Concomitant Liver Cirrhosis Research Articles

Does liver cirrhosis affect outcomes in non-metastatic esophageal squamous cell carcinoma (ESCC) undergoing radiotherapy-based treatment?

89 Background: Liver cirrhosis frequently coexists with esophageal squamous cell carcinoma (ESCC), as both conditions share alcohol consumption as a common etiological factor. Surgical intervention is often contraindicated or associated with significant morbidity in patients with non-metastatic ESCC and liver cirrhosis. Consequently, radiotherapy-based therapy is commonly employed. This study aims to investigate prognostic factors for overall survival in such patients undergoing radiotherapy-based therapy. Additionally, we will evaluate predictors for the 90-day mortality rate, proposed as a measure to mitigate treatment-related toxicity and prevent unwarranted or excessive medical interventions. Methods: From January 2001 to December 2021, we conducted a retrospective review of the medical records of 1298 patients diagnosed with esophageal squamous cell carcinoma (ESCC). Within this cohort, we identified 103 patients with concomitant liver cirrhosis, diagnosed through abdominal ultrasonography, computerized tomography, and/or liver biopsy, as appropriate. Of these individuals, 78 patients with non-metastatic ESCC and liver cirrhosis were included in our analysis. We collected clinicopathologic parameters and examined their correlation with overall survival and the 90-day mortality rate. Results: Univariate analysis revealed several factors significantly associated with inferior overall survival: Child-Pugh classification B/C (P<0.001, compared to A), radiotherapy alone (P=0.03, compared to chemoradiotherapy), prothrombin time prolonged by ≥2 seconds (P=0.024), albumin levels ≤3.5g/dl (P<0.001), controlled/refractory ascites (P=0.01, compared to no ascites), and total bilirubin levels ≥1.5mg/dl (P=0.004). In multivariate analyses, albumin levels ≤3.5g/dl (P=0.001, odds ratio: 2.500) and total bilirubin levels ≥1.5mg/dl (P=0.019, odds ratio: 2.012) were identified as independent prognostic factors. Among the 78 patients receiving radiotherapy-based therapy, the 90-day mortality rate was 10.3% (n=8). Clinical 8th AJCC stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), prothrombin time prolonged by ≥4 seconds (P=0.009), and albumin levels ≤3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality rate. The logistic model indicated that albumin levels ≤3.5g/dl (P=0.015, odds ratio: 16.129) and clinical 8th AJCC stage IVA (P=0.012, odds ratio: 17.544) were independently associated with higher 90-day mortality rate. Conclusions: In patients undergoing radiotherapy-based therapy for non-metastatic esophageal squamous cell carcinoma (ESCC) and liver cirrhosis, pretreatment hypoalbuminemia has been associated with increased 90-day mortality and unfavorable prognosis.

Research of <i>PNPLA3</i> I148M Gene Polymorphism in Patients with Non-Alcoholic Fatty Liver Disease, with Liver Cirrhosis and with Hepatocellular Carcinoma

Aim: to determine the frequency of PNPLA3 rs738409 C>G gene polymorphism, leading to p.I148M substitution, in patients with non-alcoholic fatty liver disease (NAFLD), and to reveal the association between polymorphism and probable NAFLD outcomes: liver cirrhosis (LC) and hepatocellular carcinoma (HCC).Materials and methods. The study was conducted according to the “case-control” design, three main groups were formed: a group with NAFLD (n = 46), a group with LC (n = 61), a group with HCC (n = 50), as well as a control group (n = 70), for all groups we performed genotyping of the rs738409 polymorphism of the PNPLA3 gene. The relationship between the occurrence of different genotype variants and the diagnosis of patients was evaluated, the odds ratio (OR) of progression of NAFLD and the reliability of intergroup differences were determined.Results. NAFLD patients with PNPLA3 I148M polymorphism have a significantly higher chance of developing LC and HCC. The odds ratio for the GG genotype was 7.94 (95 % Cl: 2.19–28.84; p = 0.030) for LC and 6.51 (95 % Cl: 1.15–4.08; p = 0.039) — for HCC with concomitant LC. The presence of the minor G allele also increases the likelhood of transition from NAFLD to LC (OR = 2.38; 95 % Cl: 1.41–4.02; p = 0.010) and HCC in the presence of cirrhosis (OR = 2.17; 95 % Cl: 1.15–4.08; p = 0.039). Differences in the frequency of PNPLA3 polymorphism between the NAFLD and HCC groups were not significant. Additional risk factors for HCC associated with NAFLD are overweight (OR = 5.14; 95 % Cl: 1.94–13.67; p < 0.001), arterial hypertension (OR = 8.49; 95 % Cl: 3.05–23,62; p < 0.001) and diabetes mellitus (OR = 8.57; 95 % Cl: 1.03–71.48; p = 0.032).Conclusion. The frequency of single nucleotide polymorphism PNPLA3 significantly differs in patients with NAFLD, cirrhosis and HCC compared with the control group of healthy volunteers. The PNPLA3 I148M polymorphism increases the incidence of NAFLD progression to cirrhosis and HCC, but only with concomitant cirrhosis.

Possibilities of cryosurgery in the treatment of the abdominal cavity diseases

Aim. To study the immediate results of the use of cryosurgical instruments and ultra-low temperature liquid nitrogen in diseases of abdominal organs.Materials and research methods. The article presents the results of surgical treatment using ultra-low temperature liquid nitrogen (196oC) for 308 patients with diseases of the abdominal organs in the Department of Liver and Pancreas Surgery of the Institute of Gastroenterology of the Republic of Tajikistan from 2016 to 2022.The results and discussion. The authors proposed an algorithm for the use of the ultra-low temperature of liquid nitrogen in the treatment of diseases of the abdominal organs after the development of the latest cryogenic equipment. It turned out that the resulting cryodestruction leads to the death of parasitic elements of alveococcosis, echinococcosis, and liver tuberculosis, as well as to cytolysis of atypical calls in hepatocellular carcinoma. The most important advantage of liver cryosurgery, especially in concomitant chronic viral hepatitis and liver cirrhosis, is a reliable parenchymal haemo-and cholestasis, a decrease in intraoperative blood loss, an increase in the radicality of an operation, and reliable prevention of intraoperative dissemination of malignant and parasitic diseasesConclusion. The accumulated experience of surgeries for various diseases of the abdominal organs using ultra-low temperature liquid nitrogen allows concluding that cryosurgery of the abdominal organs has an undoubted prospect. The positive characteristic of using cryotechnology in the treatment of severe diseases of abdominal organs suggests that it is advisable to introduce the method into clinical practice on a wide scale.

Experience of treating patients with complicated forms of gallstone disease on the background of liver cirrhosis

Annotation. In recent years, further improvement of minimally invasive surgical interventions has been noted. Surgical treatment of complicated gallstone disease has become quite standardized all over the world. However, accompanying cirrhosis of the liver remains the most severe comorbid condition. The purpose of this study is to determine the optimal treatment strategy of this category of patients. We analyzed the results of surgical treatment of 79 patients with complicated forms of gallstone disease and concomitant liver cirrhosis. All patients were conditionally divided into 2 groups: a control group of patients who were treated according to the standard program – 38 patients and the main group of patients who were treated using an improved diagnostic and treatment program – 41 patients. The patients of the retrospective group underwent a standard diagnostic and treatment program according to the recommendations for diagnosis and treatment of patients with complicated forms of gastrointestinal tract with correction of hepatorenal insufficiency. Since 2016, an updated diagnostic and treatment algorithm has been introduced in patients with complicated forms of gastrointestinal tract against the background of liver cirrhosis. All patients underwent a balanced approach in the analysis of manifestations of liver cirrhosis, which manifested itself in the introduction of the principles of controlled antibacterial therapy according to the level of C-reactive protein; differentiated implementation of thromboprophylaxis: according to the standard scheme and early postoperative thromboprophylaxis based on the risks of hemorrhagic complications. The results of this research were statistically analyzed using chi-square test and statistical comparison of both groups. According to the results of a comparative analysis of the results of the treatment of patients in both groups was performed, it was established that postoperative complications occurred both in patients of the main group and in the comparison group. However, the frequency of occurrence of complications in the groups of studied patients has a significant difference. In the main group, complications were 14.6% versus 34.2% (in the comparison group) at p≤0.05 (χ2=4.14), which indicates that the improved diagnostic and treatment program made it possible to significantly reduce postoperative complications, and the outcome of treatment of patients with complicated forms of gallstone disease.

Risk stratification of cirrhotic patients undergoing esophagectomy for esophageal cancer: A single-centre experience.

BackgroundConcomitant liver cirrhosis is a crucial risk factor for major surgeries. However, only few data are available concerning cirrhotic patients requiring esophagectomy for malignant disease.MethodsFrom a prospectively maintained database of esophageal cancer patients, who underwent curative esophagectomy between 01/2012 and 01/2016, patients with concomitant liver cirrhosis (liver-cirrhotic patients, LCP) were compared to non-liver-cirrhotic patients (NLCP).ResultsOf 170 patients, 14 cirrhotic patients with predominately low MELD scores (≤ 9, 64.3%) were identified. Perioperative outcome was significantly worse for LCP, as proofed by 30-day (57.1% vs. 7.7, p<0.001) and 90-day mortality (64.3% vs. 9.6%, p<0.001), anastomotic leakage rate (64.3 vs. 22.3%, p = 0.002) and sepsis (57.1 vs. 21.5%, p = 0.006). Even after adjustment for age, gender, comorbidities, and surgical approach, LCP revealed higher odds for 30-day and 90-day mortality compared to NLCP. Moreover, 5-year survival analysis showed a significantly poorer long-term outcome of LCP (p = 0.023). For risk stratification, none of the common cirrhosis scores proved prognostic impact, whereas components as Bilirubin (auROC 94.4%), INR (auROC = 90.0%), and preoperative ascites (p = 0.038) correlated significantly with the perioperative outcome.ConclusionCurative esophagectomy for cirrhotic patients is associated with a dismal prognosis and should be evaluated critically. While MELD and Child score failed to predict perioperative mortality, Bilirubin and INR proofed excellent prognostic capacity in this cohort.

Significance of fructosamine in the diagnosis of carbohydrate metabolism disorders in children with cystic fibrosis

Introduction. Cystic fibrosis associated (related) diabetes mellitus (CFDM) is one of the most common severe complications of cystic fibrosis. Today, the issue of the goodness of a single measurement of fasting blood glucose, glycated hemoglobin and fructosamine to assess the degree of carbohydrate metabolism disorders in children with cystic fibrosis is a subject of debate. The gold standard for diagnosing carbohydrate metabolism disorders (impaired fasting glycemia, various pre-diabetic conditions, diabetes mellitus) is the oral glucose tolerance test. Data about the diagnostic value of fructosamine for predicting CFDM aren’t dispositive. No credible studies of fructosamine in children with cystic fibrosis have been found in the Russian medical literature.Aim. To determine the diagnostic informative value of the blood fructosamine and other single-measured glycemic marker levels in the early diagnosis of carbohydrate metabolism disorders at the pre-diabetes stage in children with cystic fibrosis.Materials and methods. The results of laboratory tests and instrumental examinations of 87 children with cystic fibrosis aged 5–18 years were reviewed. A cross-sectional study of fructosamine, fasting blood sugar and glycated hemoglobin level (some patients underwent an oral glucose tolerance test), and liver fibroelastometry were also performed.Results and discussion. An increase in the fructosamine level was observed, which indicates a possible CFDM in children (p = 0.049): CFDM is highly likely, if the level of fructosamine is ≥255.5 µmol/l (reference ranges for children are 272–285 µmol/l; sensitivity = 57.1%, specificity = 85.2%). It has been found that children with cystic fibrosis and liver cirrhosis have increased fructosamine levels: cut-off = 253.0 µmol/l (Sn – 70.0%, Sp – 85.2%).Conclusion. The fructosamine level, a single determination of fasting blood glucose and glycated hemoglobin are not informative markers for the diagnosis of pre-diabetic conditions in cystic fibrosis in children. It is important to bear in mind that concomitant liver cirrhosis can affect the fructosamine levels. CFDM can be diagnosed at the lower fructosamine level, despite the generally accepted ranges.

Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients

Abstract Background Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR). Methods We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team. Results Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98) Conclusion Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Outcomes After Transfemoral Transcatheter Aortic Valve Implantation With a SAPIEN 3 Valve in Patients With Cirrhosis of the Liver (a Tertiary Care Center Experience)

Little is known about the utility of transcatheter aortic valve implantation (TAVI) in patients with cirrhosis of the liver, and their outcomes have not been studied extensively in literature. We performed a retrospective analysis of patients with severe symptomatic aortic stenosis (AS) who underwent transfemoral TAVI with a SAPIEN 3 valve at our institution between April 2015 and December 2018. We identified 32 consecutive patients with evidence of cirrhosis of the liver on imaging (including ultrasound and/or computed tomography) and patients with severe symptomatic AS who underwent transfemoral TAVI with a SAPIEN 3 valve. Among 1,028 patients, 32 had cirrhosis of the liver and 996 constituted the control group without cirrhosis. Mean age in the cirrhosis group was 74.5 years compared with 81.2 years in the control group. Baseline variables were comparable between the groups. Compared with the noncirrhotic group, patients with cirrhosis had a similar 1-year mortality (12% vs 12%, p=1), a lower 30-day new pacemaker after TAVI rate (6% vs 9%, p=0.85), a higher 30-day and 1-year readmission rate for heart failure (11% vs 1% and 12% vs 5%, p=0.12, respectively), and a similar 1-year major adverse cardiac and cerebrovascular event rate (15% vs 14%, p=0.98). In conclusion, patients with severe AS with concomitant liver cirrhosis who underwent TAVI demonstrated comparable outcomes to their noncirrhotic counterparts.

Comparison of the Efficacy and Safety of Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation and Concomitant Liver Cirrhosis: A Systematic Review and Meta-Analysis.

Patients with atrial fibrillation (AF) have a higher risk of developing thromboembolic events. Current guidelines recommend the use of oral anticoagulants for stroke prevention in these patients. Several clinical trials demonstrated that direct oral anticoagulants (DOACs) have similar efficacy and are safer alternatives to traditional oral anticoagulants. However, patients with concomitant liver cirrhosis were excluded from these trials. We aimed to systematically identify and review published clinical studies on the use of DOACs in patients with AF and liver cirrhosis and assess the efficacy and safety of DOACs in these patients. A systematic review of clinical trials and retrospective studies was conducted by searching the PubMed, Cochrane Library, Embase, SCOPUS, and Web of Science databases up to September 2020. Three retrospective studies were included, involving 4011 patients with AF and liver cirrhosis. The use of DOACs was associated with a significant reduction in ischemic stroke (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.42-0.90; p = 0.01), major bleeding events (HR 0.64; 95% CI 0.57-0.72; p < 0.001), and intracranial hemorrhage (HR 0.49; 95% CI 0.40-0.59; p < 0.001). Compared with warfarin in patients with AF and liver cirrhosis, DOACs appear to be associated with improved efficacy and safety outcomes. Randomized controlled trials are warranted to confirm these findings.

S1084 Patient Characteristics and In-Hospital Outcomes of Clostridium difficile Infection in Patients With Liver Cirrhosis

INTRODUCTION: Clostridium difficile infection (CDI) is exponentially increasing among hospitalized patients and has become one of leading cause of gastrointestinal death. Patients with Liver Cirrhosis (LC) have low immunity response and are frequently administered chronic antimicrobial therapies which increases risk of CDI among LC patients. The aim of this study is to examine clinical characteristics and outcomes of CDI patients with LC. METHODS: We queried Nationwide Inpatient Sample database from October2015 – December 2017 using ICD-10-CM codes to identify adult patients with CDI and LC (Age ≥ 18 years). SAS 9.4 was used for analysis to determine baseline characteristics, Elixhauser comorbidities & outcomes among CDI patients with LC with non-LC groups. Further, Multivariate logistic regression analysis was performed to analyze adjusted mortality. RESULTS: Among 761,230 patients with CDI, 36,705 (4.8%) had concomitant LC. Male gender was prominent among CDI with LC patients (54.8%) while Female in non-LC group (58.2%, P < 0.0001). CDI Patients with LC were younger (60.5 vs 66.3, P < 0.0001) with majority belonging to age 45-64 years (52.8%) while non-LC patients were mainly in age 65-84 years (44.9%, P < 0.0001). CDI with LC patients reported significantly more prevalence of comorbidities as alcohol abuse (25.8% vs 3.6%,P < 0.0001) and coagulopathy (36.9% vs 8.6%,P < 0.0001), and significant higher complications such as ascites(20.8% vs 2.5%,P < 0.0001) and peritonitis(6.2% vs 1.7%,P < 0.0001). Outcomes showed significantly higher in-hospital mortality(9.4% vs 6.1%,P < 0.0001; adjusted OR(95% CI): 1.87(1.78–1.97), P < 0.0001),longer median length of stay (7 vs 6 days, P = 0.003), higher median hospitalization cost (14403 vs 11485 $, P < 0.0001) & lower transfer to facility (28.5% vs 33.9%,P < 0.0001) in CDI patients with LC. CONCLUSION: CDI patients with LC reported higher comorbidities and complications such as ascites, peritonitis, liver disease, alcohol abuse and coagulopathy. Presence of LC in CDI patients leads to higher mortality rate, longer length of stay & have higher hospitalization cost. More studies are required to be focused on management of CDI patients with LC.Table 1.: Patient-Level Characteristics of Clostridium difficile infection (CDI) with Liver Cirrhosis(LC) versus CDI patients without LCTable 2.: In-hospital Outcomes among Clostridium difficile infection (CDI) with Liver Cirrhosis(LC) versus CDI patients without LC

Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis.

BACKGROUNDAtrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. However, the outcomes associated with AF in hospitalized patients with liver cirrhosis are unknown.AIMTo determine the outcomes of hospitalized patients with liver cirrhosis and AF.METHODSIn this study, we examined morbidity and mortality of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database, the largest publicly available inpatient healthcare database in the United States.RESULTSA total of 696937 patients with liver cirrhosis were included, 45745 of whom had concomitant AF (6.6%). Liver cirrhosis patients with AF had higher rates of in-hospital mortality (12.6% vs 10.3%, P < 0.001), clinical stroke (1.6% vs 1.1%, P < 0.001), and acute kidney injury (28.2% vs 25.1%, P < 0.001), and less gastrointestinal bleeding (4.4% vs 5.1%, P < 0.001) and blood transfusion (22.5% vs 23.8%, P < 0.001) compared with those who did not have the arrhythmia. In addition, they had a longer length of stay (8 ± 10 d vs 7 ± 8 d, P < 0.001) and higher hospitalization costs (20720 ± 33210 $ vs 16272 ± 24166 $, P < 0.001).CONCLUSIONIn subjects with liver cirrhosis, AF is associated with higher rates of inpatient mortality, stroke, and acute kidney injury compared to those who do not have the cardiac arrhythmia.

The TACE’s role in the management of primary liver cancer

Objective: Identify the most effective and safe method of transcatheter hepatic artery chemoembolization (TACE) in patients with primary liver cancer. Methods: Overall, 139 patients, who underwent 558 TACE procedures were included in the study. Gender in the group of patients was distributed approximately equally and amounted to 72 men (52%) and 67 women (48%), the average age was 57.8 (9.9) years (range from 23 to 92 years). In most patients, the underlying disease for the development of hepatocellular carcinoma was cirrhosis of the liver in the outcome of hepatitis C or B. Characteristics of liver tumors were examined by magnetic resonance imaging or computed tomography and ultrasound. For verification of the diagnosis, a percutaneous liver biopsy was performed under ultrasound guidance, and the level of alpha-fetoprotein was also determined. All patients were considered unresectable due to cirrhosis and / or local spread of the tumor. Chemoembolization was performed by following scheme: one procedure in 2 months, not less than 3 procedures. Doxorubicin was used for chemotherapy. As a carrier of chemotherapy, Lipiodol (Guerbet, France) or saturable Hepaspheres (Merit Medical, USA) were used. Each patient received from 3 to 13 procedures. Results: Postembolization syndrome occurred in all cases, but was effectively treated. One patient died due to acute liver failure with the borderline stage of the disease according to the BCLC classification (EASL 2012) and the multinodular form of HCC. There were no serious complications in the treatment process. In two patients in the area of the puncture of the femoral artery, pseudoaneurysm was formed, which was eliminated by compression under ultrasound guidance. About 10% of patients developed subacute cholecystitis in the postoperative period and were associated with non-targeted chemoembolization in the cystic artery. In all patients, the symptoms of cholecystitis at the time of discharge were relieved conservatively. Survival median – 19 months. Dynamics of tumors was assessed by RECIST criteria. In the group of patients with hepatocellular carcinoma after first 3 TAСEs partial response and stabilization were observed in 83%, progression in 17%. In 18 cases (13%), histologically proved tumor necrosis after TAСE was achieved, without progression during follow-up. Three patients after reducing of tumor size was resected, 32 patients continue treatment. Conclusion: Transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma shows high efficacy, low mortality and the development of postoperative complications in patients with concomitant liver cirrhosis and locally advanced tumor lesion.

Antibiotic prophylaxis of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis

Purpose of the study. The goal of this investigation was to determine the main risk factors in development of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis.&#x0D; Materials and methods. We retrospectively reviewed medical records of 247 patients who undergone treatment in minimally invasive surgery centre of Zhytomyr regional clinical hospital during 2009–2018. All patients with complicated gallstone disease were divided in two groups: group 1 – patients with concomitant liver cirrhosis – 79(31,98%), and group 2 – patients without liver cirrhosis – 168 (68,02%). Theinclusion criteria were presents of complicated gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice and Mirizzi syndrome), and verified liver cirrhosis. Patients with oncological history, immunodeficiency and morbid obesity were excluded. Liver cirrhosis was staged by Child-ТurcotteРugh system. In all cases patient’s condition was assessed by APACHE II scoring system and patients with cirrhotic lesion were additionally analyzed by MELD score. Acute calculous cholecystitis was diagnosed in 185 patients: group 1 – 68(Child A – 36, Child B – 31, Child C – 1), group 2 – 117 patients. The signs of cholodecholithiasis with obstructive jaundice were present in 49 cases: group 1 – 7 (Child A – 5, Child B – 1, Child C – 1), group 2 – 42. Mirizzi syndrome was verified in 9 cases: group 1 – 2 (Child A – 1, Child B – 1, group 2 – 7.&#x0D; Results and discussion. In all patients treatment was started in conservative way that included detoxic, antibacterial and hepatoprotective components. In group of control early operative tactic in cases with acute calculous cholecystitis was preferred. Antimicrobial prophylaxis was performed in cases of severe and moderate calculous cholecystitits with use of cephalosporines of 2 generation in moderate case, and protected cephalosporines of 3 generation in combination with metronidazol in severe. In main group providing of antimicrobial therapy was performed very carefully, because of higher risk of hepato-renal insufficiency. The early de-escalation therapy was mandatory performed. Purulent complications occurred in 13,2% of patient with liver cirrhosis in comparison with control group with 1,7% of complications.&#x0D; Conclusion. The treatment of complicated gallstone disease in patients with liver cirrhosis is very risky in case of postoperative purulent complications. In case of Child A stage of cirrhosis the treatment is safe, and the incidents of purulent complications is the same like in the absence of cirrhosis. Administration of antibiotics in cirrhotic should be very careful because of higher risk of hepato-renal insufficiency. The early de-escalation therapy should be mandatory performed. The «gold» standard of empirical antimicrobial therapy is the use of cephalosporines of 2 and 3 generation.

Su1391 ESD FOR EARLY GASTRIC CANCER IN LIVER CIRRHOSIS: A META-ANALYSIS

Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastric cancer (EGC). ESD has an advantage over endoscopic mucosal resection as it allows the removal of larger lesions in an en bloc fashion. Liver cirrhosis has been associated with an increased incidence of bleeding with surgical intervention. In this meta-analysis, we aimed to assess the efficacy and safety of ESD for EGC when performed in patients with concomitant liver cirrhosis.

Can we perform esophagectomy for esophageal cancer patients with concomitant liver cirrhosis? A comprehensive systematic review and meta-analysis.

Liver cirrhosis is sometimes encountered in esophageal cancer patients intended for surgery. However, the impact of liver cirrhosis on patients with surgically treated esophageal cancer remains unclear. Therefore, we conducted the first meta-analysis focusing on current topic. We comprehensively searched relevant studies in Pubmed, Embase, and Web of Science on September 3, 2018. Data for analysis included both short-term (including morbidity and mortality rates) and long-term (5-year survival rate) outcomes. Our meta-analysis was conducted by using the STATA 12.0 package. We finally included a total of six cohort studies involving a total of 1426 patients (161 cirrhotic patients and 1265 noncirrhotic patients). Meta-analysis showed that cirrhotic patients had a significantly higher morbidity rate (risk ratio (RR)=1.226; 95% Confidence interval (CI)=[1.043, 1.442]; P=0.014) than noncirrhotic patients. For specific complications, cirrhotic patients had a significantly higher rate of pulmonary complications (RR=2.354; 95%CI=[1.376, 4.026]; P=0.002) and pleural effusion (RR=2.414; 95%CI=[1.482, 3.613]; P<0.001) than noncirrhotic patients and there was a trend toward a higher rate of anastomotic leak (RR=1.759; 95%CI=[0.945, 3.274]; P=0.075) in cirrhotic patients. Moreover, cirrhotic patients also had a significantly higher mortality rate (RR=2.529; 95%CI=[1.480, 4.324]; P=0.001) than noncirrhotic patients. Cirrhotic patients tended to yield a lower 5-year survival rate than those noncirrhotic patients after surgical resection of esophageal cancer (RR=0.715; 95%CI=[0.492, 1.039]; P=0.079). In conclusion, liver cirrhosis was significantly correlated with high morbidity and mortality rates. However, there was no sufficient evidence of unfavorable survival in cirrhotic patients. Esophagectomy can be performed for certain esophageal cancer patients with concomitant liver cirrhosis with acceptable operative risks, providing that careful preoperative evaluation and patient selection have been achieved.

Esophagectomy in patients with liver cirrhosis: a systematic review and Bayesian meta-analysis

Patients with esophageal carcinoma and concomitant liver cirrhosis carry a high operative risk and may be denied esophagectomy. We performed a systematic review of the literature and meta-analysis to investigate postoperative outcomes in these patients. Studies reporting outcomes after esophagectomy in patients with liver cirrhosis were searched in Medline, Embase, Cochrane Library, ISI Web of Science, and Scopus until June 2017, matching the terms "liver cirrhosis", "esophageal neoplasm" and/or "esophageal surgery". Extracted data included study characteristics, demographic and clinical patient characteristics, type of surgical procedure, and postoperative outcomes. A systematic review and Bayesian meta-analysis were performed. Five observational, retrospective and single-arm studies with a total of 157 patients were included. The main cause of death was liver failure followed by pneumonia/sepsis and anastomotic leak. Ascites and pleural effusion were the most frequent postoperative complications (pooled rates 36% and 34%, respectively). The pooled morbidity rate was 74% (95% HPD=46-81%) while the pooled mortality was 18% (95% HPD=17-27%). Study heterogeneity (τ2) was low, ranging from 0.046 to 0.080. An incidental diagnosis of liver cirrhosis was reported in 15.6% of patients in one series. Five-year survival was similar between cirrhotic and non-cirrhotic patients but was statistically significantly higher in patients with MELD score<10. Sound scientific evidence with regard to efficacy and outcomes of esophagectomy in patients with concomitant liver cirrhosis is lacking. There is a need to properly select these frail patients to reduce postoperative morbidity and mortality rates.

The epidemiology of hepatocellular cancer in Poland.

IntroductionThis article summarize the available data on hepatocellular carcinoma (HCC) epidemiology in Poland. Data regarding the HCC incidence rate are divergent. Statistical data presented by NFZ appear more credible in that matter than data published by the Polish Oncology Center (POC).Material and methodsThe analysis included data from the Polish Bibliography Database (GBL), the Polish National Health Fund Institution (NFZ), the scientific paper “Malignant neoplasms in Poland” issued by POC and the central liver transplant registry maintained by the Polish transplant coordinating center “Poltransplant” (2010-2015).ResultsData regarding the HCC incidence rate are divergent. Statistical data presented by NFZ appear more credible in that matter than data published by POC.ConclusionsThe occurrence of HCC in Poland is at the average European level and is similarly rising. The incidence rate is underestimated. It is due to faulty epidemiology data collection techniques. The highest risk group comprises men over the age of 50 with concomitant liver cirrhosis. The most common HCC etiology is HCV infection.

The Safety and Efficacy of Endoscopic Submucosal Dissection in Patients With Early Gastric Cancer and Concomitant Liver Cirrhosis

Introduction: Endoscopic submucosal dissection (ESD) allows en bloc resection of lesions with R0 margins and is superior to endoscopic mucosal resection (EMR), however it has a higher risk of bleeding and perforation. Our aim is to assess its safety and efficacy in patients with early gastric cancer and concomitant liver cirrhosis (LC). Methods: A comprehensive systematic review of major research databases was performed for patients with LC and EGC that underwent ESD. Pooled data analysis was performed, statistical analysis was done using Fisher's exact test. Results: Four studies met inclusion criteria [1-4]. A total of 115 lesions in 112 patients with LC had undergone ESD for EGC compared to 138 lesions in 138 patients in the control group. The number of patients with Child-Pugh Class A/B/C were 86/25/1 respectively. Lesion size mean was 20mm, 13/49/53 lesions were located in the upper, middle and lower third of the stomach respectively in the LC group. Procedure time mean was 71 minutes (10-450) in the LC group. En Bloc resection was achieved in 108/115 (94%) lesions (p=0.92) and R0 margins were achieved in 104/115 (90%) in the control group (p=0.65). There were 10 (9%) (p=0.51) bleeding events in the LC group which all occurred in Child-Pugh Class B 10/25 (P < 0.0001). There was 1 (0.9%) reported perforation (p=0.57) and no mortality related to the ESD procedure. Conclusion: ESD for EGC in LC was associated with a higher risk of bleeding in Child-Pugh Class B which can be controlled endoscopically in without an increase in mortality or perforation. Efficacy of ESD in LC patients was comparable to non LC patients. ESD can be safely used for EGC with concomitant LC however endoscopists should exercise caution while performing ESD in patients with Child-Pugh Class B and possibly C.Table: Table. Outcomes of ESD in Cirrhotics vs Non Cirrhotics

Analysis of lifestyle factors in patients with concomitant chronic pancreatitis and liver cirrhosis

Background & objectivesChronic pancreatitis (CP) and liver cirrhosis (LC) are common gastroenterological disorders but their co-incidence is considered to be rare. This study was designed to identify lifestyle factors that are associated with the development of concomitant LC in patients with CP. MethodsIn a retrospective case-control study between 2000 and 2005 122 patients with both CP and LC and 223 matched control patients with CP and no known liver disease were identified in 11 European university medical centers. Another 24 patients and 48 CP controls were identified in the period between 2006 and 2012. ResultsAlcoholism was most commonly regarded as aetiology for both CP (82.2%; 95% confidence interval (CI): 75.0–88.0%) and LC (79.5%; 95% CI: 72.0–85.7%) as compared to controls with CP only (68.6%; 95% CI: 62.7–74.1%). The preferred type of alcoholic beverage and pattern of alcohol intake were the only significant lifestyle factors in multivariate analysis. Frequency of alcohol intake (p = 0.105) and smoking status (p = 0.099) were not significant in bivariate analysis and dropped out of the multivariate model. Recurrent and chronic pancreatic pain was observed more often in patients with only CP, whereas gallstones were more common in individuals with both chronic disorders. ConclusionsThese findings indicate that certain lifestyle factors might be important for the development of concomitant CP and LC. More studies will be needed to identify additional genetic and environmental factors underlying this association.

Schistosomiasis and hepatopulmonary syndrome: the role of concomitant liver cirrhosis.

BACKGROUND Hepatopulmonary syndrome (HPS) is defined as an oxygenation defect induced by intrapulmonary vasodilation in patients with liver disease or portal hypertension. It is investigated in patients with liver cirrhosis and less frequently in those with portal hypertension without liver cirrhosis, as may occur in hepatosplenic schistosomiasis (HSS).OBJECTIVES To investigate the prevalence of HPS in patients with HSS, and to determine whether the occurrence of HPS is influenced by concomitant cirrhosis.METHODS We evaluated patients with HSS with or without concomitant liver cirrhosis. All patients underwent laboratory testing, ultrasound, endoscopy, contrast echocardiography, and arterial blood gas analysis.FINDINGS Of the 121 patients with HSS, 64 were also diagnosed with liver cirrhosis. HPS was diagnosed in 42 patients (35%) and was more frequent among patients with concomitant liver cirrhosis than in those without cirrhosis (42% vs. 26%), but the difference was not significant (p = 0.069). HPS was more common in those with spider naevi, Child-Pugh classes B or C and high model for end stage liver disease (MELD) scores (p < 0.05 each).MAIN CONCLUSIONS The prevalence of HPS was 35% in this study. The occurrence of liver cirrhosis concomitantly with HSS may have influenced the frequency of patients presenting with HPS.