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The gut microbiota has acquired significant attention in recent years for its potential as a diagnostic biomarker for colorectal cancer (CRC). In this literature review, we looked at the studies exploring alterations in gut microbiota composition associated with CRC, the potential mechanisms linking gut dysbiosis to CRC development, and the diagnostic approaches utilizing gut microbiota analysis. Our research has led to the conclusion that individuals with CRC often display alterations in their gut microbiota composition compared to healthy individuals. These alterations can include changes in the diversity, abundance, and type of bacteria present in the gut. While the use of gut microbiota as a diagnostic biomarker for CRC holds promise, further research is needed to validate its effectiveness and standardize testing protocols. Additionally, considerations such as variability in the microbiota composition among individuals and potential factors must be addressed before microbiota-based tests can be widely implemented in clinical practice. [ABSTRACT FROM AUTHOR]

Primary biliary tract neuroendocrine tumors (NETs) are extremely rare tumors that account for 0.2-2% of all gastrointestinal neuroendocrine tumors. The typical presentation is with jaundice and other symptoms related to biliary obstruction.We present a case of right hepatic duct NET in a 27-year-old female patient, asymptomatic, presented for a routine ultrasound examination that revealed moderate dilatation of the intrahepatic biliary ducts and a 20 mm hyperechoic lesion in the right hepatic biliary duct. Additional imaging was performed with the presumptive diagnosis of cholangiocarcinoma. After surgery, the histopathological and immunohistochemical report was conclusive for the diagnosis of G2 well-differentiated NET. [ABSTRACT FROM AUTHOR]

To evaluate liver stiffness measurements success rates (SR) by pSWE and 2D-SWE implemented on different ultrasound probes from different vendors and evaluate the input on the success rate of a new bariatric probe (DAX) in obese patients. A prospective study was conducted in which liver stiffness measurements (LSM) were performed in 201 consecutive subjects (60.1% men, average BMI = 28.7 ± 4.9 kg/m2, average age 59 ± 18.4 years, 38% obese) with or without chronic hepatopathies evaluated during the same session by point Shear Wave Elastography (pSWE), 2D Shear Wave Elastography (2D SWE), and Transient Elastography (TE) implemented on the following systems: Siemens ACUSON Sequoia (5C-1 convex transducer with pSWE and 2D SWE, Deep Abdominal Transducer (DAX) with pSWE and 2D SWE, 4V-1 linear transducer with pSWE), Aixplorer Mach 30 (C6-1X convex transducer with 2D SWE) and FibroScan Compact 530 (M and XL probes). Reliable LS measurements were defined as the median value of 10 measurements and an IQR/M<0.3. Valid LSM were obtained in 99%(199/201) using TE, 99%(199/201) using 2D SWE (C6-1X), 98.5% (198/201) using 2D SWE (5C-1), 99%(199/201) using 2D SWE (DAX), 97.5%(196/201) using pSWE (5C-1), 97.5%(196/201) using pSWE (DAX) and 91.5% (184/201) using pSWE (4V-1). No significant difference were found between the SR of TE, 2D SWE using C6-1X, 5C-1, DAX and pSWE using C5-1 and DAX (p>0.05. pSWE using the linear probe 4V-1 had significantly lower SR compared to the other probes (p< 0.001). 38% (77/201) of subjects were obese. Valid LSM were obtained in 100% of the obese (77/77) using 2D SWE DAX, in 98.7% (76/77) using TE, 2D SWE C6-1X, and pSWE DAX, in 97.4% (75/77) using pSWE and 2D SWE 5C-1 and in 83.1% (64/77) using pSWE 4V-1. No significant differences were found between the SR of TE, 2D SWE using C6-1X, 5C-1, DAX and pSWE using C5-1 and DAX in obese subjects (p>0.05). pSWE using the linear probe 4V-1 had significantly lower SR compared to the other probes in obese subjects (p<0.001). 2D SWE and pSWE implemented on convex ultrasound probes have very high success rates for liver stiffness measurements in general population and in obese, with no significant differences between them. pSWE implemented on 4V-1 linear ultrasound probe has a significantly lower success rate for liver stiffness measurements compared to pSWE and 2D SWE implemented on convex ultrasound probes. 2D SWE DAX probe had the highest SR (100%) in obese, with no significant differences compared to the other 2D SWE and pSWE implemented on convex ultrasound probes. [ABSTRACT FROM AUTHOR]

Liver fibrosis is the most significant prognostic factor in chronic liver disease (CLD). Clinical practice guidelines recommend the use of non-invasive techniques, such as two-dimensional shear-wave elastography (2D-SWE), to assess liver elasticity as a marker of fibrosis. It is presumed that changes due to necro-inflammation modify the propagation of shear waves [1]. Therefore, new imaging techniques that investigate the dispersion properties of shear waves have been developed, which can serve as an indirect method of measuring liver viscosity (Vi PLUS). This study aims to analyze the performance of SWE to assess viscosity, to analyze factors influencing Vi PLUS measurements in a large cohort of patients with CLD, and to assess the normal ranges of liver viscosity measurements in participants with healthy livers. 867 consecutive adult subjects were enrolled in this prospective study (199 with healthy livers and 668 with CLD). Subjects were first examined using the Supersonic MACH® 30 US system (Hologic® SuperSonic® Imagine, Aix-en-Provence, France). Gray-scale US, as well as 2D-SWE and Vi PLUS measurements were performed. Secondly, TE measurements were performed with a FibroScan® Compact 530 device (EchoSens®, Paris, France). The mean Vi PLUS values in normal, ALD, HBV, HCV, NAFLD patients were: 1.6±0.3 Pa·s, 2.8±0.8 Pa·s, 1.9±0.3 Pa·s, 2.1±0.5 Pa·s and 2±0.4 Pa·s respectively (table 1). The mean Vi PLUS values were significantly higher in subjects with chronic liver disease than in normal subjects, independent of the etiology (p>0.05). Mean Vi PLUS values were significantly higher in subjects with ALD compared to HCV (p<0.0001), HBV (p<0.0001) and NAFLD subjects (p<0.0001); significantly higher in subjects with HCV compared to HBV (p=0.0001) and NAFLD subjects (p=0.011). No significant differences were found between HBV and NAFLD subjects (p=0.0615). In univariate regression analysis, Vi PLUS measurements were independently associated with: BMI (p<0.001), abdominal circumference (p<0.001), age (p<0.001), AST (p<0.001), ALT (p=0.009), the presence of diabetes mellitus (p<0.0001) and the presence of arterial hypertension (p<0.001). In multiple regression analysis the model including: abdominal circumference (p<0.0001), AST (p<0.0001) and ALT values (p=0.0029) was associated with ViPLUS measurements. Vi PLUS and 2D-SWE by SSI are highly feasible methods. The mean liver viscosity determined by Vi PLUS in our cohort of participants with healthy livers was 1.69 Pa·s. CLD patients had significantly higher viscosity values. Increased liver stiffness, high transaminases and obesity were associated with high viscosity values. [ABSTRACT FROM AUTHOR]

Background and Aim: Contrast enhanced ultrasound (CEUS) has been proven to be a reliable method for the characterization of focal liver lesions (FLL). The aim of this paper was to evaluate the performance of CEUS for the diagnosis of liver hemangiomas in a large cohort of patients.Material and Method: We performed a multicentre prospective study which included successive CEUS examinations from fourteen centers from Romania. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for hemangioma if a typical pattern was present following contrast (centripetal fill in during the arterial phase, hyperenhanced lesion during venous and late phases). In all cases a reference method was available (contrast CT or MRI or biopsy). The trial was registered in clinicaltrials.gov (Identifier NCT01329458).Results: During February 2011 - May 2015, 1153 CEUS examinations were performed for the evaluation of de novo FLL. Out of the 1153 de novo FLL, 238 cases were diagnosed as hemangiomas by CEUS (typical enhancing pattern). Contrast CT/MRI and biopsy diagnosed additional 24 hemangiomas. From the 238 cases diagnosed as hemangiomas by CEUS, in 11 the final diagnosis was different. Considering contrast CT/MRI and biopsy as reference methods, CEUS had 90.4% sensitivity, 98.8% specificity, 95.4% positive predictive value, 97.4% negative predictive value, resulting in 96.9% diagnostic accuracy for the diagnosis of hemangiomas.Conclusion: CEUS is a sensitive and very specific method for the diagnosis of hemangiomas. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the accuracy of CEUS in the characterization of pancreatic solid lesions, considering cross sectional imaging techniques (CE-CT/MRI) as the "gold standard" methods. Material and methods: We performed a retrospective, monocentric study that included 91 solid pancreatic lesions which were evaluated by CEUS and by a second-line contrast imaging technique (CT or MRI), considered as the reference method. Results: The rate of a conclusive diagnosis based on a typical enhancement pattern was 94% (78/83 cases). In 72 cases out of 83 (86.7%) there was a perfect concordance between CEUS and the "gold-standard" imaging method (CE-CT/MRI). In our study, 88% (73/83) of the pancreatic lesions were categorized as malignant due to their typical wash-out aspect in the late phase. The overall accuracy of CEUS for the differential diagnosis of solid pancreatic tumors was approximately 81%. The accuracy of CEUS for the diagnosis of hypoenhancing pancreatic tumors was approximately 89.1%; while for the diagnosis of hyperenhancing pancreatic tumors it was approximately 72.8%. Conclusion: CEUS allows the differentiation between hypo- vs. hyperenhancing pancreatic solid lesions, with a considerable diagnostic accuracy, a fundamental step in the precise diagnosis of pancreatic tumors. [ABSTRACT FROM AUTHOR]

Unlabelled: The Aim: of this study was to summarize the spectrum of pancreatic pathology assessed by contrast enhanced ultrasound (CEUS) in a single Gastroenterology Center and to emphasize its accuracy in assessing two of the most important pancreatic lesions: solid tumors and necrotic lesions in acute pancreatitis. Material and Methods: Our retrospective study included 197 patients with pancreatic lesions (de novo pancreatic masses; acute, severe pancreatitis; other pathologies) evaluated by CEUS from October 2009 to May 2013, in which a reference method (contrast CT/MRI) was available. Results: A conclusive diagnosis was established according to the EFSUMB Guidelines in 87.8% of the 197 cases. In 87.3% cases there was a perfect concordance between CEUS and the reference method (contrast CT/MRI). 95 examinations were made for pancreatic solid masses: 41.1% (39) were hypoenhanced, 34.7% (33) were hyperenhanced, and 20% (19) were isoenhancing - chronic pancreatitis and autoimmune pancreatitis - while in 4.2% (4) cases CEUS was inconclusive. 60 examinations were made in severe acute pancreatitis and in 50% (30) cases pancreatic necrosis was diagnosed. 42 examinations were performed for other lesions: 64.2% (27) pancreatic pseudocysts, 11.9% (5) cystic tumors, 23.8% (10) other pathologies (abscesses, fibrosis, etc). CEUS accuracy for solid tumors was 92.9%. For necrotic lesions the accuracy was 97.4%. Conclusions: CEUS has turned to be a good method for the characterization of different pancreatic pathologies and for evaluating acute pancreatitis. CEUS was conclusive in 90% cases and it should be considered as a first line imaging method in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Liver stiffness measurement (LSM) using Transient Elastography (TE) for liver fibrosis assessment is difficult to be performed in obese and overweight patients by standard M probe, thus the XL probe was developed. The aim of our paper was to assess the usefulness of the XL probe in daily clinical practice.Material and Method: Our study included 216 patients (mean BMI 30.1+/-4.1 kg/m2) with chronic hepatopathies, in which paired measurements were made using the M (3.5MHz) and XL (2.5 MHz) probes in the same session. In each patient 10 valid LSM were acquired with each probe, a median was calculated, expressed in kiloPascals (kPa). Unreliable TE measurements were considered: fewer than 10 valid shots; with a success rate (SR) <60% and/or interquartile range interval (IQR) ≥30%.Results: In 127 patients reliable LSM could not be obtained by standard M probe, 10 of them normal weight, 25 of them overweight, and 92 obese. By XL probe reliable measurements were obtained in 80/127(63%) of these patients: 8/10 (80%) of the normal weights, 17/25 (68%) of the overweight and 55/92 (59.8%) of the obese. In 98 patients with reliable M probe measurements, XL probe LSMs were also performed. XL LS values strongly and significantly correlated with those obtained by M probe (Spearman r=0.789, p<0.0001), but were significantly lower [median 6.4 kPa (range 3.1 - 53.8) vs 7.7 kPa (range 3.7-69.1), Wilcoxon paired t test p<0.001)].Conclusion: By using the XL probe, reliable LSM by TE can be obtained in more than 60% of patients with unreliable measurements by M probe. LSM by XL probe are significantly correlated, but lower, than those obtained by M probe. [ABSTRACT FROM AUTHOR]

Abstract: We used supersonic shear imaging to determine the liver stiffness (LS) values of 82 patients without known liver pathology and studied the factors that influence these measurements. Five LS measurements were made in each subject, and the median value, expressed in kilopascals, was calculated. Reliable LS measurements were obtained in 84.5% of patients. Higher body mass index and older age were associated with failure to obtain reliable measurements. The mean value of LS measurements determined by SSI in our cohort of patients without known liver pathology was 6 ± 1.4 kPa. The mean LS measurements determined by SSI for men were significantly higher than those for women; body mass index did not significantly influence SSI measurements. Thus, 6 kPa is the mean SSI value in patients without known liver pathology, with higher values being obtained in men. [Copyright &y& Elsevier]

Abstract: Our aim was to compare liver stiffness (LS) measurements by means of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in patients with chronic hepatitis B and C, according to the severity of fibrosis. We also compared the correlation strength of ARFI and TE measurements with liver fibrosis. We included 53 patients with hepatitis B and 107 with hepatitis C in which liver biopsy, ARFI and TE measurements were performed in the same session. The mean LS values measured with ARFI were similar in patients with chronic hepatitis B and C and depended on the stage of fibrosis. The correlation strength of LS measurements by ARFI and by TE with fibrosis was similar in chronic hepatitis B and C patients. In conclusion, for the same stage of fibrosis, the mean LS values by ARFI were similar in patients with chronic hepatitis B and C. ARFI had similar predictive value with TE in both chronic viral hepatitis. [Copyright &y& Elsevier]

Background: Liver biopsy (LB) is still considered to be the gold standard for assessment of liver fibrosis. Objectives: To evaluate the effectiveness of various non-invasive methods for predicting liver fibrosis, including transient elastography (TE), APRI score, Lok score, Forns score, FIB-4 score, Fibrosis Index, King score, and Bonacini score, in comparison with the effectiveness of LB and to create a new scoring system for fibrosis prediction. Patients and Methods: This study included 212 patients with chronic HCV hepatitis. LB, TE, and various biological tests were performed during a single hospital visit. Using established formulae, data from these tests were used to create scores for assessment of liver fibrosis. Results: The results of all the tests showed significant correlation with histological fibrosis. TE results (r = 0.62), King score (r = 0.57), and APRI score (r = 0.56) showed the closest correlation with severity of fibrosis. The following formula was derived from our data by multiple regression: Predicted liver fibrosis score (PLF score) = 0.956 + 0.084 × TE + 0.004 × King score + 0.124 × Forns score + 0.202 × APRI score. A direct correlation (r = 0.68) was found between the PLF score and liver fibrosis. The cut-off values of the PLF score for various stages of fibrosis were: F ≥ 1, 1.77 (Area under ROC curve (AUROC) = 0.76); F ≥ 2, 2.18 (AUROC = 0.78); F ≥ 3, 2.47 (AUROC = 0.86); and F = 4, 2.98 (AUROC = 0.97). Conclusions: We found that our newly developed PLF score, which is derived from the scores of multiple tests, is more strongly correlated with fibrosis than each component score used individually. The PLF score is more effective than TE for predicting severe fibrosis, but they have similar effectiveness in predicting liver cirrhosis. [ABSTRACT FROM AUTHOR]

Aim: Focal liver lesions (FLLs) are quite frequently discovered in daily practice at routine ultrasound. The aim of our study is to present a single centre experience concerning the use of contrast enhanced ultrasound (CEUS) in the characterization of FLL and to find when one can avoid using other expensive imaging modalities such as contrast enhanced CT or MRI. Method: We performed a prospective, single centre study during September 2009 - April 2010, and we evaluated 379 FLLs. A CEUS examination was considered conclusive if the FLL had a typical enhancement pattern according to the EFSUMB guidelines. Results: From the 379 cases with FLL, 198 (52.2%) were patients without known liver disease and 181 (47.8%) with known chronic liver disease (156 had cirrhosis, 25 chronic hepatitis); in 296/379 cases (78.1%) CEUS was conclusive. CEUS allowed the positive diagnosis of benign vs. malignant lesion in 261/294 (88.8%) de novo FLLs (CEUS performed for the first time), while in 33 (11.2%) cases it was inconclusive and could not differentiate between benign or malignant lesions. The CEUS results included 129 (49.4%) benign lesions and 132 (50.6%) malignant. Conclusion: CEUS was conclusive in approximately 80% of the FLLs and the benign or malignant character of a lesion was demonstrated in about 90% of cases. Thus, when faced with an uncharacteristic FLL on standard ultrasound examination, our local strategy is to perform CEUS as a first-line investigation, thus avoiding other expensive examinations. [ABSTRACT FROM AUTHOR]

Background and aim: The current standard of care in chronic HCV genotype 1 hepatitis is the combination of pegylated interferon (PegIFN) with ribavirin for 48 weeks. The aim of our paper was to verify if there are significant differences regarding the sustained virologic response (SVR) in patients treated with PegIFN alfa-2a vs. those treated PegIFN alfa-2b, both in combination with ribavirin. Method: We performed a retrospective study on 507 patients with chronic viral C hepatitis treated with PegIFN alpha-2a 180 μg/kg/week or PegIFN alpha-2b 1.5 μg/kg/week plus ribavirin in the recommended doses according to weight, following the current treatment guidelines. We evaluated the SVR defined as PCR RNA-HCV undetectable 24 weeks after the end of treatment. Results: There were no differences regarding the baseline characteristics among the subgroups of patients treated with PegIFN alpha-2a or PegIFN alpha-2b concerning the pretreatment viral load (p=0.2445), the severity of fibrosis (p=0.2403), the mean age of the patients (p=0.9597) and the women/men ratio (p=0.2087). The SVR rates in patients treated with PegIFN alpha-2a were similar to those in patients treated with PegIFN alpha-2b: 208/338 (61.5%) vs. 94/169 (55.6%) (p=0.2129). Conclusion: Sustained virologic response rates were similar in HCV genotype 1 patients treated with PegIFN alpha-2a and with Peg-IFN alpha-2b. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) infection is a widespread global health issue and a primary cause of diseases like gastritis, gastroduodenal ulcers, and gastric cancer. This study examines the prevalence of H. pylori infection in patients undergoing upper endoscopy and assesses the efficacy of bismuth quadruple therapy (BQT) and levofloxacin triple therapy. A retrospective analysis of 507 gastroscopies was conducted, with indications including epigastric pain, heartburn, postprandial fullness, early satiation, and regurgitation. Rapid urease tests were performed, and endoscopic findings documented. Two treatment regimens were used: BQT as the first-line therapy and levofloxacin triple therapy as the second-line. Of the 507 patients, 68.8% were infected with H. pylori. Gastric ulcer patients had significantly higher H. pylori prevalence compared to those with small polyps, Barrett's esophagus, or normal endoscopy. Among the 310 patients who participated in follow-up interviews, 11.9% did not initiate therapy and 5.1% discontinued due to intolerance. The overall eradication rate was 88.6%, with BQT showing a higher eradication rate (89.4%) compared to levofloxacin triple therapy (83.8%). The study highlights the high prevalence of H. pylori among patients with gastrointestinal symptoms and the effectiveness of BQT as a first-line treatment. [ABSTRACT FROM AUTHOR]

In the current literature, there is only a small number of studies that have evaluated the utility of point share wave elastography for pancreatic assessment. Objective: To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. Material and method: We included 70 subjects (52.8% women, 47.2% men, average BMI=25.9±4.9 kg/m2, average age 46.8±18.4 years) with a normal pancreatic ultrasound aspect and with no history of pancreatic disease or diabetes, in whom elastography measurements were performed with a Siemens Acuson S2000 Virtual Touch ultrasound system (Siemens AG, Erlangen, Germany) using a 4CI transducer. For each patient, 10 valid VTQ measurements of the pancreatic parenchyma were performed under fasting conditions. Reliable measurements were defined as a median value of ten pancreas stiffness measurements with a success rate ≥60% and an interquartile range interval <30%. Results: Out of 70 subjects, reliable measurements were acquired in 61 subjects (87.1%) by means of VTQ elastography. The mean pancreas stiffness values in healthy subjects was 1.26 m/s ± 0.1 m/s, CI 95% (1.24-1.28). There were no significant differences between the mean pancreas stiffness in men vs. women 1.25 m/s ± 0.09 m/s, CI 95% (1.21-1.28) vs. 1.28 m/s ± 0.1 m/s CI 95% (1.25-1.31) (p=0.103). Conclusion: VTQ can be a useful tool for pancreas quantification characterized by a good feasibility (87.1%) in healthy subjects. The mean pancreas stiffness values in healthy individuals was 1.26 m/s ± 0.1m/s. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diminutive polyps present a unique challenge in colorectal cancer (CRC) prevention strategies. This study aims to assess the characteristics and variables of diminutive polyps in a Romanian cohort, intending to develop a combined resect-and-retrieve or resect-and-discard strategy that reduces the need for an optical diagnosis. Materials and Methods: A prospective cohort study was conducted at two endoscopy centers in Romania from July to December 2021. Adult patients undergoing colonoscopies where polyps were identified and resected were included. Endoscopic procedures employed advanced diagnostic features, including blue-light imaging (BLI) and narrow-band imaging (NBI). Logistic regression analysis was utilized to determine factors impacting the probability of adenomatous polyps with high-grade dysplasia (HGD). Results: A total of 427 patients were included, with a mean age of 59.42 years (±11.19), predominantly male (60.2%). The most common indication for a colonoscopy was lower gastrointestinal symptoms (42.6%), followed by screening (28.8%). Adequate bowel preparation was achieved in 87.8% of cases. The logistic regression analysis revealed significant predictors of HGD in adenomatous polyps: age (OR = 1.05, 95% CI: 1.01–1.08, p = 0.01) and polyp size (>5 mm vs. ≤5 mm, OR = 4.4, 95% CI: 1.94–10.06, p < 0.001). Polyps classified as Paris IIa, Ip, and Isp were significantly more likely to harbor HGD compared to the reference group (Is), with odds ratios of 6.05, 3.68, and 2.7, respectively. Conclusions: The study elucidates significant associations between the presence of HGD in adenomatous polyps and factors such as age, polyp size, and Paris classification. These findings support the feasibility of a tailored approach in the resect-and-discard and resect-and-retrieve strategies for diminutive polyps, potentially optimizing CRC prevention and intervention practices. Further research is warranted to validate these strategies in broader clinical settings. [ABSTRACT FROM AUTHOR]

In the current literature, there is only a small number of studies that have evaluated the utility of point share wave elastography for pancreatic assessment. To assess the feasibility of Virtual Touch Quantification (VTQ) elastography for pancreas assessment, as well as the mean pancreatic stiffness values in healthy subjects. We included 70 subjects (52.8% women, 47.2% men, average BMI = 25.9 ± 4.9 kg/m2, average age 46.8 ± 18.4 years) with a normal pancreatic ultrasound aspect and with no history of pancreatic disease or diabetes, in whom elastography measurements were performed with a Siemens Acuson S2000 Virtual Touch ultrasound system (Siemens AG, Erlangen, Germany) using a 4CI transducer. For each patient, 10 valid VTQ measurements of the pancreatic parenchyma were performed under fasting conditions. Reliable measurements were defined as a median value of ten pancreas stiffness measurements with a success rate ≥ 60% and an interquartile range interval < 30%. Out of 70 subjects, reliable measurements were acquired in 61 subjects (87.1%) by means of VTQ elastography. The mean pancreas stiffness values in healthy subjects was 1.26 m/s ± 0.1 m/s, CI 95% (1.24-1.28). There were no significant differences between the mean pancreas stiffness in men vs. women 1.25 m/s ± 0.09 m/s, CI 95% (1.21-1.28) vs. 1.28 m/s ± 0.1 m/s CI 95% (1.25-1.31) (p = 0.103). VTQ can be a useful tool for pancreas quantification characterized by a good feasibility (87.1%) in healthy subjects. The mean pancreas stiffness values in healthy individuals was 1.26 m/s ± 0.1m/s. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is globally recognized as a prevalent malignancy known for its significant mortality rate. Recent years have witnessed a rising incidence trend in colorectal cancer, emphasizing the necessity for early diagnosis. Our study focused on examining the impact of the SMAD7 gene variant rs4939827 on the risk of colorectal cancer occurrence. The composition of our study group included 340 individuals, comprising 170 CRC diagnosed patients and 170 healthy controls. We performed genotyping of all biological samples using the TaqMan assay on the ABI 7500 Real-Time PCR System (Applied Biosystems, Waltham, MA, USA). This investigation focused on the rs4939827 gene variant, assessing its association with CRC risk and clinicopathological characteristics. Genotyping results for the SMAD7 gene variant rs4939827 revealed a 42.6% prevalence of the C allele in CRC patients (p = 0.245) and a 22.8% prevalence of the T allele in control subjects (p = 0.109). This study concluded that there was an elevated risk of CRC in the dominant model for CC/CT+TT, with a p-value of 0.113 and an odds ratio (OR) of 2.781, within a 95% confidence interval (CI) of 0.998 to 3.456. The findings of our research indicate a correlation between variants of the SMAD7 gene and the likelihood of developing colorectal cancer in our study population. Consequently, these results could be instrumental in facilitating early diagnosis of colorectal cancer utilizing information on single-nucleotide polymorphism (SNP) and genetic susceptibility to the disease. [ABSTRACT FROM AUTHOR]

Aims: Ultrasound (US) is an essential diagnostic and educational tool in medical practice, and its effective implementation into medical curricula is critical. This study aimed to compare the efficacy of two disparate educational approaches-an optional semester course and a specifically curated intensive workshop-on the learning curve of medical students in abdominal ultrasonography. Material and methods: Engaging fourth and fifth-year medical students, this study, incorporated both theoretical and practical elements of US, providing participants with hands-on experience and evaluative assessments pre- and post-training. Students were segregated into two groups: one experienced a 14-hour optional semester course and the other a 6-hour intensive workshop, both yielding distinct teaching methodologies yet aspiring for synonymous educational outcomes. Results: Involving a total of 93 participants, findings elucidated that regardless of the educational method employed, post-training identification of US structures exhibited a significant enhancement compared to pre-training. Interestingly, no substantial disparities were discerned between the two educational approaches nor gender-based differences in learning outcomes. Conclusions: This investigation provides pivotal insights into the versatile utility of different educational strategies in abdominal US training for medical students, affirming that varied pedagogical methods can achieve comparable augmentations in student proficiency. Further research is paramount to ascertain the optimal integration of US education into medical curricula, considering aspects such as duration, depth, and mode of delivery. [ABSTRACT FROM AUTHOR]

Aim: Nonalcoholic Fatty Liver Disease (NAFLD) is increasing in frequency in daily practice and evaluation of liver steatosis, fibrosis and inflammation severity are essential for prognosis assessment. The aim was to evaluate the usefulnessof a new liver steatosis quantification system - Ultrasound-Guided Attenuation Parameter (UGAP) from General Electric Healthcare, using Controlled Attenuation Parameter (CAP) as the reference method.Material and Method: 179 consecutive subjects, in whom liver steatosis was assessed in the same session using UGAP, implemented on LOGIQ E10 system (GE Healthcare), and CAP (FibroScan, EchoSens). To discriminate between steatosis stages by CAP, we used the cut-offs recommended by the manufacturer: S1 (mild) - 230 dB/m, S2 (moderate) - 275 dB/m, S3 (severe) - 300 dB/m.Results: We classified our cohort by means of CAP into the following groups: S0 (no steatosis): 48/176 (27.2%), S1 (mild): 56/176 (31.6%), S2 (moderate): 14/176 (7.3%) and S3 (severe): 59/176 (33.9%). The mean UGAP values increased with the steatosis grade and for each group were the following: S0: 198.3±25.7 dB/m, S1: 216.86±26.3 dB/m, S2: 237.79±26.3 dB/m, and S3: 270.8±31.62 dB/m respectively (p<0.001). A very good positive correlation was found between UGAP and CAP values (r=0.73, p<0.0001). The best cut-off values for predicting different grades of liver steatosis using CAP as the reference were: S1 - 192.5 dB/m (AUC 0.83); S2 - 231 dB/m (AUC 0.90) and S3 - 248 dB/m (AUC 0.91).Conclusion: UGAP seems to be a good method for liver steatosis quantification and correlates strongly with CAP values. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) remains a challenging medical condition, where a deeper metabolic insight could pave the way for innovative treatments. This research harnessed serum metabolomics to discern potential diagnostic markers for AP and distinguish between its biliary (BAP) and alcohol-induced (AAP) forms. Leveraging high-performance liquid chromatography coupled with mass spectrometry, the metabolic signatures of 34 AP patients were contrasted against 26 healthy participants, and then between different etiologies of AP. The results identified metabolites primarily from glycerophospholipids, glycerolipids, fatty acyls, sterol lipids, and pteridines and derivative classes, with the Human Metabolome Database aiding in classification. Notably, these metabolites differentiated AP from healthy states with high AUROC values above 0.8. Another set of metabolites revealed differences between BAP and AAP, but these results were not as marked as the former. This lipidomic analysis provides an introduction to the metabolic landscape of acute pancreatitis, revealing changes in multiple lipid classes and metabolites and identifying these metabolites. Future research could add and discover new diagnostic biomarkers and therapeutic strategies enhancing the management of acute pancreatitis. [ABSTRACT FROM AUTHOR]

Ultrasound elastography including transient elastography (TE), point shear wave elastography, (pSWE) and two (three)- dimensional shear wave elastography (2D-SWE) have been introduced mainly for the evaluation of the liver. All the techniques are also feasible for the examination of spleen, whereas pSWE and 2D-SWE can be used for the assessment of the pancreas, kidney, gastrointestinal tract and other organs. Strain elastography also plays a role for non-liver applications. The aim of the current report is to highlight unique features and techniques for the elastographic examinations in children and to report initial results in non-liver applications. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): Usefulness in patients with chronic liver disease," by Y. Yilmaz and colleagues in the 2011 issue.

Vibration-controlled transient elastography (VCTE) was the first non-invasive method used for assessing liver fibrosis in patients with chronic liver disease. Over the years, many studies have evaluated its performance. It is now used globally, and, in some countries, it represents the primary step in evaluating liver fibrosis. The aim of this study is to assess the feasibility of VCTE and highlight the prevalence of liver fibrosis stages assessed by VCTE in a large cohort of patients at a single study center. We also aimed to observe the trends in liver stiffness (LS) values over the years according to each type of hepatopathy. A retrospective study was conducted over a period of 13 years (2007–2019) and included patients who presented to our clinic for LS measurements (LSMs), either with known liver diseases or with suspected liver pathology who were undergoing fibrosis screening. The database contained a total of 23,420 measurements. Valid LSMs were obtained in 90.91% (21,291/23,420) of the cases, while 2129 (9.09%) of the measurements were either failed or unreliable. In untreated patients with chronic viral hepatitis, LS values tended to increase during the years, while in patients undergoing antiviral therapy LS values significantly decreased. Our comprehensive study, one of the largest of its kind spanning 13 years, emphasizes the reliability and significance of VCTE in real-world clinical settings. [ABSTRACT FROM AUTHOR]

The aim of the paper was to propose a score for performance evaluation in colonoscopy units. Method. We proposed a score (CDCD score - Cecal intubation, polyp Detection rate, Cleansing and Documentation of cecal intubation) based on the following parameters that assess the quality of colonoscopy units: total colonoscopies rate, polyp detection rate, rate of cecal intubation photo record, rate of recorded Boston bowel preparation scale (BBPS) (rated 1 to 5 stars). The mean score obtained based on the above mentioned criteria was used as a quality parameter of the endoscopy unit. We applied and calculated this score in all screening colonoscopies performed in our Endoscopy Department during the last 4 years. Results. The study group included 856 screening colonoscopies. The rate of total colonoscopies was 92.1% (789/856 cases) and the polyp detection rate was 23.9%. Regarding the quality of bowel preparation, the BBPS was recorded in 51.1% cases. The cecal intubation was photo recorded in 44% of cases. We considered that of the 4 parameters, the highest weight for an excellent quality belonged to the cecal intubation rate, followed by the polyp detection rate, because they evaluate the endoscopic technique, while the other 2 are more administrative. Thus, for the unit's assessment we used the following equation: UNIT'S QUALITY CDCD SCORE = (3xcecal intubation rate+3xpolyp detection rate+1xphoto documentation+1xBBPS documentation)/8. Thus, the CDCD Score for our unit was ≈4 stars (3.7 stars). Conclusion. The proposed CDCD score may be an objective tool for the quality assessment in different endoscopy units. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the impact of COVID-19 infection on patients with decompensated liver cirrhosis (DLC) in terms of acute-on-chronic liver failure (ACLF), chronic liver failure acute decompensation (CLIF-AD), hospitalization, and mortality. In this retrospective study, we analyzed patients with known DLC who were admitted to the Gastroenterology Department with COVID-19. Clinical and biochemical data were obtained to compare the development of ACLF, CLIF-AD, days of hospitalization, and the presence of independent factors of mortality in comparison with a non-COVID-19 DLC group. All patients enrolled were not vaccinated for SARS-CoV-2. Variables used in statistical analyses were obtained at the time of hospital admission. A total of 145 subjects with previously diagnosed liver cirrhosis were included; 45/145 (31%) of the subjects were confirmed with COVID-19, among which 45% had pulmonary injury. The length of hospital stay (days) was significantly longer in patients with pulmonary injury compared to those without (p = 0.0159). In the group of patients with COVID-19 infection, the proportion of associated infections was significantly higher (p = 0.0041). Additionally, the mortality was 46.7% in comparison with only 15% in the non-COVID-19 group (p = 0.0001). Pulmonary injury was associated with death during admission in multivariate analysis in both the ACLF (p < 0.0001) and the non-ACLF (p = 0.0017) group. COVID-19 significantly influenced disease progression in patients with DLC in terms of associated infections, hospitalization length, and mortality. [ABSTRACT FROM AUTHOR]

Non-invasive tests have been developed to determine the severity of liver disease in patients with alcohol use disorder (AUD). We aimed to assess the severity of liver steatosis and liver fibrosis (LF) in a cohort of patients with AUD using liver elastography and biological scores. Materials and methods: A prospective study was performed on 172 subjects, without previously known liver disease, with a positive AUDIT-C score, serum markers, and vibration-controlled transient elastography (VCTE) with Controlled Attenuation Parameter (CAP). Results: From 172 subjects with positive AUDIT-C test, VCTE diagnosed advanced fibrosis (F3) in 13.9% (24/172) of the subjects and liver cirrhosis (F4) in 17.5% (30/172). Moderate and severe steatosis was found in 18.6% (32/172), respectively 52.3% (90/172). Significant correlations were found between liver stiffness and APRI (r=0.33, p=0.001), FIB-4(r=0.31, p=0.0012) and the age-platelet index (r=0.25, p=0.008). FIB-4 (p=0.01) and age-platelet index (p=0.03) were independently associated with the presence of advanced fibrosis. Age-platelet index (AUC-0.82) performed significantly better than AST/ALT (AUC-0.55) and APRI (AUC-0.58) (p= 0.0001 and p= 0.0014, respectively), but no differences were found when compared to FIB-4 (AUC-0.77) (p=0.35) for predicting advanced fibrosis. Conclusion: In conclusion, in a cohort of patients with AUD, 70.9% presented moderate and severe liver steatosis and 17.5% were newly diagnosed with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-based elastography techniques became in the last years reliable tools to predict the severity of liver fibrosis in chronic hepatopathies. Usually, these techniques are integrated in high-end US machines but recently they became available in medium-range ones. To evaluate the performance of point Shear-Wave Elastography from Siemens, implemented on the new ACUSON Juniper Ultrasound System, for the non-invasive assessment of liver fibrosis, and to identify liver stiffness (LS) cut-off value for predicting advanced fibrosis, using Transient Elastography (TE) as the reference method. Material and method: We included 201 consecutive subjects (60% men, mean BMI = 28.7 ± 4.9 kg/m2, mean age 59 ± 18.4 years) with or without chronic hepatopathies in whom LS was evaluated in the same session by means of 2 elastography techniques: TE and p-SWE from Siemens. Reliable LS measurements were defined for TE as the median value of 10 measurements with an interquartile range/median (IQR/M) <30%, and for p-SWE as the median value of 10 measurements acquired in a homogenous area and an IQR/M <30%. A cut-off of ≥ 9.5 kPa by TE was used to define advanced fibrosis (F≥3) [1]. Valid liver stiffness measurements (LSM) were obtained in 97.5% of patients using both elastography methods. Therefore, 196 subjects were included in the final analysis (27.8% with TE ≥ 9.5 kPa). A moderate positive correlation was found between the LS values obtained by the 2 methods: r=0.68, p<0.0001 (Spearman correlation). LS values obtained by p-SWE were significantly lower than those obtained by TE: 8.3 kPa vs. 10.12kPa (p<0.0001). The best p-SWE cut-off value for advanced fibrosis (F≥3) was 7.4 kPa (AUC- 0.95; Se-81.5%; Sp-98%; PPV-95.7%; NPV-93.3%) Using the new US system, the best p-SWE cut-off value for predicting advanced fibrosis was 7.4 kPa. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the performance and optimal cut-off points of UDFF for the non-invasive assessment of liver steatosis, using transient elastography (TE) with CAP as a reference method. We included 271 consecutive patients, with or without chronic liver disease (43.7% female, mean age 53.3 ± 13.05 years). Liver steatosis was evaluated in the same session by two techniques: UDFF - using a Siemens ACUSON Sequoia system (Deep Abdominal Transducer-DAX) and by CAP – using a FibroScan Compact M 530 device (M and XL probes). The following CAP cut-off values were used to differentiate among different grades of steatosis: 248dB/m for mild steatosis (S1), 268 dB/m for moderate steatosis (S2) and 280 dB/m for severe steatosis (S3). According to BMI, from the 271 patients 41% were obese, 34% were overweight and 25% normal weight. The correlation between UDFF and CAP was good, r=0.75, p<0.0001. We calculated the following UDFF optimal cut-off values to differentiate among steatosis grades: for S1->5% [(with 88.4% Se, 77.5% Sp,73.8% NPV, 90.3% PPV and an AUC of 0.92 (0.89-0.95), p<0.0001];for S2 >10% [(with 69.3% Se, 99% Sp, 99.1% NPV, 67.9% PPV and an AUC of 0.95 (0.92-0.97), p<0.0001]; and for S3 >15% [(with46.9% Se, 100% Sp, 100% NPV, 60.5% PPV and an AUC of 0.93 (0.89-0.96), p<0.0001]. UDFF is a good method for classifying steatosis severity with the following cut-offs:> 5% for mild steatosis,> 10% for moderate steatosis and > 15% for severe steatosis,the specificity increasing with steatosis severity. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the performance and optimal cut-off points for p-SWE and 2D-SWE for the non-invasive assessment of advanced liver fibrosis, using transient elastography as a reference method. Siemens ACUSON Sequoia (5C-1 convex transducer and Deep Abdominal Transducer-DAX) and FibroScan Compact M 530 (M and XL probes) were used. We included 198 consecutive patients with or without chronic liver disease that had all five LS values available. LS was evaluated in the same session by 3 elastographic techniques: TE, p-SWE and 2D-SWE. Reliable measurements were defined as the median value of 10 measurements and an IQR/M<0.3. For cACLD, the transient elastography cut-off point of 9.5 kPa was used [1]. From the 198 patients, 41.5% were women and 58.5% were men, mean age 54.8 ±13.8 years. The best cut-off values cACLD were: for 2D-SWE- 5C1 probe:>8.8 kPa, Se=97.7%, Sp=38.6%, AUC=0.84, p<0.0001;DAX probe:>7.6 kPa, Se= 40.9%, Sp=99.9%, AUC=0.84, p<0.0001; ForpSWE- 5C1 probe: >9.1 kPa, Se=54.5%, Sp=97.7%, AUC=0.86, p<0.0001; DAXprobe: > 8.8 kPa, Se=50%, Sp=98.5%, AUC=0.88, p<0.0001. The best cut-off value for predicting cACLD in pSWE range between 8.8 kPa and 9.1 kPa and for 2D-SWE raged between 7.6 kPa and 8.8 kPa. [ABSTRACT FROM AUTHOR]

Acute pancreatitis (AP) is the most common gastrointestinal indication requiring hospitalisation. Severe hypertriglyceridaemia (HTG) is the third most common aetiology of AP (HTGAP), with a complication rate and severity that are higher than those of other aetiologies (non-HTGAP). The aim of this study was to evaluate the supposedly higher complication rate of HTGAP compared to non-HTGAP. The secondary objectives were to find different biomarkers for predicting a severe form. This was a retrospective study that included patients admitted with AP in a tertiary department of gastroenterology and hepatology. The patients were divided into two groups: HTGAP and non-HTGAP. We searched for differences regarding age, gender, the presence of diabetes mellitus (DM), the severity of the disease, the types of complications and predictive biomarkers for severity, hospital stay and mortality. A total of 262 patients were included, and 11% (30/262) of the patients had HTGAP. The mean ages were 44.4 ± 9.2 in the HTGAP group and 58.2 ± 17.1 in the non-HTGAP group, p < 0.0001. Male gender was predominant in both groups, at 76% (23/30) in the HTGAP group vs. 54% (126/232) in non-HTGAP, p = 0.02; 53% (16/30) presented with DM vs. 18% (42/232), p < 0.0001. The patients with HTG presented higher CRP 48 h after admission: 207 mg/dL ± 3 mg/dL vs. non-HTGAP 103 mg/dL ± 107 mg/dL, p < 0.0001. Among the patients with HTGAP, there were 60% (18/30) with moderately severe forms vs. 30% (71/232), p = 0.001, and 16% (5/30) SAP vs. 11% (27/232) in non-HTGAP, p = 0.4 Among the predictive markers, only haematocrit (HT) and blood urea nitrogen (BUN) had AUCs > 0.8. According to a multiple regression analysis, only BUN 48 h was independently associated with the development of SAP (p = 0.05). Diabetes mellitus increased the risk of developing severe acute pancreatitis (OR: 1.3; 95% CI: 0.1963–9.7682; p = 0.7). In our cohort, HTGAP more frequently had local complications compared with non-HTGAP. A more severe inflammatory syndrome seemed to be associated with this aetiology; the best predictive markers for complicated forms of HTGAP were BUN 48 h and HT 48 h. [ABSTRACT FROM AUTHOR]

Introduction: Acoustic Radiation Force Impulse (ARFI) elastography is a non-invasive technique for liver fibrosis assessment. Aim: To assess the feasibility of ARFI elastography in a large cohort of subjects and to identify factors associated with impossibility to obtain reliable liver stiffness (LS) measurements by means of this technique. Methods: Our retrospective study included 1031 adult subjects with or without chronic liver disease. In each subject LS was assessed by means of ARFI elastography. Failure of ARFI measurements was defined if no valid measurement was obtained after at least 10 shots and unreliable in the following situations: fewer than 10 valid shots; or median value of 10 valid measurements with a success rate (SR)<60% and/or an interquartile range interval (IQR) ≥ 30%. Results: Failure of LS measurements by means of ARFI was observed in 4 subjects (0.3%), unreliable measurements in 66 subjects (6.4%), so reliable measurements were obtained in 961 subjects (93.3%). In univariant analysis, the following risk factors were associated with failed and unreliable measurements: age over 58 years (OR=0.49; 95% CI 0.30-0.80, p=0.005), male gender (OR=0.58; 95% CI 0.34-0.94, p=0.04), BMI>27.7 kg/m(2) (OR=0.23, 95% CI 0.13-0.41, p<0.0001). In multivariate analysis all the factors mentioned above were independently associated with the risk of failed and unreliable measurements. Conclusions: Reliable LS measurements by means of ARFI elastography were obtained in 93.3% of cases. Older age, higher BMI and male gender were associated with the risk of failed and unreliable measurements, but their influence is limited as compared with Transient Elastography. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Acoustic Radiation Force Impulse (ARFI) elastography is a non-invasive technique for liver fibrosis assessment. Aim: To assess the feasibility of ARFI elastography in a large cohort of subjects and to identify factors associated with impossibility to obtain reliable liver stiffness (LS) measurements by means of this technique. Methods: Our retrospective study included 1031 adult subjects with or without chronic liver disease. In each subject LS was assessed by means of ARFI elastography. Failure of ARFI measurements was defined if no valid measurement was obtained after at least 10 shots and unreliable in the following situations: fewer than 10 valid shots; or median value of 10 valid measurements with a success rate (SR)<60% and/or an interquartile range interval (IQR)≥30%. Results: Failure of LS measurements by means of ARFI was observed in 4 subjects (0.3%), unreliable measurements in 66 subjects (6.4%), so reliable measurements were obtained in 961 subjects (93.3%). In univariant analysis, the following risk factors were associated with failed and unreliable measurements: age over 58 years (OR=0.49; 95% CI 0.30–0.80, p =0.005), male gender (OR=0.58; 95% CI 0.34–0.94, p =0.04), BMI>27.7kg/m2 (OR=0.23, 95% CI 0.13–0.41, p <0.0001). In multivariate analysis all the factors mentioned above were independently associated with the risk of failed and unreliable measurements. Conclusions: Reliable LS measurements by means of ARFI elastography were obtained in 93.3% of cases. Older age, higher BMI and male gender were associated with the risk of failed and unreliable measurements, but their influence is limited as compared with Transient Elastography. [Copyright &y& Elsevier]

Abstract: Our study tried to identify the factors associated with discordance between liver stiffness values assessed by acoustic radiation force impulse (ARFI) elastography and histologic fibrosis in 106 chronic hepatitis C patients. Liver biopsy (LB) and ARFI measurements were performed in the same session. A discordance of at least two stages of fibrosis in the Metavir scoring system between ARFI results and LB was defined as significant. The performance of ARFI elastography was assessed using the following cut-offs: F1-1.19 m/s, F2-1.34 m/s, F3-1.55 m/s and F4-1.80 m/s. Discordance of at least two stages of fibrosis between ARFI results and histologic assessment were observed in 31.7% of the patients. In an univariate analysis, female sex (p = 0.004), interquartile range interval (IQR) ≥30% (p = 0.04), high alanine aminotransferases (p = 0.008) and high aspartate aminotransferases levels (p = 0.003) were associated with discordances. In a multivariate analysis, the female sex (p = 0.006) and IQR ≥30% (p = 0.004) were associated with discordances. Therefore, IQR parameter should be used for ARFI measurements. [Copyright &y& Elsevier]

Objectives: Contrast Enhanced Ultrasound is an imaging method that can evaluate imediatelly focal liver lesions discovered by ultrasound. The aim of this study is to demonstrate if Contrast Enhanced Ultrasound can be reliable as a diagnostic method for hepatocellular carcinoma. Material and methods: We included in our retrospective monocentric study all patients evaluated in our Department during 2 years, which had hepatocellular carcinoma as final diagnosis (using Contrast Enhanced Ultrasound, Contrast Enhanced Computed Tomography, Magnetic Resonance Imaging or biopsy). 91 patients with chronic liver diseases were evaluated, with a total of 114 liver nodules. The enhancement pattern of the nodules was evaluated according to the 2008 guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology. The lesions with arterial enhancement and washout in the portal or late phase were considered hepatocellular carcinoma. The nodules were classified according to their size in ≤3 cm and >3 cm. Outcomes: Of all nodules, 103 had hyperenhancing arterial pattern and washout was observed in 79 cases. In our study, this method established the diagnosis of hepatocellular carcinoma in 45 of 55 cases with liver nodules larger than 3 cm (81.8%) vs. 34 of 59 cases with nodules smaller than 3 cm (57.6%) (p<0.001). Conclusions: 69.3% of all hepatocellular carcinoma had a typical enhancement pattern on Contr ast Enhanced Ultrasound, performing better in nodules larger than 3 cm, than in smaller nodules (p<0.001). [ABSTRACT FROM AUTHOR]

Objectives: Contrast Enhanced Ultrasound is an imaging method that can evaluate imediatelly focal liver lesions discovered by ultrasound. The aim of this study is to demonstrate if Contrast Enhanced Ultrasound can be reliable as a diagnostic method for hepatocellular carcinoma. Material and methods: We included in our retrospective monocentric study all patients evaluated in our Department during 2 years, which had hepatocellular carcinoma as final diagnosis (using Contrast Enhanced Ultrasound, Contrast Enhanced Computed Tomography, Magnetic Resonance Imaging or biopsy). 91 patients with chronic liver diseases were evaluated, with a total of 114 liver nodules. The enhancement pattern of the nodules was evaluated according to the 2008 guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology. The lesions with arterial enhancement and washout in the portal or late phase were considered hepatocellular carcinoma. The nodules were classified according to their size in ≤3 cm and >3 cm. Outcomes: Of all nodules, 103 had hyperenhancing arterial pattern and washout was observed in 79 cases. In our study, this method established the diagnosis of hepatocellular carcinoma in 45 of 55 cases with liver nodules larger than 3 cm (81.8%) vs. 34 of 59 cases with nodules smaller than 3 cm (57.6%) (p<0.001). Conclusions: 69.3% of all hepatocellular carcinoma hada typical enhancement pattern on Contrast Enhanced Ultrasound, performing better in nodules larger than 3cm, than in smaller nodules (p<0.001). [ABSTRACT FROM AUTHOR]

Abstract: Our study assessed acoustic radiation force impulse (ARFI) reproducibility and the factors influencing it. The intra- and interoperator reproducibility were studied in 33 and 58 patients, respectively. Intraclass correlation coefficient (ICC) was used to assess ARFI reproducibility. The overall intraoperator agreement was better than the interoperator one: ICC 0.90 vs. ICC 0.81. The correlation of repeated ARFI measurements was higher, but not significantly so, in cases in which intraoperator reproducibility was assessed compared with the ones in which interoperator reproducibility was studied: r = 0.848 vs. r = 0.694 (p = 0.08). For both intra- and interoperator reproducibility, the ICCs were smaller in women vs. men (0.88 vs. 0.91 and 0.67 vs. 0.86, respectively), in patients with high body mass index (BMI) ≥25 kg/m² vs. <25 kg/m² (0.88 vs. 0.91 and 0.79 vs. 0.82, respectively), in patients with ascites vs. no ascites (0.80 vs. 0.93 and 0.78 vs. 0.84, respectively) and in noncirrhotic vs. cirrhotic patients (0.77 vs. 0.82 and 0.70 vs. 0.83, respectively). [Copyright &y& Elsevier]

Background: In chronic liver diseases, a correct estimation of the severity of liver fibrosis is important for recommendations regarding the treatment. Nowadays, evaluation of fibrosis is done by noninvasive methods such as biochemical scores and transient elastography instead of liver biopsy. The lack of sensitivity to detect fibrosis, because of its heterogeneity is a drawback of liver biopsy (LB). Objectives: To compare transient elastography (TE) and acoustic radiation force impulse (ARFI) for the evaluation of liver stiffness (LS), against percutaneous LB. Patients and Methods: Our study comprised of 223 subjects; 52 without fibrosis (38 volunteers and 14 patients with F0 on LB), 36 with F1, 40 with F2, 26 with F3 and 69 with liver cirrhosis (46 with LB and 23 with signs of cirrhosis). For each patient we performed in the same session 10 TE and 5 ARFI measurements. The median values were calculated. Results: A strong linear correlation (Spearman rho = 0.870) was found between TE and fibrosis (P < 0.0001); there was also a weaker correlation between ARFI and fibrosis (Spearman rho = 0.646; P < 0.0001). TE measurements were also correlated with ARFI measurements (Spearman rho = 0.733, P < 0.0001). The best test for predicting significant fibrosis (F ≥ 2) was TE with a cut-off value of 7.1 kPa (AUROC 0.953). For ARFI, the cut-off value was 1.27 m/s--area under ROC curve (AUROC): 0.890, sensitivity (Se) of 88.7%, specificity (Sp) of 67.5%, positive predictive value (PPV) of 64.5%, and negative predictive value (NPV) of 90% (P = 0.0044). For predicting cirrhosis (F = 4), the optimum cut-off values were 14.4 kPa for TE (AUROC: 0.985, Se: 95.6%, Sp: 94.7%, PPV: 89.2%, NPV: 98%) and 1.7 m/s for ARFI (AUROC: 0.931, Se: 93%, Sp: 86.7%, PPV: 73.6%, NPV: 96.9%) (P = 0.0102). Conclusions: LS evaluation by means of ARFI is not superior to TE for the assessment of liver fibrosis. ARFI is an accurate test for the diagnosis of cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Chronic viral hepatitis can be evaluated using invasive or noninvasive methods. Objectives: The aim of this study was to evaluate liver stiffness in inactive HBsAg carriers compared with normal subjects and determine if it is influenced by viral load in these patients. Patients and Methods: We prospectively evaluated 140 inactive HBsAg carriers and 152 normal subjects (without any signs or history of liver disease). In all subjects, liver stiffness was measured by 3 experienced physicians using a FibroScan® device (EchoSens, France) per standard procedures. We excluded patients for whom the SR of liver stiffness measurements was <60% and those who had measurements with an IQR>30%. Results: The mean liver stiffness in inactive HBsAg carriers was 5.6±2.1kPa, significantly higher than in normal subjects (4.8±1.2 kPa, p = 0.0002). In 16.4% (23) of inactive carriers, liver stiffness exceeded 7 kPa (the cutoff for significant fibrosis F > 2). In patients with undetectable viral loads, the mean liver stiffness was 4.9± 1.2 kPa, significantly lower than in those with detectable DNA (<2000 IU/ml)(6.7±2.7 kPa, p<0.001). Conclusions: Inactive HBsAg carriers have higher liver stiffness values compared with healthy individuals. Liver stiffness in inactive HBsAg carriers with detectable viral loads is higher than in those who are aviremic, suggesting that low viral loads promote fibrosis. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of Percutaneous Ethanol Injection Therapy (PEIT) for the treatment of hepatocarcinoma in a series of Romanian patients, and to compare it with previous studies. Material and method: We retrospectively evaluated 88 patients with liver cirrhosis (LC) and hepatocellular carcinoma (HCC) treated by PElT. Multiple sessions of PELT were performed to treat a single nodule of 2-10 cm in diameter. The Child-Pugh classification was used for evaluating the severity of LC and the Okuda and Barcelona scores for HCC. The efficacy of PElT was assessed by CT or MRI one month after the therapy. The patients' survival after PElT was calculated starting from the first PELT procedure until the moment of death or the end of study (2000-2005). We analyzed the main factors which influenced the survival of the treated patients. Results: The global survival was 38.07±3.97 months, longer in patients with Child-Pugh A class, than in Child-Pugh B class (Log Rank 0.04). Patients with HCC less than 3 cm in diameter survived significantly longer than patients with tumors more than 5 cm (Log Rank 0.007). Also, survival was better in the Barcelona A stage than in the Barcelona B and C stages (Log Rank 0.002) and in patients with alpha-fetoprotein less than 200 ng/l (Log Rank 0.002). Conclusion: The main factors which influenced the survival of patients treated by PELT were: the size of the HCC, the Child-Pugh class, the Barcelona stage and the level of alpha-fetoprotein at the time of initiation of therapy. [ABSTRACT FROM AUTHOR]

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Aim: The updated Baveno VI guidelines recommend that screening for high-risk varices (HRV) by esophago-gastro-duodenoscopy (EGD) can be avoided in patients with compensated advanced chronic liver disease (cACLD) who have liver stiffness LSM<20 kPa and platelet count PLT>150,000/L. The aims of this study were to validate extended Baveno VI criteria in patients with chronic liver disease and to establish cut-off values for our cohort.Materials and Methods: This retrospective study included 839 patients with liver cirrhosis evaluated by Transient Elastography (TE), biological tests, and upper endos-copy, all within one year. The Baveno VI criteria were validated on a sub-group of 728 patients (Cohort 1, randomly selected from the study sample) and tailored cut-off points were determined. The remaining 111 patients comprised the validating set (Cohort 2) for these specific cut-off values.Results: In Cohort 1, Baveno VI criteria had 86.2% accuracy. The calculated cut-offs to rule-in HRV were PLT<150,000/mm3 and LSM >35.3 kPa; while to rule-out HRV they were PLT >150.000/mm3 and LSM <19.6 kPa. In patients in the "grey-zone", by multivariate analysis, albumin was independently associated with HRV at a cut-off of ˂3.4 g/dl. In the validation cohort, the calculated rule out cut-offs had 100% accuracy.Conclusions: The Baveno VI criteria had a good accuracy for exclusion of HRV in this large cohort of cirrhotic patients. Adding an albumin-related threshold increased performance and broadened applicability. Using the calculated rule-out criteria for HRV, all unnecessary EGD could be excluded. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the severity of liver fibrosis and steatosis in a cohort of type 2 diabetic patients, using non-invasive Methods: Transient Elastography (TE) and Controlled Attenuation Parameter (CAP). Material and Method: The study included 704 type 2 diabetic patients prospectively randomized, evaluated in the same session by means of TE and CAP (FibroScan, EchoSens) to assess both liver fibrosis and steatosis. Reliable liver stiffness measurements (LSM) were defined as the median value of 10 LSM with an IQR/median < 30%. For TE and CAP, M and XL probes were used. A cut-off value of 10.1 kPa [1] was used to define severe fibrosis (F ≥ 3). For differentiation between stages of steatosis we used the following cut-off values recommended by the manufacturer: S1 (mild) < 230, S2 (moderate) 275-300 db/m, S3 (severe) > 300 db/m. Results: Out of 704 diabetics screened we excluded those with associated viral hepatitis, those with an AUDIT-C score ≥ 8 and those with unreliable LSM. The final analysis included 485 subjects (54.3% women, mean age 60 ± 9.5; mean BMI = 31.6 ± 6.1 kg/m2) with reliable LSM. 32.1% of patients had obesity grade I, 17.9 % had obesity grade II and 8.9% had obesity grade III (IMC ≥ 40 kg/m2). Mild, moderate and severe steatosis by means of CAP was found in 15.6%, 15.6 % and 59.3% cases, respectively. The median CAP values of patients with mild, moderate and severe steatosis were 260 db/m, 287.5 db/m and 354 db/m. Clinically relevant fibrosis was detected by means of TE in 19.6% (95/485) of subjects. Conclusion: In our group, 59.3% of diabetic patients had severe steatosis by means of CAP. Regarding the liver fibrosis, we found that 19.6% of them had severe fibrosis (TE ≥ 10.1kPa), suggesting the need for further assessment. [ABSTRACT FROM AUTHOR]