Euroasian Journal of Hepato-Gastroenterology最新文献

Background: Therapeutic plasma exchange (PLEX) removes toxins and different mediators from plasma in patients with acute-on-chronic liver failure (ACLF).

Aim: To observe the safety and outcome of PLEX in ACLF patients in Bangladesh.

Materials and methods: Twenty-eight patients with ACLF attending Bangabandhu Sheikh Mujib Medical University from September 2020 to May 2021 were enrolled in the study. The patients were given different treatment modalities and followed up for 3 months or up to death. The patients were divided into two groups, each containing 14 patients of ACLF. One group of 14 patients received standard medical therapy (SMT) for ACLF and the second group of 14 patients received SMT plus PLEX.

Results: At 90 days, a total of 13 patients (46.43%) survived, of them 8 (57.1%) belonged to PLEX group and 5 (35.7%) were from SMT group. Serum bilirubin and ALT declined significantly after 7 and 30 days but not after 90 days in PLEX group in comparison to SMT group (p <0.05) but other biochemical parameters were not significantly different (p >0.05) between these two groups. Significant (p <0.05) improvement of MELD, MELD-Na, and AARC scores was observed in each group from baseline to subsequent first, second, and third follow-up but no significant (p >0.05) difference was observed in between two groups. Binary logistic regression analysis found that bilirubin, MELD score, MELD-Na score, and AARC score were predictors of mortality.

Conclusion: The study presented here has shown that PLEX is safe in Bangladeshi in ACLF patients, but its efficacy remains to be checked in large-scale randomized trial or in combination therapy with other procedures in ACLF patients.

How to cite this article: Al Mukit A, Al Mahtab M, Rahim MA, et al. Plasma Exchange in Patients of Acute on Chronic Liver Failure: An Observational Study in Bangladesh. Euroasian J Hepato-Gastroenterol 2022;12(1):1-5.

Disconnected pancreatic duct syndrome (DPDS) is a condition where there is a ductal disconnection between viable secreting distal pancreatic tissues and the gastrointestinal tract. It may follow acute or chronic pancreatitis, abdominal trauma, and pancreatic surgery, leading to necrosis or structural disintegration of the pancreatic duct.

Aim: The aim of our study is to describe the imaging features of DPDS on ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) that helps in diagnosis.We present a case series of DPDS with their imaging features in two settings, one in the patient with acute necrotizing pancreatitis and the other with blunt abdominal trauma.

Conclusion: Imaging plays a significant role in preoperative diagnosis. Contrast-enhanced computed tomography provides a comprehensive assessment of pancreatic duct integrity, and it shows its type and site of ductal disruption. It is a simple, effective noninvasive imaging modality in diagnosing pancreatic duct disruption.

How to cite this article: Satyam S, Singh S, Sah PK. Disconnected Pancreatic Duct Syndrome: A Case Series. Euroasian J Hepato-Gastroenterol 2022;12(1):60-63.

Aim: To briefly discuss the imaging features of different types of intra-abdominal fat necrosis.

Background: Trauma and ischemic insult may result in intra-abdominal fat necrosis. Fat necrosis may present with acute abdomen, clinically simulating with other etiologies, such as acute diverticulitis and acute appendicitis.

Main body: Imaging plays a crucial role in making the exact diagnosis and differentiating it from other pathologies that may require surgical intervention. Computed tomography (CT) is the most commonly used imaging modality. A small fat attenuation lesion with a hyperattenuating rim in contact with the ventral surface of the sigmoid colon indicates epiploic appendagitis while a larger fat-attenuation lesion on the right side of the abdomen in between the colon and anterior abdominal wall indicates omental infarction. Fat stranding at the root of the mesentery with fat ring sign represents inflammatory mesenteric panniculitis while retractile or sclerosing mesenteritis appears as a fibrotic spiculated mass with or without calcification, mimicking mesenteric carcinoid. In patients with acute pancreatitis, the amount of inflamed fat correlates with clinical severity and outcome.

Conclusions: Familiarity with the imaging features of different types of intraabdominal fat necrosis helps in establishing an accurate diagnosis, thus avoiding unnecessary intervention.

How to cite this article: Patel RK, Mittal S, Singh S. Imaging of Mischievous Intra-abdominal Fat Presenting with Abdominal Pain: A Pictorial Review. Euroasian J Hepato-Gastroenterol 2022;12(1):45-49.

Background: Every year, worldwide, the celebration for patient safety is carried out; since about 2.6 million people are documented who die each year from events that can potentially be avoided during their medical care, it is even estimated that around 15% of hospital costs can be attributed to treatment resulting in patient safety. As an important part of its dissemination in the medical-surgical community, we present the following article in relation to the critical vision of safety in the bile duct, promoted and published initially by Dr Steven Strasberg, which aims to reduce the number of complications during laparoscopic cholecystectomies.

Materials and methods: A bibliographic search was carried out in PubMed, Medline, Clinical Key, and Index Medicus. From May 2020 to July 2021 in Spanish and English with the following.

Conclusions: Strasberg's critical view is a proposed strategy to minimize the risk to zero during laparoscopic gallbladder surgery. It consists of obtaining a plane in which the surgeon can visualize the anatomical structures that make up the bile duct, as well as its irrigation and drainage. Being able to clearly observe these structures allows the surgeon to cut freely and safely to avoid bile duct injuries which are not so uncommon during this procedure.

How to cite this article: Montalvo-Javé EE, Contreras-Flores EH, Ayala-Moreno EA, et al. Strasberg's Critical View: Strategy for a Safe Laparoscopic Cholecystectomy. Euroasian J Hepato-Gastroenterol 2022;12(1):40-44.

Cervical adenocarcinoma accounts for 25% of invasive cervical cancer which frequently metastasize distantly to the lungs, liver, bone, and brain. Metastases to the common bile duct from cervical cancer are exceedingly rare with few reported cases in the literature. Diagnosis of bile duct metastases from cervical cancer can be established with endoscopic ultrasound-guided fine-needle aspiration cytology, biliary cytobrushing, or direct cholangioscopy with biopsy, and this would guide further therapies such as endoscopic biliary drainage and systemic chemotherapy. We hereby present a rare case of obstructive jaundice from metastatic biliary stricture with "beaded" appearance in a patient with cervical adenocarcinoma. How to cite this article: Lee SL, Sidhu J, Ng CY. Metastatic Biliary Stricture with "Beaded" Appearance from Cervical Adenocarcinoma. Euroasian J Hepato-Gastroenterol 2021;11(2):97-99.

Background: Recently for advanced gallbladder carcinoma, neoadjuvant chemotherapy has emerged as an important strategy in place of adjuvant chemotherapy with the hope that it will help to improve the resectability and survival.

Aim and objective: The goal was to conduct a systematic review of published publications on the benefits of neoadjuvant chemotherapy for advanced gallbladder cancer treatment.

Materials and methods: This systematic review followed the Meta-analysis Of Observational Studies in Epidemiology standards. The clinical benefit rate of neoadjuvant chemotherapy, curative resectability rate, and R0 resection were the major outcomes of interest. The secondary outcomes of interest were overall and disease-free survival.

Results: Six published papers were included (n = 420). One-hundred and twenty-eight cases (30.47%) despite receiving neoadjuvant chemotherapy had disease progression. Although 67.38% of patients (283 of 420) in this systematic review showed good response to the neoadjuvant chemotherapy, just 51.66% (217 of 420 cases) were operated, out of which only 171 cases were deemed to be feasible for surgical resection and had curative resection. Out of the cases that underwent curative surgery, 91.81% had R0 resection (157 out of 171 patients). The overall survival rate was found to be 18.5-50.1 months for patients in whom curative surgery was done and 5.0-10.8 months for nonsurgery patients.

Conclusion: No sufficient data exist to advocate the regular use of neoadjuvant chemotherapy in advanced gallbladder carcinoma, as data showed that only 1/3 of patients benefited and had a R0 resection. Further research should be the randomized controlled trials to further quantify the benefit of neoadjuvant chemotherapy in advanced gallbladder carcinoma.

How to cite this article: Naveed S, Qari H, Thau CM, et al. Neoadjuvant Chemotherapy for Advanced Gallbladder Cancer: Do We have Enough Evidence? A Systematic Review. Euroasian J Hepato-Gastroenterol 2021;11(2):87-94.

Background: About 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course.

Aim and objective: The purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms.

Materials and methods: A total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated.

Results: Biliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT.

Conclusion: Patients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning.

How to cite this article: Patel RK, Chandel K, Mittal S, et al. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepato-Gastroenterol 2021;11(2):76-80.

Inflammatory bowel disease (IBD) is a serious condition characterized by a complex interaction of genetic, environmental, and inflammatory variables that affect the gut and other extragastrointestinal systems. Self-medication with steroids has become a major issue in light of the current pandemic situation in IBD patients. We observed a higher frequency of steroid self-medication (17.9%) and steroid overprescription (28.2%) by non-gastroenterologists during the pandemic. The use of telemonitoring tools can improve patient-IBD care provider communications in terms of drug compliance and better disease outcomes. How to cite this article: Vinay G. Increased Self-medication with Steroids in Inflammatory Bowel Disease Patients during COVID-19 Pandemic: Time to Optimize Specialized Telemonitoring Services. Euroasian J Hepato-Gastroenterol 2021;11(2):103-104.

Needle knife papillotomy has become an invaluable advanced biliary access technique in routine endoscopic retrograde cholangiopancreatography (ERCP). Albeit poorly standardized in terms of procedural details, usually superficial cuts are applied to open the bile duct in an onion-like manner. However, this implies the capability to direct cuts from some distance from the papilla controlling needle knife movements in a complex fashion involving elevator movements. Here, an as-yet unreported technique designated the "lever technique" is presented for difficult needle knife access, when encountering technical difficulties, such as unstable scope position and awkward bile duct angle to allow for controlled needle knife navigation. In such variant rescue approach involving well-characterized prepapillary stone impaction by preceding same-session endoscopic ultrasound (EUS), thus providing some safety plane, ultranear-view instrumentation is coupled with exclusive needle knife navigation by moving the large dial, thus moving scope and needle knife-like as one endoscopic device. How to cite this article: Zimmer V. "Lever Technique": A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video). Euroasian J Hepato-Gastroenterol 2021;11(2):95-96.

Introduction: More than 180 million people have been infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and more than 4 million coronavirus disease-2019 (COVID-19) patients have died in 1.5 years of the pandemic. A novel therapeutic vaccine (NASVAC) has shown to be safe and to have immunomodulating and antiviral properties against chronic hepatitis B (CHB).

Materials and methods: A phase I/II, open-label controlled and randomized clinical trial of NASVAC as a postexposure prophylaxis treatment was designed with the primary aim of assessing the local and systemic immunomodulatory effect of NASVAC in a cohort of suspected and SARS-CoV-2 risk-contact patients. A total of 46 patients, of both sexes, 60 years or older, presenting with symptoms of COVID-19 were enrolled in the study. Patients received NASVAC (100 μg per Ag per dose) via intranasal at days 1, 7, and 14 and sublingual, daily for 14 days.

Results and discussion: The present study detected an increased expression of toll-like receptors (TLR)-related genes in nasopharyngeal tonsils, a relevant property considering these are surrogate markers of SARS protection in the mice model of lethal infection. The HLA-class II increased their expression in peripheral blood mononuclear cell's (PBMC's) monocytes and lymphocytes, which is an attractive property taking into account the functional impairment of innate immune cells from the periphery of COVID-19-infected subjects. NASVAC was safe and well tolerated by the patients with acute respiratory infections and evidenced a preliminary reduction in the number of days with symptoms that needs to be confirmed in larger studies.

Conclusions: Our data justify the use of NASVAC as preemptive therapy or pre-/postexposure prophylaxis of SARS-CoV-2 and acute respiratory infections in general. The use of NASVAC or their active principles has potential as immunomodulatory prophylactic therapies in other antiviral settings like dengue as well as in malignancies like hepatocellular carcinoma where these markers have shown relation to disease progression.

How to cite this article: Fleites YA, Aguiar J, Cinza Z, et al. HeberNasvac, a Therapeutic Vaccine for Chronic Hepatitis B, Stimulates Local and Systemic Markers of Innate Immunity: Potential Use in SARS-CoV-2 Postexposure Prophylaxis. Euroasian J Hepato-Gastroenterol 2021;11(2):59-70.