Introduction

Hepatic venous pressure gradient (HVPG) measurement is invasive. Non-invasive methods for evaluating the severity of portal hypertension in patients with transjugular intrahepatic portosystemic shunt (TIPS) are warranted.

Aims & Methods

This study aims to evaluate the efficacy of spleen stiffness in predicting HVPG and TIPS dysfunction. We performed a systematic review in PubMed, Embase and Cochrane databases, searching for studies comparing spleen stiffness measurements pre-TIPS and post-TIPS. The primary outcome was spleen stiffness. The secondary outcome was spleen stiffness in the context of TIPS dysfunction. The MD was used for continuous outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I² statistics.

Results

The meta-analyses included 13 studies and 521 patients. There was a significant difference in spleen stiffness reduction after TIPS compared to baseline, measured by SSW m/s (MD -0.49; 95% CI -0.55 to -0.43; p<0.01; I²=0%) and by SSM kPa (MD -11.19; 95% CI -13.32 to -9.07; p<0.01; I²=0%). TIPS dysfunction was associated with increased spleen stiffness values (MD 0.35; 95% CI 0.24 to 0.45; p<0.01; I²=0%) compared to normal tips function similarly to those found in pre-TIPS patients.

Conclusion

Our study showed that spleen stiffness is a non-invasive measure to evaluate HPVG reduction after TIPS placement. Spleen stiffness may also be useful in monitoring TIPS dysfunction.

Introduction

Acute esophageal variceal bleeding (EVB) typically requires initial treatment involving pharmacotherapy and endoscopy, particularly endoscopic variceal ligation (EVL). In cases of rebleeding, transjugular intrahepatic portosystemic shunt (TIPS) is recommended, but in regions with limited TIPS access, repeated endoscopic therapy is common. This study evaluates the outcomes of EVL in managing rebleeding and mortality in resource-constrained settings.

Aims & Methods

Patients experiencing acute EVB and undergoing EVL were followed for up to five years or until death. Treatment involved vasoactive drugs and EVL until variceal eradication was achieved. Primary endpoints included bleeding control effectiveness and the need for a second EVL session to manage rebleeding. Rebleeding and mortality rates at 6 weeks and 5 years were analyzed. Logistic regression analysis identified risk factors associated with rebleeding and mortality.

Results

Among 118 patients with acute EVB undergoing EVL, no treatment failures occurred within five days. Eighty-three percent were successfully controlled with one EVL session, while 17% required at least two sessions for recurrent bleeding. In the rebleeding group, no patients rebled within five days after the first EVL, but 75% rebled within 6 weeks. Second EVL was performed for these patients, with a failure rate of 25%. Recurrent EVBs were ultimately controlled by other endoscopic therapy. There was no significant difference in 6-week mortality between rebleeding (15%) and non-rebleeding (18%) groups (p=0.72). Factors associated with 6-week mortality included age, hepatocellular carcinoma, post-bleeding beta-blocker use, creatinine, bilirubin, albumin, Child-Pugh class, and MELD score (Table). Beta-blocker use was associated with preventing recurrent EVB within six months (OR 0.053, 95% CI: 0.004-0.687, p = 0.025). Over five years, the rebleeding group showed a higher mortality trend (90%) compared to the non-rebleeding group (68.8%), though not statistically significant (p=0.06).

Conclusion

In resource-limited settings, multiple attempts of EVL demonstrate success in controlling rebleeding. Long-term trends indicate higher mortality in rebleeding cases, although not statistically significant.

Disclosure

The authors declare that they have no conflict of interest.

Introduction

The prevalence of musculoskeletal disorders (MSD) among gastroenterologists is estimated between 39 to 89%. Factors associated with MSDs among endoscopists include a high number of procedures (over 20/week), prolonged procedure times (over 16 hours/week), the age of the endoscopist (> 40 years vs ≤ 40 years), and female sex.
This study aimed to evaluate the prevalence of MSD among French gastroenterologists and identify risk factors of MSD

Aims & Methods

A computerized, anonymized questionnaire was e-mailed to all members of French society of endoscopy (SFED) over a one-month period. Demographic data were collected, as well as the level of endoscopic activity performed, the quantity and volume of endoscopies performed per week, the presence of pain associated with the practice of endoscopy, and an assessment of stress.

Results

485 gastroenterologists responded to the questionnaires, the majority were male (55%), with a median age of 48 years (IQR 37–60), and 45.6% practiced endoscopy for more than 20 years. 74.3% of respondents worked full-time, mostly in private practice (47% in private practice, 13% in mixed public-private practice). Endoscopy was performed for a median of 15 hours per week (IQR 10–18.8), with 24 procedures per week (IQR 15–30).
76.3% of participants had already experienced joint and/or musculoskeletal pain related to work. Pain complaints mainly concerned the lower back (55%), shoulders (36% left, 37% right%), neck (50%), and wrists (30% both side). More than half of the participants (55.9%) reported that the pain persisted after procedures, with 17.8% experiencing nocturnal pain and about a quarter reporting pain lasting more than 3 months.
The impact of MSD on workload was evaluated. 5.1% of the gastroenterologists reported loss of efficiency, 3,8% adapted their job, 2.4% decreased their activity, and 2.1% had work stoppage. 35% declared to have management of their MSD (28.1% painkiller, 23.2% reeducation, 3.5% surgery). To reduce discomfort, 74.7% of respondents reported using an adjustable-height examination table, and half adjusted the height and distance of the screen.
In multivariate analysis, factors associated with MSD were, femal sexe (OR 1.85 (1.15-3.01) p = 0.012, number of endoscopy (OR 1.05 (1.01-1.11) p=0.03, activity > 20 years (OR 2.42 (0.89, 6.47) p=0.079.) The risk of MSD was higher after 16.5 hours of endoscopy/ week (Se 35%, Sp 83%).

Conclusion

Musculoskeletal pain among French gastroenterologists is common and concerning. Therefore, it is essential to develop preventive programs to support their health and ensure the quality and safety of care.

Introduction

Chronic liver disease, particularly cirrhosis, leads to significant morphological and psychological endocrine changes, which can have an impact on patients' sexual health. Although sexual health is an important parameter of quality of life, it remains little studied in hepatology.

Aims & Methods

The aim of our work is to study the prevalence and degree of sexual dysfunction in male patients with chronic liver disease, and the associated risk factors.
This is a monocentric, comparative, descriptive and analytical study conducted during the year 2023.We included male patients followed for chronic hepatopathies (group 1 (G1)) as well as a control group of subjects followed in gastroenterology consultation presenting no hepatic pathology (group 2(G2)). Exclusion criteria were the existence of overt hepatic encephalopathy, cognitive disorders or active alcohol abuse, limiting the reliability of the survey.
Sexual health was assessed using the IIEF (International Index of Erectile Function) questionnaire, which covers five domains: erection, orgasm, desire, satisfaction with intercourse and overall satisfaction. Two software packages were used for statistical analysis: Jamovi version 2.3.28 and Microsoft Excel.

Results

Our study included 120 patients, 60 followed for chronic liver disease, and 60 without liver pathology (control group).
Mean age was 44.6 years (21-73 years).
In the group of patients with hepatopathies, we found:
34 (65%) cirrhotics, 24 (40%) of whom had a history of decompensation.
18 (30%) HBV, 11(18%) HCV, 5 (8%) NAFLD, 5 (8%) of undetermined cause, 5 (8%) portal hypertension, 4 (6.6%) portal thrombosis, 12 (19.8%) others.
Patients in the liver disease group had more erectile dysfunction, orgasmic dysfunction, disorders of desire, disorders of sexual satisfaction and disorders of overall satisfaction compared with the control group, with respectively 40/60 (66. 6%) vs 16/60 (26.6%) p 0.003; 35/60 (58.3%) vs 14/60 (23.3%) p 0.012; 41/60 (68.3%) vs 10/60 (16.6) p <.001; 38/60 (63.3%) vs 18/60 (30%) p <.001; and 45/60 (75%), vs 17/60 (28.3%) p <.001.
After statistical analysis, cirrhosis was the only statistically significant risk factor for sexual dysfunction in our study (OR 7.9 ;p 0.012).
Moreover, 100% of patients said they had never been asked about their sexual health during a consultation.

Conclusion

Sexual dysfunction is common in patients followed for liver disease, with cirrhosis as the main risk factor. Sexual dysfunction should be systematically screened, with a multidisciplinary approach to the management of these patients.

Introduction

This study revisits the management and outcomes of acute upper gastrointestinal bleeding (AUGIB) in cirrhotic patients across the United Kingdom, allowing comparisons with the last UK wide audit undertaken in 2007 .¹

Aims & Methods

Focusing on cirrhotic patients with variceal bleeding, we analyze patient profiles, investigations, treatments, and outcomes, drawing comparisons with the 2007 study. A prospective multi-center observational study of adults (>16 years) presenting to 152 UK hospitals with AUGIB between 3 May - 2 Jul 2022.

Results

744/5101 (15%) presenting with AUGIB had known cirrhosis (Child-Pugh categories: A:1%, B: 47%, C: 11%.)with median age of 59yrs (IQR 49.7-69). 73%(547/744) were new admissions. Glasgow-Blatchford score(GBS), stratified patients into, 22% medium-risk(GBS 2-6),47% high-risk(7-11),and 30% very high-risk(≥12). For pre-endoscopy management: 58%(433) received proton pump inhibitors(PPI), 50%(371) terlipressin/vasopressor and 44%(326) antibiotics. An endoscopy was performed for 91%(679/744). Time to endoscopy from presentation was: 0-12 hrs in 25%, 12-24 hrs in 25%, & 24-48 hrs in 21%. 45% (307/679) were identified to have varices (91% - oesophageal, 15% - gastric and 2% - duodenal) and 33%(224/679) had non-variceal findings. Median age of patients with varices (n=307) was 57 yrs (IQR 49-68). Stigmata of recent bleed were noted for 72%(222) - 45% blood in the upper GI tract and 65% high risk markings on varices and endotherapy was applied for 78%(241). Variceal therapy applied in 70%(214 – 93% banding, 12% injection therapy), Danis stent 2%(5) and Sengstaken tube 6%(14). 18% (55) had evidence of further in-patient bleeding after index endoscopy. During inpatient stay, 26%(81) needed >1 endoscopy, and 2%(6) underwent transjugular intrahepatic portosystemic shunt(TIPSS). 67%(206) were transfused ≥1 packed red blood cells, 17%(53) platelets and 22%(68) fresh frozen plasma for AUGIB. Median length of stay was 7days (IQR 5-11) and in-hospital mortality was 13%(40). Comparisons with the 2007 audit for patients with varices revealed an increased average age (58yrs vs 54.5 yrs), increased pre-endoscopic use of PPI (62% vs 50%),vasopressors (70% vs 57%) and antibiotics (61% vs 27%). There was a significant increase in those receiving endotherapy (78% vs 64%) and undergoing TIPSS (2% vs .8%), along with a lower likelihood of further in-patient bleeding after an index endoscopy (18% vs 26%), and numerically lower in-hospital mortality (13% vs 15.2%).Comparisons with the 2007 audit are presented in table 1.
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Conclusion

Compared with 2007 patients presenting with variceal haemorrhage were more likely to receive optimal treatment, had reduced length of stay, reduced rebleeding and a trend towards reduced mortality. Our data suggests that further improvements in pre-endoscopic management and provision of TIPSS are required.

References

1. Hearnshaw et al Gut 2011