients had multiple prothrombotic conditions (41%), of which an underlying myeloproliferative neoplasm was the most frequent (59%). The JAK2V617F mutation was associat- ed with more complete occlusion of all hepatic veins (JAK2 muta- tion + : 70% vs JAK2 mutation - : 23% and a higher severity score. The step-wise treatment algorithm used in our unit, in function of the severity of the liver impairment and the number and the exten- sion of hepatic veins occluded, resulted in the following treatments : only anticoagulation (n = 7.21%), recanalization procedure (n = 4.21%), portosystemic shunts (n = 9.26%) and liver transplanta- tion (n = 14.44%). This resulted in a 10 year survival rate of 90%. Treatment of the underlying hemostatic disorder offered a low re- currence rate. None of the 21 patients with a myeloproliferative neoplasm died in relation to the hematologic disorder.
Hepatic Sarcoidosis : Clinico-pathological characterization of symptomatic cases
Aim : The aim of this study was to investigate the clinical and pathological features of hepatic sarcoidosis in symptomatic cases.
Methods : Twenty-two symptomatic hepatic sarcoidosis cases were included in the study. Hepatic sarcoidosis was determined by typical imaging, histopathology, and high angiotensin-converting enzyme levels. Demographic data, laboratory data, imaging find- ings, liver biopsies, and clinical findings were analyzed. Portal hypertension (PH) was defined by the presence of ascites and/or varices ; imaging findings suggestive of PH-splenomegaly (> 12 cm on longest axis) ; portal vein dilation (> 13 mm) ; collateral vessel formation ; and hepatic venous pressure gradient = 6 mmHg.
Results : Mean age was 49.63 ± 10.7 years. Liver tests showed elevated serum alkaline phosphatase and gamma-glutamyl trans- peptidase levels (95%). Serum albumin levels were low (< 3 g/dl) in 32% of the patients. Histologically, hepatic granulomas were lo- cated in the portal/periportal areas, with or without parenchymal involvement (77%). Duct damage (27%), absent portal veins (32%), and hepatomegaly (41%) were also observed. Clinically, chronic cholestatic symptoms and PH features were observed in 41% and 50% of the patients, respectively. Three-quarters of pa- tients with PH features were non-cirrhotic. Cirrhosis and bleeding varices were observed in 14%. Hepatic sarcoidosis overlaps with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) was observed in two cases.
Conclusion : Sarcoidosis causes significant hepatic disease. PH and jaundice are main clinical presentations in liver sarcoidosis patients. Imaging findings of PH should be carefully reviewed, as it can occur even before the establishment of cirrhosis. Hepatic sarcoidosis mimics and overlaps with PBC and PSC. (Acta gastro- enterol. belg., 2015, 78, 306-313).
Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy
Background and study aims : In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption.
Materials and methods : A totally 60 patients were enrolled in the study. Propofol group (Group 1) : A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70- 75 was achieved.
