Introduction

Pancreatic cystic lesions (PCLs) have an increasing incidence and their management should be guided by recent guidelines. Currently, there is an electronic tool available, called iCyst, which can assist physicians in determining patient follow-up. The aim of this study was to retrospectively determine, using the iCyst application, whether guidelines were correctly followed at the time of diagnosis and, if not, whether this had a negative impact on patients.

Aims & Methods

Patients with PCLs followed in the outpatient clinic of the Gastroenterology Department of a large tertiary center between January 2022 and December 2023 were included.

Results

One hundred patients were evaluated (female sex - 60%; mean age - 64.2 ± 12.5 years; mean follow-up time - 4.3 ± 2.8 years). Comparing the suggestions of iCyst with what was implemented, it was found that the guidelines were respected to the following extents: European - 73%; AGA - 71%; IAP - 58%. In 9% of cases, none of the guidelines were applied. Regarding follow-up, a significant increase (>5 mm) in lesion size was observed in 11% of cases. Of the 9 patients in whom no guideline was followed, only 1 had dimensional growth, which was an IPMN with high-risk features and surgical indication; however, this patient refused any intervention and subsequently died from a non-pancreatic cause. In the remaining patients with lesion growth, in 6 cases, the plan followed was similar to that proposed by all three guidelines simultaneously, in 3 to that proposed by the EU and AGA guidelines, and in one case, the IAP guideline was followed. There was no statistically significant association between evolution and the implemented guideline.

Conclusion

The results show that, in the vast majority of evaluated patients, the plan proposed by at least one of the three international recommendations was respected, especially the European. It is noteworthy that there seems to be no correlation between strict adherence to these guidelines and the final outcome for the patient.

References

1. Klibansky DA, Reid-Lombardo KM, Gordon SR, Gardner TB. The clinical relevance of the increasing incidence of intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol. 2012 May;10(5):555–8.
2. Bassi C, Sarr MG, Lillemoe KD, Reber HA. Natural History of Intraductal Papillary Mucinous Neoplasms (IPMN): Current Evidence and Implications for Management. Journal of Gastrointestinal Surgery. 2008 Apr 1;12(4):645–50.
3. Mella JM, Gómez EJ, Omodeo M, Manzotti M, Roel M, Pereyra L, et al. Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines. Gastroenterología y Hepatología. 2018 May 1;41(5):293–301.
4. Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study. Medicine. 2016 Dec;95(51):e5535.
5. Farrell JJ. Pancreatic Cysts and Guidelines. Dig Dis Sci. 2017 Jul 1;62(7):1827–39.

Introduction

Gastric linitis is a kind of adenocarcinoma that invades the stomach and is composed of separate cells. The predicted survival rate for this condition over a five-year period ranges from 3 to 10%. The excessive cell growth that characterizes gastric linitis also results in the formation of fibrous tissue, which makes the stomach wall thicker and less flexible. Consequently, mucous biopsies frequently do not provide useful information.

Aims & Methods

The aim of this study is to evaluate the diagnostic performance of echo-endoscopic biopsy puncture (EUS-FNB) in the diagnosis of gastric linitis.This study is an observational retrospective monocentric analysis conducted over a period of 4 years from January 2018 to December 2022. It includes all patients who underwent a parietal gastric and/or ganglionary puncture under echo endoscopic guidance using a 20G or 22G Procore® or Acquire® type 22G FNB needle. The purpose of the procedure was to investigate suspected cases of gastric linitis. The study is conducted at the University Hospital Centre in Marrakech, which serves as a tertiary care department and is a point of reference for all regional and provincial hospitals. The appearance of parietal gastric thickness, abdominal DMT, an infiltrated aspect of the stomach, folds, or gastric stenosis in high digestive endoscopy led to the suspicion of gastric linitis.The data was obtained from various sources, including hospital registers, patient medical records, the computerized system "Hosix" for morphological and anatomopathological data, and the collaboration of the medical and paramedical staff from the departments of gastroenterology, visceral surgery, and anatomopathology. The statistical analysis was conducted using SPSS version 22.0. Socio-demographic, clinical and para-clinical data were collected taking into account the global ethical rules relating to confidentiality and protection of patient-specific data.

Results

Out of 42 patients who performed biopsy puncture under high echo-endoscopy on suspicion of diagnosis, ten patients had gastric linitis. The diagnosis of gastric linitis was obtained by puncture in 90% of cases (9/10). Eight patients (80%) had previously undergone at least one oeso-gastro-duodenal fibroscopy with returning negative mucous biopsies. Six patients were diagnosed as early as 1st EEH while 3 others required a second series of biopsies. While the mucous biopsies were also unsuccessful, echo-guided biopsy allowed the diagnosis of other more serious diseases in 43% of cases (n = 18/42) including gastric metastases of a breast cancer (n=2), other gastric adenocarcinomas of the intestinal type (N=8), and cases of T-type gastric lymphoma in one case and MALT type in 2 cases.

Conclusion

In case of suspicion of gastric linitis, guided biopsy puncture under echo-endoscopy is a cost-effective approach in 90% of cases, without noticeable side effects. It should be considered the procedure of choice for early diagnosis of gastric linitis when mucous biopsies return negative.

Introduction

Transjugular intrahepatic portosystemic shunt (TIPS) reduces the portal vein blood flow into the liver while declining portal venous pressure, resulting in liver ischemia injury and even liver failure.

Aims & Methods

This study aimed to verify the impact of the post-TIPS early liver injury on survival through large sample retrospective analysis and explore the risk factors of post-TIPS liver injury. The data of patients undergoing TIPS in West China Hospital from November 2009 to March 2021 were collected. We analysed the predictive ability of end-stage liver disease model score (MELD) on the 90-day, 1-year and 3-year survival rates after TIPS and screened out the independent predictive factors of post-TIPS liver injury by regression analysis.

Results

A total of 1108 patients were included. The post-TIPS MELD score was superior to other scoring systems, with a better predictive effect on the 90-day survival rate and 1-year survival rate. The 90-day survival rate (98.3% vs. 87.2%, HR 15.9, 95% CI 7.9-31.9, P < 0.001), 1-year survival rate (95.1% vs. 79.2%, HR 8.3, 95% CI 5.0-13.7, P < 0.001) and 3-year survival rate (86.5% vs. 68.8%, HR 4.0, 95% CI 2.8-5.7, P < 0.001) were significantly higher in patients with a post-MELD score less than 15. Preoperative total bilirubin, serum creatinine, INR and change of portosystemic pressure gradient were independent predictors of early liver injury after TIPS.

Conclusion

Baseline liver function and pressure reduction contribute to the occurrence of early liver injury after TIPS. Post-TIPS MELD score can accurately predict short-term and long-term survival.

Introduction

Hepatocellular carcinoma (HCC) is the sixth most common cancer in incidence and the third in mortality worldwide. Its incidence is variable worldwide. Seventy-two percent of cases occur in Asia. It is more common in males. Alpha-Feto protein is negative in only 30% of patients with HCC. 60-months survival of HCC ranges from 70% (for early stages) to 20% (for advanced stages). The overall median survival of metastatic HCC is 11 months. Patients with negative AFP usually have better survival than those with positive AFP. The effect of AFP negativity on metastatic HCC survival duration and the factors affecting survival of this subgroup of patients is not well studied.

Aims & Methods

This study aims to identify the factors affecting the overall survival of patients with AFP negative metastatic HCC and their survival duration. A total of 1146 patients with AFP-negative metastatic HCC diagnosed between 1975 to 2020 were extracted from the U.S. Surveillance, Epidemiology and End-results (SEER) program databases. Univariable and Multivariable Cox regression were performed, associated hazards ratio (HR) and Kaplan Meier curves/statistics were generated for overall survival analysis.

Results

Most patients were males (78.8%). Their mean age was 65.6. Most patients were of white race (74.9%) and of non-Spanish-Hispainc-Latino origin (79.8%). Most patients lived in metropolitan areas (87.6%) and earned $75,000+ (37.3%). Most patients were married (48.1%). The mean tumor size was 9.93 cm with 75.1% > 2cm in size. Most patients had T0/T1 stage (41.1%) followed by T3 (32.7%). Most patients had N0/Nx stage (72.7%). Most patients didn’t receive chemotherapy (62.1%).
The median survival of the cohort was 5 months (95% confidence interval: 5-6 months). The survival of the cohort was 99%, 28.3%, 8.5%, 3.8% at 1,12, 36 and 60 months respectively. Univariable Cox regression was statistically significant for age (HR 1.01), grade III (HR 1.55), grade IV (2.75), receiving chemotherapy (HR 0.48), black race (HR 0.80). Univariable Cox regression was non-statistically significant for sex, T stage, N stage, origin, rurality, marital status. Grade wasn’t included in multivariable cox regression due to missing data (71.9%). Multivariable cox regression model was only statistically significant for receiving chemotherapy (HR 0.49).

Conclusion

The overall survival of AFP-negative metastatic HCC is very poor. Chemotherapy may be associated with better survival. However, the chemotherapy variable in SEER is limited by data incompleteness and possible unmeasured causes for receiving or not receiving chemotherapy. It is unclear if patients with negative AFP metastatic HCC survive longer than those with positive AFP metastatic HCC. More studies are needed to study the effect of different biomarkers on the survival of HCC patients.

References

McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of Hepatocellular Carcinoma. Hepatology. 2021;73 Suppl 1(Suppl 1):4-13. doi:10.1002/hep.31288

Introduction

Spontaneous bacterial peritonitis (SBP) is a common bacterial infection in cirrhotic patients, which can lead to severe complication and even death. Proton pump inhibitors (PPIs), are associated with high susceptibility to enteric infections. The aim of this study is to assess if PPIs use in cirrhotic patients is a risk factor for developing SBP.

Aims & Methods

We conducted a retrospective study (January 2019 to March 2024) on all cirrhotic patients with ascites admitted in the Gastroenterology Department of “St. Spiridon” County Clinical Emergency Hospital Iasi, a tertiary referral center. We identified all cases of SBP, defined as elevated ascitic fluid absolute PMN count > 250 cells/mm³, with or without positive ascitic fluid bacterial culture. We assessed previous PPI administration and their respective indications for all patients, to identify a potential risk correlation.

Results

Out of the 1530 cirrhotic patients, 832 (54,4%) were male and 698 (45,6%) were female, with a mean age of 54 years. One hundred and seventy-four patients (11.4%) were diagnosed with SBP. Among them, 50 patients (28.7%) presented previous treatment with PPIs, with a valid indication in 14 (28%) cases. Out of the 1356 cirrhotic patients with ascites but without SBP, 1098 (71.8%) patients had no history of PPIs use. Among the remaining 258 patients (16.9%) undergoing previous PPI treatment, 156 (60.5%) had a valid indication. PPIs were identified as a risk factor for SBP (OR 1.71 [95% CI 1.20 to 2.44]; P=0.0029).

Conclusion

Patients with cirrhosis and ascites who receive PPIs are at a significant risk of SBP, as previous studies have demonstrated. Moreover, given that most patients with SBP lacked a valid indication for PPIs, it is crucial to accurately assess their necessity for such treatment. These findings highlight once again the importance of a comprehensive clinical approach to managing cirrhotic patients.

Introduction

Metabolic dysfunction-associated fatty liver disease (MAFLD) has become the most common chronic liver disease in recent years. However, medications to improve MAFLD has no standard. Several potential agents have been widely investigated for the treatment of MAFLD. Pemafibrate, a selective peroxisome proliferator-activated receptor-α modulator, has been reported to improve dyslipidemia. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) is an oral antidiabetes drug that promotes glucose excretion into the urine. These medications have potential therapeutic effects on MAFLD.

Aims & Methods

This retrospective study aimed to evaluate the effects of long-term administration of pemafibrate plus SGLT2i in patients with dyslipidemia and type 2 diabetes complicated by MAFLD. Transient elastography (FiboScan; Echosens, Paris, France) was used for liver stiffness measurement (LSM) and assessment of the controlled attenuation parameter (CAP). In total, 594 patients with dyslipidemia and type 2 diabetes complicated by MAFLD started pemafibrate plus SGLT2i treatment between 2019 and 2020 at our hospital. Pre- and post-treatment transient elastography data were compared.

Results

Following 3 years of pemafibrate plus SGLT2i treatment, the median LSM significantly decreased from 10.1 kPa to 6.4 kPa (P < 0.001) and the median CAP significantly decreased from 321 dB/m to 219 dB/m (P < 0.001), in spite of no significant reductions of the studied patients’ weight. Moreover, serum parameters, including hemoglobin A1c, alanine aminotransferase, and gamma-glutamyl transferase, significantly decreased over the study period.

Conclusion

The findings of our study confirm that long-term administration of pemafibrate plus SGLT2i can improve hepatic fibrosis by ameliorating hepatic steatosis and inflammation in patients with dyslipidemia and type 2 diabetes complicated by MAFLD.

References

Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008; 48(5): 835-847.
Yamashita S, Masuda D, Matsuzawa Y. Clinical Applications of a Novel Selective PPARα Modulator, Pemafibrate, in Dyslipidemia and Metabolic Diseases. J Atheroscler Thromb. 2019; 26(5): 389-402.
Mantovani A, Petracca G, Csermely A, et al. Sodium-Glucose Cotransporter-2 Inhibitors for Treatment of Nonalcoholic Fatty Liver Disease: A Meta-Analysis of Randomized Controlled Trials. Metabolites. 2020; 11(1): 22.
Murakami K, Sasaki Y, Asahiyama M, et al. Selective PPARα Modulator Pemafibrate and Sodium-Glucose Cotransporter 2 Inhibitor Tofogliflozin Combination Treatment Improved Histopathology in Experimental Mice Model of Non-Alcoholic Steatohepatitis. Cells. 2022;11(4):720.