History Of Chronic Hepatitis Research Articles

A complex case study: coexistence of multi-drug-resistant pulmonary tuberculosis, HBV-related liver failure, and disseminated cryptococcal infection in an AIDS patient

BackgroundHepatitis B virus (HBV) infection can cause liver failure, while individuals with Acquired Immunodeficiency Virus Disease (AIDS) are highly susceptible to various opportunistic infections, which can occur concurrently. The treatment process is further complicated by the potential occurrence of immune reconstitution inflammatory syndrome (IRIS), which presents significant challenges and contributes to elevated mortality rates.Case presentationThe 50-year-old male with a history of chronic hepatitis B and untreated human immunodeficiency virus (HIV) infection presented to the hospital with a mild cough and expectoration, revealing multi-drug resistant pulmonary tuberculosis (MDR-PTB), which was confirmed by XpertMTB/RIF PCR testing and tuberculosis culture of bronchoalveolar lavage fluid (BALF). The patient was treated with a regimen consisting of linezolid, moxifloxacin, cycloserine, pyrazinamide, and ethambutol for tuberculosis, as well as a combination of bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) for HBV and HIV viral suppression. After three months of treatment, the patient discontinued all medications, leading to hepatitis B virus reactivation and subsequent liver failure. During the subsequent treatment for AIDS, HBV, and drug-resistant tuberculosis, the patient developed disseminated cryptococcal disease. The patient’s condition worsened during treatment with liposomal amphotericin B and fluconazole, which was ultimately attributed to IRIS. Fortunately, the patient achieved successful recovery after appropriate management.ConclusionEnhancing medical compliance is crucial for AIDS patients, particularly those co-infected with HBV, to prevent HBV reactivation and subsequent liver failure. Furthermore, conducting a comprehensive assessment of potential infections in patients before resuming antiviral therapy is essential to prevent the occurrence of IRIS. Early intervention plays a pivotal role in improving survival rates.

Utilization of Biopsy-Guided CT Scan in Diagnosing Liver Cancer: A Case Study

Introduction: Liver cancer is one of the most common types of cancer in Indonesia and has a high mortality rate. Early diagnosis of liver cancer is very important to increase the patient's chances of recovery. Biopsy-guided CT scan is an effective method for diagnosing liver cancer.
 Case presentation: We report the case of a 55 year old man with a history of chronic hepatitis B who presented with complaints of right upper abdominal pain and weight loss. Physical examination revealed hepatomegaly and ascites. Investigations, including abdominal ultrasound and liver function tests, showed a mass in the liver. CT scan of the abdomen with contrast showed a hypodense mass in the right hepatic lobe. A CT-guided liver biopsy was performed and the histopathological diagnosis was hepatocellular carcinoma (HCC). The patient then underwent partial resection hepatectomy and chemotherapy.
 Conclusion: Biopsy-guided CT scan is a valuable tool for the diagnosis of HCC in patients with chronic hepatitis B.

A Rare Autopsy Case of Aggressive Combined Hepatocellular-Cholangiocarcinoma with Stem Cell Features in A 59-Year-Old Female

Abstract Introduction/Objective Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare liver tumor with histologic and phenotypic features of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. It is believed to arise from hepatic progenitor cells. It consists of intermingled malignant biliary and hepatic tissue and thus is a distinct entity, rather than two separate coexisting malignancies. Methods/Case Report A 59-year-old female with a history of hepatitis C and cirrhosis presented with abdominal pain, shortness of breath, and altered mental status. She developed hematemesis and went into cardiac arrest. Massive transfusion and cardiopulmonary resuscitation were initiated. She was intubated, and an esophageal/gastric balloon was placed. She then underwent a procedure to relieve portal hypertension and related gastrointestinal bleeding. Despite extensive interventions, her condition continued to deteriorate. She expired one day after her initial presentation. Results (if a Case Study enter NA) At autopsy, the liver was diffusely and markedly fibrotic with numerous nodules of varying size with invasion into adjacent vasculature. Microscopic examination of the nodules revealed cHCC-CC with stem cell features and lymphovascular invasion. Further examination revealed tumor emboli scattered throughout the right lung. The patient’s history of chronic hepatitis C may have contributed to the development of her cHCC-CC. Although gross appearance resembled cirrhosis, upon microscopic inspection the nodules showed excessive tumor burden. Ultimately the patient had end stage liver disease due to the accumulation of damage and consequent fibrosis. This led to portal hypertension with subsequent massive gastrointestinal bleeding, hemorrhagic shock, and death. Conclusion cHCC-CC is a rare aggressive primary liver tumor with a poor prognosis. It can present with a cirrhotomemetic pattern with small nodules that can evade clinical and radiographic detection. Autopsy findings can provide valuable insights into the pathogenesis and clinical course of cHCC-CC, highlight the aggressive nature of the disease, and may inform future diagnostic and therapeutic strategies. Accurate diagnosis of this tumor is important for patient management and prognostication.

Pure Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for a Giant Hepatocellular Carcinoma (> 15 cm) Abutting the Liver Hilum

IntroductionThis video manuscript presents a unique case of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure performed in case of a giant hepatocellular carcinoma (> 15 cm in size) whereby both stages were completed via the pure laparoscopic approach. MethodsThis case was performed in our institution in 2022. All data were obtained from the patient’s records in our prospectively maintained database. Institutional Review Board (IRB) was not required for this publication. ResultsA 67-year-old Chinese male with a history of chronic hepatitis B infection presented with a giant liver mass. Magnetic resonance imaging (MRI) scan demonstrated a tumour, with features compatible with hepatocellular carcinoma, measuring 15.4 cm in maximal diameter in the right lobe of the cirrhotic liver with no distal metastasis. The indocyanine green (ICG) retention test at 15 min was prolonged at 25.5%, and the CT volumetry showed a borderline future liver remnant (FLR) volume of 692 ml or 22.9% (based on measured volume) and a standardized FLR of 49%. Stage 1 ALPPS was successfully completed via the pure laparoscopic approach. He was well post-operatively, and a repeat CT volumetry at 7 days showed an increase in FLR to 826 ml, and the ICG retention test improved to 18.1%. The patient underwent pure laparoscopic second-stage ALPPS, 8 days later. The patient recovered well with no liver decompensation or local complications. ConclusionThe use of MIS for in 2-stage ALPPS procedure for giant HCCs larger than 10 cm is technically feasible and safe when attempted in high-volume centres by experienced surgeons, while benefiting from the advantages of MIS liver resection.

PSUN329 Non-islet Cell Tumor Hypoglycemia Secondary to Advanced Hepatocellular Carcinoma in a 29-Year-Old Male

Abstract Summary: Non-islet cell tumor hypoglycemia (NICTH) is a rare, but serious complication that can be seen in most all tumors. It is typically mediated by high levels of an incompletely processed form of insulin-growth factor 2 ("big IGF-2") that is produced by the tumor. We describe a case of a 29-year-old male with history of chronic hepatitis B and advanced stage hepatocellular carcinoma (HCC) who had failed prior chemotherapies. The patient was admitted to the hospital for a liver biopsy, following which he developed severe hypoglycemia, refractory to high dose, continuous dextrose infusion. Evaluation was remarkable for low levels of insulin, proinsulin, C-peptide, and IGF-1, normal cortisol, and an IGF-2: IGF-1 ratio of 8, suggestive of NICTH due to IGF-2, although the patient's hypoglycemia may additionally have been due to worsening, and strikingly extensive tumor invasion of the liver. This patient was unfortunately not considered a surgical candidate; hypoglycemia was ultimately controlled with initiation of high dose corticosteroids and total parenteral nutrition with high amounts of dextrose. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

SEVERE COLCHICINE TOXICITY IN A SUICIDE ATTEMPT CAUSING MULTIORGAN FAILURE: A SURVIVAL STORY

SEVERE COLCHICINE TOXICITY IN A SUICIDE ATTEMPT CAUSING MULTIORGAN FAILURE: A SURVIVAL STORY

S3494 Whipple’s Disease Without Arthropathy in an Immunocompromised Patient

Introduction: Whipple’s disease (WD) is a rare disorder caused by the pathogen Tropheryma whipplei. It presents with non-specific symptoms which can mimic the presentation of other gastrointestinal pathogens, especially in immunocompromised patients. We report a unique presentation of WD involving an immunocompromised patient who experienced non-specific gastrointestinal symptoms without arthralgia, which is a characteristic symptom of this disease. Case Description/Methods: A 67-year-old man with a history of chronic hepatitis B infection and Human immunodeficiency virus (HIV) infection presented with weight loss, nausea, vomiting and myalgia. Of note, patient did not have arthralgia. Physical exam revealed cervical lymphadenopathy and diffuse abdominal tenderness. Patient was anemic (hemoglobin of 8.6 g/dL) with a normal white count. Endoscopy demonstrated erythema in the gastric body, lymphangiectasia of the duodenum, and increased granularity of the terminal ileum. Mucosal biopsies revealed macrophages in the lamina propria with focal histiocytic aggregates throughout the small bowel and cecum, with positive PAS staining, consistent with Whipple’s disease. Confirmatory T. whipplei PCR testing was positive (Figure). Discussion: WD is a rare diagnosis that must be considered in the differential diagnoses of patients presenting with unexplained nausea, vomiting, diarrhea and anemia. Furthermore, in patients with HIV, the possibilities would also include opportunistic gastrointestinal pathogens. Classic WD is characterized by diarrhea, weight loss, abdominal pain and extra-intestinal involvement manifesting as joint pain, endocarditis, dementia, supranuclear gaze palsy, and mediastinal lymphadenopathy. Diagnosis involves biopsy of affected tissue demonstrating foamy macrophages with PAS (+) substance, which can be confirmed by PCR or immunohistochemistry. Treatment involves an initial course of penicillin or ceftriaxone followed by a prolonged course of Bactrim, or a one-year course of doxycycline and hydroxychloroquine, followed by lifelong doxycycline therapy, which is more likely to prevent disease relapse. In the absence of suppressive therapy, relapse of WD is common and may lead to further complications, including neurological involvement.Figure 1.: Periodic Acid-Schiff-Staining Macrophages (circles) Within the Lamina Propria of the Duodenal Bulb (a) and Cecum (b) as Seen Via Light Microscopy with a 20x Objective Lens.

The relationship between peripheral blood mitochondrial DNA copy number and incident risk of liver cancer: a case-cohort study

Objective: To investigate the association between peripheral blood mitochondrial DNA copy number (mtDNAcn) and incident risk of liver cancer. Methods: At the baseline of Dongfeng-Tongji (DFTJ) cohort, 27 009 retirees were recruited from Dongfeng Motor Corporation in 2008. After excluding people without baseline DNA, with current malignant tumor and loss of follow-up, 1 173 participants were randomly selected into a sub-cohort by age-and gender-stratified sampling method at a proportion of 5% among all retirees. A total of 154 incident liver cancer cases identified from the cohort before December 31, 2018 (4 cases had been selected into the sub-cohort) were selected to form the case cohort of liver cancer. For the above 1 323 participants, their baseline levels of mtDNAcn in peripheral blood cells were measured by using quantitative real-time PCR method. The restricted cubic spline analysis was used to fit the shape of the association between baseline mtDNAcn and incident risk of liver cancer. The weighted Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95%CI. Results: In this case-cohort study, the median follow-up time was 10.3 years. The restricted cubic spline analysis indicated that the relationship between peripheral blood mtDNAcn and incident risk of liver cancer followed a U-shaped pattern (Pnon-linear<0.05). All case-cohort population were divided into four subgroups by sex-specific quartiles of mtDNAcn levels among sub-cohort participants, when compared to participants in the Q2 subgroup of mtDNAcn, those in the Q1 subgroup (HR=2.00,95%CI:1.08-3.70) and Q4 subgroup (HR=4.11,95%CI:2.32-7.26) both had a significantly elevated risk of liver cancer, while those in the Q3 subgroup (HR=1.05,95%CI:0.54-2.05) had not. There were no significant multiply interaction effects of aging, gender, tobacco smoking, alcohol drinking and history of chronic hepatitis on the above association (Pinteraction>0.05). Conclusion: Both extremely low and high baseline level of mtDNAcn in peripheral blood cells are associated with an increased risk of incident liver cancer, but the underlying mechanisms need to be further clarified.

Clinical significance of half-hepatic blood flow occlusion technology in patients with hepatocellular carcinoma with cirrhosis.

BACKGROUNDMost patients with primary hepatocellular carcinoma (HCC) have a history of chronic hepatitis B and usually present with varying degrees of cirrhosis. Owing to the special nature of liver anatomy, the blood vessel wall in the liver parenchyma is thin and prone to bleeding. Heavy bleeding and blood transfusion during hepatectomy are independent risk factors for liver cancer recurrence and death. Various clinical methods have been used to reduce intraoperative bleeding, and the Pringle method is most widely used to prevent blood flow to the liver.AIMTo investigate the effect of half-hepatic blood flow occlusion after patients with HCC and cirrhosis undergo hepatectomy.METHODSThis retrospective study included 88 patients with HCC and liver cirrhosis who underwent hepatectomy in our hospital from January 2017 to September 2020. Patients were divided into two groups based on the following treatment methods: the research group (n = 44), treated with half-hepatic blood flow occlusion technology and the control group (n = 44), treated with total hepatic occlusion. Differences in operation procedure, blood transfusion, liver function, tumor markers, serum inflammatory response, and incidence of surgical complications were compared between the groups.RESULTSThe operation lasted longer in the research group than in the control group (273.0 ± 24.8 min vs 256.3 ± 28.5 min, P < 0.05), and the postoperative anal exhaust time was shorter in the research group than in the control group (50.0 ± 9.7 min vs 55.1 ± 10.4 min, P < 0.05). There was no statistically significant difference in incision length, surgical bleeding, portal block time, drainage tube indwelling time, and hospital stay between the research and control groups (P > 0.05). Before surgery, there were no significant differences in serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin, and prealbumin levels between the research and control groups (P > 0.05). Conversely, 24 and 72 h after the operation the respective serum ALT (378.61 ± 77.49 U/L and 246.13 ± 54.06 U/L) and AST (355.30 ± 69.50 U/L and 223.47 ± 48.64 U/L) levels in the research group were significantly lower (P < 0.05) than those in the control group (ALT, 430.58 ± 83.67 U/L and 281.35 ± 59.61 U/L; AST, 416.49 ± 73.03 U/L and 248.62 ± 50.10 U/L). The operation complication rate did not significantly differ between the research group (15.91%) and the control group (22.73%; P > 0.05).CONCLUSIONHalf-hepatic blood flow occlusion technology is more beneficial than total hepatic occlusion in reducing liver function injury in hepatectomy for patients with HCC and cirrhosis.

Hepatitis B e antigen and e antibody in a multi-ethnic cohort of adult chronic hepatitis B virus patients followed at a single liver unit for a period of 20 years.

Hepatitis B virus e antigen (HBeAg) loss and the appearance of antibodies to HBeAg (anti-HBe) are favourable events in the history of chronic hepatitis B virus (CHB) infection. Most CHB patients have the HBeAg/anti-HBe profiles +/- or -/+, and little is published on the derivation or fate of the +/+ and -/- profiles. We have used electronically accessible patient data to study the HBeAg and anti-HBe profiles of a multi-ethnic cohort of adult HBV patients seen at a single centre over a period of more than 20 years. 3594 HBsAg-positive patients were identified and patients with viral coinfection or acute HBV infection were excluded. Cross-sectional and longitudinal analyses of HBeAg/anti-HBe status were undertaken. Compared with White or Black patients, Chinese and Asian patients are more likely to be HBeAg positive during child-bearing years. Patients with +/+ profile are likely to undergo HBeAg loss and seroconversion during relatively short follow-up. Chinese patients have a relatively increased rate of seroconversion. For HBeAg-positive patients, the risk of seroconversion diminishes with advancing age. Despite HBeAg loss, seroconversion is seldom observed after age 60 years. The proportion of HBV patients with -/- increases with age, and most acquire this profile by HBeAg loss but without antecedent seroconversion. -/- patients can lose HBsAg and develop anti-HBs. It was not possible to demonstrate a favourable impact of antiviral treatment on the rate of HBeAg seroconversion.

A Rare Cause of Chronic Abdominal Pain and Weight Loss

Question: This 63-year-old woman with a history of chronic hepatitis B infection with liver cirrhosis presented with intermittent epigastric pain in the left upper quadrant of her abdomen for 3 months. Esophagogastroduodenoscopy was performed and showed only mild gastritis without Helicobacter pylori infection. Furthermore, postprandial pain deteriorated after prokinetic agents use and proton pump inhibitor could not relieve her symptoms. Her weight loss was from 51 kg to 46 kg in the past 3 months.

Laparoscopic right hemihepatectomy following a novel optimized portal vein embolization: a video case report

BackgroundThis article is the first report of laparoscopic major hepatectomy of Hepatocellular carcinoma (HCC) following optimized portal vein embolization (oPVE).Case presentationThe patient was diagnosed with a single 3 × 3.5 cm HCC located in segment 5 and 8 detected by enhanced computed tomography and magnetic resonance imaging. The lesion was adjacent to the right anterior and posterior portal veins, making it difficult to confirm the adequate liver functional remnant volume, surgical margin and R0 resection. In addition, the liver cirrhosis induced by a long history of chronic hepatitis B virus increased the potential risk of postoperative liver failure and refractory ascites. Therefore, we conducted a laparoscopic surgery following oPVE, by which the safe tumor margin was ensured and the outcome of the surgery was improved. The patient was discharged on the seventh day after the surgery. The AFP gradually decreased to a normal level during the 90-day follow-up.ConclusionThis case report demonstrates that, in experienced hands for selected patients, laparoscopic hepatectomy after portal vein embolization is feasible and may be an alternative to open liver resection.

Rate of liver fibrosis and some related factors in senior military officers examined at Military Hospital 121 in 2021-2022

Background: Liver fibrosis is a common disease in the elderly and cirrhosis is the leading cause of death from liver diseases worldwide. Accurately determining the degree of liver fibrosis plays an important role in diagnosis, prognosis and appropriate intervention. Objectives: To determine the rate of liver fibrosis stages and learning some related factors in Senior Military Officers examined at Military Hospital 121 in 2021-2022. Materials and methods: A cross-sectional descriptive study was conducted on 952 patients who are senior military officers examined at Military Hospital 121 in 2021-2022. Information collected includes general information and liver elastography results. Results: The rate of liver fibrosis of the study subjects was 19.9%, of which 15.8% at F1 stage, 2.0% at F2 stage, 1.5% at F3 stage and 0.6% at F4 stage. Factors associated with liver fibrosis include (p&lt;0.05): age group (OR=1.48), BMI (OR=4.59), history of hepatitis B (OR=2.88), a history of hepatitis C (OR=3.43), a heavy drinking habit (OR=3.8), and a family history of cirrhosis (OR=17.5). Conclusion: The rate of liver fibrosis of Senior Military Officers is quite high (19.9%), but most of them are at the F1 stage (mild fibrosis) with 15.8%, 2% in the F2 stage, 1.5% in the F3 stage and only 0.6% in the cirrhosis stage (F4). The study subjects were elderly, with BMI ≥ 30, have a history of chronic hepatitis B and C, drink a lot of alcohol and have a family history of cirrhosis, the rate of liver fibrosis is higher.

Laparoscopic Segmentectomy IV Using Hepatic Round Ligament Approach Combined with Fluorescent Negative Staining Method

Laparoscopic segmentectomy, which maximizes the preservation of the functional hepatic reserve and the possibility for future repeat hepatectomy while ensuring adequate surgical margin, is a feasible alternative to hemihepatectomy for hepatocellular carcinoma (HCC) (Vigano et al. in Ann Surg 270(5):842-851, 2019, Ishizawa et al. in Ann Surg 256(6):959-964, 2012). Herein, we present a video of laparoscopic segmentectomy IV for HCC using hepatic round ligament approach combined with fluorescent negative staining method. A 44-year-old male with history of chronic hepatitis B virus (HBV) infection for 22 months was referred for treatment of a single HCC in segment IV. The procedure was performed according to the following steps: (1) lowering the hilar plate based on Laennec's capsule (Sugioka et al. in J Hepatobiliary Pancreat Sci 24(1):17-23, 2017) after cholecystectomy; (2) cutting the Glisson's pedicles to segment IV along the fissure for the round ligament; (3) the first parenchyma transection was along the falciform ligament, while cutting some deep pedicles to segment IV; (4) clamping the left Glisson's pedicle and using fluorescent negative staining method (Abo et al. in Eur J Surg Oncol 41(2):257-264, 2015, Funamizu et al. in J Hepatobiliary Pancreat Sci, 2021, Xu et al. in Surg Endosc 34(10):4683-4691, 2020); (5) the second parenchyma transection was performed along the boundary of negative fluorescence region to expose the middle hepatic vein (MHV) using a combination of cranial and caudal approaches. The operative time was 190 min, and blood loss during operation was 80 mL. The histopathologic examination showed a solitary HCC, 2.5 cm in diameter, with negative surgical margin and no microvascular invasion. The patient had an uneventful postoperative recovery and was discharged on postoperative day 5. The round ligament approach combined with fluorescent negative staining method for laparoscopic anatomic segmentectomy IV is a feasible and effective technique.

The Characteristics of Natural Killer Cells and T Cells Vary With the Natural History of Chronic Hepatitis B in Children

Background and Aims: The immune status of children with chronic hepatitis B (CHB) in different phases is still unclear. The aim of this study was to investigate the phenotype and cytokine-producing ability of natural killer (NK) and T cells and to better understand the immune characteristics of children with different phases of CHB.Methods: Treatment-naive children with CHB were divided into groups with different clinical phases of CHB. Fresh peripheral blood drawn from hepatitis B virus (HBV)-infected and healthy children was processed to perform flow cytometric analysis.Results: A total of 112 treatment-naive children with CHB and 16 comparable healthy controls were included in this study. The expression of HLA-DR on NK cells and CD38 on T cells were upregulated, especially in the IA phase, in children with CHB compared with healthy controls. The ability of circulating NK cells instead of CD8+ T cells to produce IFN-γ in children with CHB was slightly increased, but TNF-α production seemed to be decreased compared with that in healthy controls. The expression of some activation markers varied among children with different phases of CHB, especially the higher CD38 expression found on T cells in the IA phase. Regression analysis revealed that IFN-γ and TNF-α production by NK cells and CD8+ T cells seemed to have positive correlations with ALT elevation and an activated status of NK cells or T cells.Conclusion: NK cells and T cells tended to be phenotypically activated (especially in the IA phase) in children with CHB compared with healthy controls. However, their cytokine-producing function was not obviously elevated, especially IFN-γ production by CD8+ T cells. More studies investigating the mechanism and observing the longitudinal changes in the immune status in children with CHB are needed.

S1652 Impact of COVID-19 on Clinical Diagnosis and Management of Pre-procedural Imaging in Gastroenterology

Introduction: Choledocholithiasis, the presence of gallstones in the common bile duct (CBD), commonly presents as abdominal pain, jaundice, and an elevated bilirubin and is further evaluated with abdominal ultrasound and consideration of MRCP or ERCP based on clinical predictors. Herein, we describe a novel approach to abdominal pain and hyperbilirubinemia due to SARS-CoV-2 (Covid 19) which led to additional imaging and an incidental malignancy diagnosis. Case Description/Methods: A 52-year old man with a history of chronic hepatitis B virus presented with one week of abdominal pain and jaundice. Admission labs were significant for a total bilirubin of 4.1mg/dL, and positive screening for Covid 19. Abdominal ultrasonography demonstrated a dilated CBD to 1.7cm. His presentation was highly suggestive of choledocolithiasis by ASGE criteria, but ERCP was deferred to abide by hospital-wide precautions at the time. As a result, the patient underwent confirmatory testing with MRCP, which showed no choledocholithiasis but demonstrated a 4.1cm enhancing lesion abutting the pancreatic body. Subsequent abdominal computed tomography found a 3.3cm soft tissue density encasing the celiac axis, suggesting lymphoma. Endoscopic ultrasound (EUS)-guided biopsy of the pancreatic lesion demonstrated an unreported 3.1cm liver mass, which was biopsied. On further review of imaging, the liver mass was not appreciated on ultrasound, CT or MRCP. It was suspected that the hyperbilirubinemia was likely due to this intrahepatic mass, described as poorly differentiated adenocarcinoma. Due to the early diagnosis he was able to be discharged and follow up with oncology to better guide his future directed therapy. Discussion: The Covid 19 pandemic forced all aspects of healthcare to adapt. Given gastroenterology’s invasive nature this also encouraged gastroenterologists to consider alternative pathways of treatment aside from the published algorithms in place. This case demonstrates how deviating from the ASGE guidelines resulted in a cascade of diagnostics which led to an eventual malignancy diagnosis which may have been otherwise missed or delayed. Guidelines are established on large sets of data and patient prognostic indicators which to our knowledge have not considered infection status or isolation needs. Further research in this area may result in amending guidelines to address isolation status and reminds practitioners to consider the patient before them and their unique patient needs.

Characteristics, management and outcomes of patients with hepatocarcinoma in a low-income country.

e16166 Background: Worldwide, every year, there are nearly 905,000 patients diagnosed with liver cancer; it is the sixth most common malignancy and the third most lethal malignancy. Almost three quarters of new patients live in areas with low and medium-income country. Guatemala has the highest mortality and incidence of liver cancer. Objectives: Describe the clinical characteristics, main risk factors, treatment and outcomes of patients with hepatocarcinoma (HCC) in Guatemala. Methods: A retrospective review was performed among patients with HCC from January 2002 to December 2019 in the Instituto Guatemalteco de Seguridad Social (IGSS). Kaplan Meier curves, Cox regression and log-rank test were used to calculate overall survival (OS) and mortality. Results: 140 patients with HCC were analyzed, 114 women and 26 men with a median age of 60 years (20 - 99), 102 patients (73%) have history of excessive alcohol consumption and 11 (8%) has history of chronic hepatitis B or C virus infection. All of the patients have liver cirrhosis, Child-Pugh A 100 patients (71%), B 34 (24%) and C 6 (5%). 10 patients (7%) have HCC BCLC A, 0 (0%) BCLC B, 121 (81%) BCLC C and 9 (6%) BCLC D. All patients with HCC BCLC A received surgical treatment with a median OS of 123 months (95% CI 89 - 156 p &lt; 0.001). 122 patients (89%) received target therapy with Sorafenib with a median OS of 17 months (95% CI 12 - 21 p &lt; 0.001) and 8 patients (6%) underwent to chemoembolization with a median OS of 32 months (95% CI 12 - 52 p &lt; 0.001). At this time, 111 patients (79%) died from the disease, 11 (8%) are alive with the disease and 8 (6%) are alive without disease. Conclusions: The most frequent risk factor for HCC is the excessive alcohol consumption, survival of patients with HCC are associated with treatment at the beginning of the disease.

Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-sectional study

BackgroundUnderstanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines.MethodsThis cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment.ResultsThe mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment.ConclusionsOur data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.

A Rare Case of Dysphagia: Diagnosis and Treatment

Question: A 75-year-old woman with a history of chronic hepatitis C virus infection was referred to our endoscopy department with several months of progressive dysphagia and weight loss. A preliminary barium study had been performed and showed a short and irregular narrowing of the proximal esophagus (Figure A).

An Unusual Cause of Epigastric Pain: Brunner's Gland Hyperplasia of the Ampulla of Vater

A 49-year-old man with a history of chronic hepatitis B presented to our outpatient clinic with occasional epigastric pain and intermittent fullness lasting 3 months. Duodenoscopy revealed ~1.5-cm broad-based polypoid ampullary mass with smooth and hyperemic mucosa .