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Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function?

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Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 307-313页

作者： Masahiro Okada Kazunari Ishii Kazushi Numata Tomoko Hyodo Seishi Kumano Masayuki Kitano Masatoshi Kudo Takamichi Murakami department of radiology kinki university faculty of medicine Gastroenterological Center Yokohama City University Medical Center department of radiology and department of gastroenterology and hepatology kinki university faculty of medicine

BACKGROUND: Excretion of gadolinium-ethoxybenzyl-diethyl- enetriamine pentaacetic acid (Gd-EOB-DTPA) in the bile may be related to liver function, because of elimination from the liver after preferential uptake by hepatocytes. The purpose of this study was to investigate the relation between liver and biliary enhancement in patients with or without liver dysfunction, and to compare the tumor-to-liver contrast in these patients. METHODS: Forty patients [group 1: normal liver and Child Pugh class A in 20 patients, group 2: Child-Pugh class B in 18 patients and Child-Pugh C in 2] were evaluated. All patients underwent MR imaging of the liver using a 1.5-Tesla system. T1 weighted 3D images were obtained at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA injection. The relation between group 3 (total bilirubin <1.8 mg/dL) and group 4 (total bilirubin ≥1.8 mg/dL) was investigated at 20 minutes. Liver and biliary signals were measured, and compared between groups 1 and 2 or groups 3 and 4. Tumor-to-liver ratio was also evaluated between groups 1 and 2. Scheffé’s post-hoc test after two-way repeated measures ANOVA and Pearson’s correlation test were used for statistical analysis. RESULTS: Liver enhancement showed significant difference at all time points between groups 1 and 2. Biliary enhancement did not show a significant difference between groups 1 and 2 at 5 minutes, but did at 10, 15 and 20 minutes. At 20 minutes significant differences between groups 3 and 4 were seen for liver and biliary enhancement. At all time points, liver enhancement correlated with biliary enhancement in both groups. At 5 minutes and 20 minutes, statistical differences between groups 1 and 2 were seen for tumor-to-liver ratio.CONCLUSIONS: The degree of biliary enhancement has a close correlation to that of liver enhancement. It is especially important that insufficient liver enhancement causes lower tumor-to-liver contrast in the hepatobiliary phase of Gd-EOB- DTPA.

关键词： magnetic resonance imaging Gd-EOB-DTPA liver bile duct hepatobiliary phase

Percutaneous endoscopic gastrostomy with Funada-style gastropexy greatly reduces the risk of peristomal infection

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gastroenterology Report 2015年第1期3卷 69-74页

作者： Naoki Okumura Naoko Tsuji Nobuto Ozaki Nozomu Matsumoto Takehisa Takaba Masanori Kawasaki Takafumi Tomita Yasuko Umehara Satoko Taniike Masashi Kono Masatoshi Kudo department of gastroenterology Sakai HospitalKinki University Faculty of MedicineSakaiJapan department of gastroenterology and hepatology Kinki University Faculty of MedicineOsaka-sayamaJapan

Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and was developed about 20 years ago in Japan.This kit has allowed us to perform dual gastropexy very easily;PEG with gastropexy has become a very popular technique in Japan.The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard‘pull’method.Methods:We retrospectively reviewed 182 consecutive,non-randomized patients undergoing PEG in our hospital,and a comparative analysis was made between the gastropexy(87 patients)and non-gastropexy(95 patients)groups.Results:The rates of patients having erythema(11.6%vs.47.9%;P<0.001),exudates(2.3%vs.14.9%;P<0.01)and infection(0%vs.6.4%;P紏0.01)in the peristomal area were lower in the gastropexy than in the non-gastropexy group.The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group(12.8%vs.2.1%;P<0.01),but no patient required a blood transfusion.Mean procedure time was longer in the gastropexy group than in the non-gastropexy group(31 vs.24 min;P<0.001).The 30-day mortality rates were 4.7%and 5.3%respectively,and these deaths were not related to the gastrostomy procedure.Conclusion:PEG with gastropexy markedly reduces peristomal inflammation.Although minor bleeding and a longer procedure time were disadvantages,there were no severe complications.The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.

关键词： percutaneous endoscopic gastrostomy gastropexy peristomal infection

Impact of alcohol consumption on treatment outcome of hepatocellular carcinoma patients with viral hepatitis who underwent transarterial chemoembolization

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World Journal of hepatology 2022年第6期14卷 1162-1172页

作者： Attapon Rattanasupar Arunchai Chang Tanaporn Prateepchaiboon Nuttanit Pungpipattrakul Keerati Akarapatima Apiradee Songjamrat Songklod Pakdeejit Varayu Prachayakul Teerha Piratvisuth Division of gastroenterology Department of Internal MedicineHatyai HospitalHatyai 90110SongkhlaThailand department of Internal medicine Hatyai HospitalHatyai 90110SongkhlaThailand Division of Intervention radiology Department of RadiologyHatyai HospitalHatyai 90110SongkhlaThailand Siriraj Gastrointestinal Endoscopy Center Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkoknoi 10700BangkokThailand NKC Institute of gastroenterology and hepatology Songklanagarind HospitalFaculty of MedicinePrince of Songkla UniversityHatyai 90110SongkhlaThailand

BACKGROUND Alcohol consumption increases the risk of hepatocellular carcinoma(HCC)in patients with pre-existing liver disease,including viral hepatitis.However,studies on the impact of alcohol consumption on the outcomes of HCC are limited.We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization(TACE)in patients with intermediate-stage HCC(Barcelona Clinical Liver Cancer[BCLC]-B).AIM To evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis.METHODS This study,conducted at Hatyai Hospital in Thailand,included HCC patients over 18 years of age with chronic viral hepatitis.Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed.Patients with chronic viral hepatitis only were categorized under group A,and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B.Both groups were compared,and the Cox proportional-hazards model was used to identify the survival-influencing variables.RESULTS Of the 69 patients,53 were categorized in group A and 16 in group B.There were no statistically significant differences in tumor characteristics between the two patient groups.However,Group A had a statistically significantly higher proportion of complete response(24.5%vs 0%,P=0.030)and a higher median survival rate(26.2 mo vs 8.4 mo;log-rank P=0.012)compared to group B.Factors associated with decreased survival in the proportional-hazards model included alcohol consumption(hazards ratio[HR],2.377;95%confidence interval[CI],1.109-5.095;P=0.026),presence of portal hypertension(HR,2.578;95%CI,1.320–5.037;P=0.006),largest tumor size>5 cm(HR,3.558;95%CI,1.824-6.939;P100 ng/mL(HR,2.536;95%CI,1.377-4.670;P=0.003).CONCLUSION In HCC BCLC B patients with chronic viral hepatitis,alcohol consumption

关键词： Alcohol misuse Chronic viral hepatitis Hepatocellular carcinoma Risk factor Survival Transarterial chemoembolization

Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

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World Journal of Clinical Cases 2018年第16期6卷 1087-1093页

作者： Shiro Hayashi Mamoru Takenaka Makoto Hosono Tsutomu Nishida department of gastroenterology and Internal medicine Hayashi Clinic department of gastroenterology Toyonaka Municipal Hospital department of gastroenterology and hepatology Kindai University Faculty of Medicine department of radiology Kindai University Faculty of Medicine

Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

关键词： Quality indicator Fluoroscopic procedures Endoscopic retrograde cholangiopancreatography Diagnostic reference levels Radiation exposure

Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm

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World Journal of gastroenterology 2010年第33期16卷 4187-4192页

作者： Keiji Mita Soo Ryang Kim Masatoshi Kudo Susumu Imoto Taisuke Nakajima Kenji Ando Katsumi Fukuda Toshiyuki Matsuoka Yoko Maekawa Yoshitake Hayashi department of gastroenterology Kobe Asahi Hospital department of gastroenterology and hepatology Kinki University School of Medicine department of radiology Osaka City University Medical School department of Surgery Hyogo Cancer Center Center for Infectious Diseases Kobe University Graduate School of Medicine

AIM:To compare the imaging results with histology and to evaluate the diagnostic sensitivity of imaging modalities for hepatocellular carcinoma(HCC)smaller than 2 cm.METHODS:Nodules smaller than 2 cm(n=34)revealed by ultrasonography(US)in 29 patients with liver cirrhosis were analyzed.Histological diagnosis of HCC was performed by ultrasonographic guidance:moderately-differentiated HCC(n=24);well-differentiated HCC(n=10).The patterns disclosed by the four imaging modalities defined the conclusive diagnosis of HCC:(1)contrast-enhanced computed tomography(CECT),hypervascularity in the arterial phase and washout in the equilibrium phase;(2)Sonazoid contrast-enhanced US(CEUS),hypervascularity in the early vascular phase and defect in the Kupffer phase;(3)gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOBDTPA)-enhanced magnetic resonance imaging(MRI),hypervascularity in the arterial phase and/or defect in the hepatobiliary phase;and(4)CT arterioportal angiography:hypervascularity by CT during arteriography and/ or perfusion defect by CT during arterial portography.RESULTS:Overall,the sensitivity of diagnosing HCC smaller than 2 cm was 52.9%(18/34)(95%CI:35.170.2)by CECT;67.6%(23/34)(95%CI:49.5-82.6)by Sonazoid CEUS;76.5%(26/34)(95%CI:58.8-89.3) by Gd-EOB-DTPA MRI;and 88.2%(30/34)(95%CI: 72.5-96.7)by CT arterioportal angiography.The diagnostic sensitivity of detecting moderately-differentiated HCC by CECT,Sonazoid CEUS,Gd-EOB-DTPA MRI and CT arterioportal angiography was 62.5%(15/24)(95%CI: 40.6-81.2),79.2%(19/24)(95%CI:57.8-92.9),75.0% (18/24)(95%CI:53.3-90.2)and 95.8%(23/24)(95% CI:78.9-99.9),respectively.A significant difference(P< 0.05)was observed between CECT and CT arterioportal angiography in all nodules.There was no difference between Sonazoid CEUS,Gd-EOB-DTPA MRI,and CT arterioportal angiography.The combined sensitivity of Sonazoid CEUS and Gd-EOB-DTPA MRI was 94.1%(32/34).CONCLUSION:Changing the main diagnostic modality for HCC smaller than 2 cm from CT arterioportal angiography to Sonazoid C

关键词： Computed tomography arterioportal angi- ography Contrast-enhanced computed tomography Diagnostic sensitivity Gd-EOB-DTPA-enhanced magnetic resonance imaging Hepatocellular carcinoma smaller than 2 cm:Sonazoid contrast-enhanced ultrasonography

Pediatric liver transplantation outcomes from a single center in Thailand

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World Journal of hepatology 2022年第3期14卷 583-591页

作者： Sittichoke Prachuapthunyachart Palittiya Sintusek Chomchanat Tubjareon Nataruks Chaijitraruch Anapat Sanpavat Teerasak Phewplung Piyaporn Wanawongsawad Ai-lada Intrarakamhang Voranush Chongsrisawat department of Pediatrics Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand Thai Pediatric gastroenterology Hepatology and Immunology Research UnitDepartment of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalThai Red CrossChulalongkorn UniversityBangkok 10330Thailand Excellence Center of Organ Transplantation King Chulalongkorn Memorial HospitalBangkok 10330Thailand department of Pathology Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand department of radiology Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial HospitalBangkok 10330Thailand

BACKGROUND Liver transplantation(LT)has become an acceptable curative method for children with several liver diseases,especially irreversible acute liver failure and chronic liver diseases.King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases.AIM To report the experience with pediatric LT and evaluate outcomes of livingrelated vs deceased-donor grafts.METHODS This evaluation included children who underwent LT between August 2004 and November 2019.Data were retrospectively reviewed,including demographics,diagnoses,laboratory values of donors and recipients,the pediatric end-stage liver disease(PELD)or model for end-stage liver disease(MELD)score,graft source,wait time,perioperative course,postoperative complications,and survival rates.Continuous data were reported using the median and interquartile range.The Mann–Whitney U-test was used to compare the wait time between the living-related and deceased-donor groups.The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications.Survival rates were calculated using the Kaplan–Meier method.RESULTS Ninety-four operated pediatric liver transplant patients were identified(54%were females).The median age at transplantation was 1.2(0.8-3.8)years.The median PELD and MELD scores were 20(13-26.8)and 19.5(15.8-26.3),respectively.Most grafts(81.9%)were obtained from living-related donors.The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6(0.3-3.1)mo vs 11.2(2.1-33.3)mo(P=0.01).Most patients were diagnosed with biliary atresia(74.5%),and infection was the most common complication within 30 d posttransplantation(14.9%).Without a desensitization protocol,9%of transplants were ABOincompatible.Eight hepatitis B core antibodies(anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications.The overall survival rate was 93.6%and 90.3%at 1 and 5 years,respectively.No

关键词： Pediatric Liver transplantation Living-donor Hepatitis B ABO-incompatible Survival

Anabolic androgenic steroid-induced liver injury:An update

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World Journal of gastroenterology 2022年第26期28卷 3071-3080页

作者： Ana Petrovic Sonja Vukadin Renata Sikora Kristina Bojanic Robert Smolic Davor Plavec George Y Wu Martina Smolic department of Pharmacology and Biochemistry Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia department of Pharmacology Faculty of Medicine OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia department of Dental medicine Faculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia department of Dental medicine Health Center Osijek-Baranja CountyOsijek 31000Croatia department of Otorhinolaryngology Neurosurgery and RadiologyFaculty of Dental Medicine and Health OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia department of Biophysics and radiology Faculty of Medicine OsijekJ.J.Strossmayer University of OsijekOsijek 31000Croatia department of radiology Health Center Osijek-Baranja CountyOsijek 31000Croatia Research department Srebrnjak Children's HospitalZagreb 10000Croatia department of medicine Division of Gastrenterology/HepatologyUniversity of Connecticut Health CenterFarmingtonCT 06030United States

Anabolic androgenic steroids(AASs)are a group of molecules including endogenous testosterone and synthetic derivatives that have both androgenic and anabolic effects.These properties make them therapeutically beneficial in medical conditions such as hypogonadism.However,they are commonly bought illegally and misused for their anabolic,skeletal muscle building,and performanceenhancing effects.Supraphysiologic and long-term use of AASs affects all organs,leading to cardiovascular,neurological,endocrine,gastrointestinal,renal,and hematologic disorders.Hepatotoxicity is one of the major concerns regarding AASs treatment and abuse.Testosterone and its derivatives have been most often shown to induce a specific form of cholestasis,peliosis hepatis,and hepatic benign and malignant tumors.It is currently believed that mechanisms of pathogenesis of these disorders include disturbance of antioxidative factors,upregulation of bile acid synthesis,and induction of hepatocyte hyperplasia.Most toxicity cases are treated with supportive measures and liver function normalizes with discontinuation of AAS.However,some long-term consequences are irreversible.AAS-induced liver injury should be taken in consideration in patients with liver disorders,especially with the increasing unintentional ingestion of supplements containing AAS.In this paper,we review the most current knowledge about AAS-associated adverse effects on the liver,and their clinical presentations,prevalence,and pathophysiological mechanisms.

关键词： Androgens Steroids Cholestasis Fibrosis Liver Chemical and drug induced liver injury

Correlation between Fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis

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World Journal of hepatology 2022年第4期14卷 744-753页

作者： Layal Al Nanaf Mohammed Hussein Kamareddine Emilie Fayad Aniqa Hussain Said Farhat department of Radiological Science American University of Science and TechnologyFaculty of Health SciencesBeirut 1100Lebanon department of Internal medicine Lankenau Medical CenterPhiladelphiaPA 19131United States department of radiology Saint George Hospital University Medical CenterBeirut 1100Lebanon faculty of medicine University of New South WalesSydney 2052Australia department of gastroenterology Saint George Hospital University Medical CenterBeirut 1100Lebanon

BACKGROUND Non-alcoholic fatty liver disease(NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis(NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIM To explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODS This study was conducted on NAFLD/NASH patients(n = 73) who underwent Fibroscan examinations at Saint George Hospital university Medical Center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase(AST)/alanine transaminase(ALT) ratio, AST platelet ratio index(APRI) score and Fibrosis-4 score.RESULTS A significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSION This study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Fibroscan Cirrhosis hepatology

Insights into hepatitis E virus epidemiology in Croatia

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World Journal of gastroenterology 2022年第37期28卷 5494-5505页

作者： Pavle Jelicic Thomas Ferenc Anna Mrzljak Lorena Jemersic Natasa Janev-Holcer Milan Milosevic Maja Bogdanic Ljubo Barbic Branko Kolaric Vladimir Stevanovic Mateja Vujica Zeljka Jurekovic Jadranka Pavicic Saric Maja Vilibic Tatjana Vilibic-Cavlek department of Environmental Health Croatian Institute of Public HealthZagreb 10000Croatia department of radiology Merkur University HospitalZagreb 10000Croatia department of gastroenterology and hepatology University Hospital Center ZagrebZagreb 10000Croatia School of medicine University of ZagrebZagreb 10000Croatia department of Virology Croatian Veterinary InstituteZagreb 10000Croatia department of Social medicine and Epidemiology Faculty of Medicine University of RijekaRijeka 51000Croatia department of Occupational and Environmental Health Andrija Stampar School of Public HealthZagreb 10000Croatia department of Virology Croatian Institute of Public HealthZagreb 10000Croatia department of Microbiology and Infectious Diseases with Clinic Faculty of Veterinary Medicine University of ZagrebZagreb 10000Croatia department of Gerontology and Social medicine Andrija Stampar Teaching Institute of Public HealthZagreb 10000Croatia Institute of Emergency medicine of Krapina-Zagorje County Krapina 49000Croatia department of Nephrology Merkur University HospitalZagreb 10000Croatia department of Anesthesiology University Hospital MerkurZagreb 10000Croatia department for Social Psychiatry Psychotherapy and PsychodiagnosticsUniversity Clinical Hospital Center“Sestre Milosrdnice”Zagreb 10000Croatia

BACKGROUND Hepatitis E virus(HEV)is an emerging virus of global health concern.The seroprevalence rates differ greatly according to geographic region and population group.AIM To analyze the seroprevalence of HEV in exposed(animal-related professions)and nonexposed populations,as well as solid organ and hematopoietic stem cell transplant patients.METHODS Forestry workers(n=93),hunters(n=74),and veterinarians(n=151)represented the exposed population.The general population(n=126)and pregnant women(n=118)constituted the control group.Transplant patients included liver transplant recipients(LTRs)(n=83),kidney transplant recipients(KTRs)(n=43),and hematopoietic stem cell transplant recipients(HSCRs)(n=39).HEV immunoglobulin G antibodies were detected using the enzyme-linked immunosorbent assay and confirmed by the immunoblot test.RESULTS The HEV seroprevalence significantly differed between groups:Veterinarians 15.2%,hunters 14.9%,forestry workers 6.5%,general population 7.1%,and pregnant women 1.7%.In transplant patients,the seropositivity was highest in LTRs(19.3%),while in KTRs and HSCRs,the seroprevalence was similar to the general population(6.9%and 5.1%,respectively).A significant increase in seropositivity with age was observed from 2.9%in individuals less than 30 years to 23.5%in those older than 60 years.Sociodemographic characteristics(sex,educational level,area of residence,and number of household members),eating habits(game meat,offal,and pork products consumption),and environmental and housing conditions(drinking water supply,type of water drainage/sewer,waste disposal,domestic animals)were not associated with HEV seropositivity.However,individuals who reported a pet ownership were more often seropositive compared to those who did not have pet animals(12.5%vs 7.0%).CONCLUSION The results of this study showed that individuals in professional contact with animals and LTRs are at higher risk for HEV infection.In addition,age is a significant risk factor for HEV seropositivity.

关键词： Hepatitis E virus Seroprevalence Veterinarians Hunters Forestry workers Transplant patients Croatia