Search

Background/aims: Anemia is commonly observed as a side effect in a treatment with protease inhibitors combined with peginterferon alpha and ribavirin for hepatitis C virus infection. This study assessed the safety, tolerability, viral kinetics, and selection of variants in telaprevir monotherapy for 24 weeks, and outcomes of the off-study treatment with peginterferon alpha-2b and ribavirin among Japanese female patients at a median age of 54 years who were difficult to treat with the standard therapy (peginterferon alpha-2b and ribavirin) alone in Japan., Methods: Four treatment-naïve patients with chronic hepatitis C virus subtype 1b infection received telaprevir (750 mg every 8 h) alone for 24 weeks. All patients then started the off-study treatment with peginterferon alpha-2b and ribavirin. Safety, tolerability, hepatitis C virus RNA levels, and emergence of telaprevir-resistant variants were monitored., Results: During the 24 weeks of telaprevir monotherapy, there was no discontinuation due to adverse events, but 2 patients stopped the intake at weeks 6 and 15 because of viral breakthrough. Emergence of telaprevir-resistant variants was observed in 3 patients who showed viral breakthrough. These variants were eliminated by the off-study treatment, and sustained virological response was achieved in all patients., Conclusions: Anemia was manageable by carefully adjusting the ribavirin dosage in the standard therapy that followed telaprevir monotherapy. This sequential regimen seems to be safer and more tolerable than the triple combination of telaprevir, peginterferon alpha, and ribavirin, especially among elderly females with low baseline hemoglobin.

Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward--oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS., Methods: Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esophageal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC1 was observed in the esophagus in 14 of the 26 patients. RC2 was noted in 11 cases, and RC0 was seen in one patient. ECDUS was performed using a Pentax EG-3630UR (forward view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270 degrees images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS., Results: (1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2%). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2%). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5%). Color flow images of pulsatile waves were detected in zero (0%) of the 4 F3 varices, in nine (42.9%) of the 21 F2 varices, and in the 1 (100%) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0%) of the 14 RC1 varices, in two (18.2%) of the 11 RC2 varices, and in the 1 (100%) case of RC0 varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3%) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2%) was significantly higher than with convex-type ECDUS (28 of the 110 patients, 25.5%) (P<0.05). The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5%) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7%) (P<0.0001)., Conclusions: Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270 degrees views. Electronic radial ECDUS was superior to convex-type ECDUS in detecting palisade veins and pulsatile waves.

Background: We examined the usefulness of endoscopic color Doppler ultrasonography, using Levovist in evaluating the arterial blood flow, in patients with esophageal varices., Methods: The study involved 110 patients with esophageal varices who were examined using endoscopic color Doppler ultrasonography (ECDUS). We compared vessel images detected by pre-contrast ECDUS with those detected by enhanced ECDUS. We evaluated the detection rate of the pulsatile wave, and measured systolic velocity and end-diastolic velocity. We calculated the resistance index (RI), which demonstrates the resistance of peripheral vessels in arterial flow., Results: Color flow images of the pulsatile wave were obtained by pre-contrast ECDUS in 3 (2.7%) of the 110 patients. Color flow images of the pulsatile waves were obtained in 40 (36.4%) of the 110 patients by enhanced ECDUS using Levovist. That is, by using Levovist, a pulsatile wave could be delineated in 37 patients in whom pulsatile waves were previously undiagnosed via pre-contrast ECDUS. Color flow images of the pulsatile waves were detected in 37 (37.7%) of the 98 F2 varices and in 3 (25.0%) of the 12 F3 varices. Color flow images of the pulsatile wave were detected in 35 (40.2%) of the 87 red color (RC)(+) varices, and in 5 (21.7%) of the 23 RC(++) or RC (+++) varices. Next, we calculated the RI of the pulsatile wave, obtained by enhanced ECDUS using Levovist, in 40 patients. The RI ranged from 0.49 to 0.83 (mean, 0.67 +/- 0.09); there were nine patients with RIs of less than 0.60, and all 9 of these patients had both F2 and RC(+) type varices (100%)., Conclusions: Levovist contrast in ECDUS examinations suggests that arterial flow is involved in the formation of esophageal varices.

Background: We evaluated the usefulness of endoscopic color Doppler ultrasonography (ECDUS) with Levovist, a galactose-based contrast agents, for detecting veins in the esophageal wall in patients with recurrent esophageal varices after endoscopic therapies., Methods: We compared vessel images detected prior to the use of contrast with those detected by enhanced ECDUS in 29 patients with recurrent esophageal varices. After the pre-contrast ECDUS examination, all 29 patients received Levovist intravenously, at a concentration of 300 mg/ml. A 7.5-ml dose of the contrast agent was injected at a slow infusion rate, of 1 ml/min. The perforating veins detected by ECDUS were classified, according to flow direction, into three different types. Type 1 showed inflow from the paraesophageal veins to the esophageal varices. Type 2 showed outflow from the esophageal varices to the paraesophageal veins, while type 3 was a mixed type with both inflow and outflow. For comparison, 26 patients without recurrent esophageal varices were studied., Results: Color flow images of perforating veins were obtained in 9 (31.0%) of the 29 patients with recurrent esophageal varices with pre-contrast ECDUS. The detection rate of perforating veins in the patients with recurrent esophageal varices (31.0%) was significantly higher than that in patients without recurrent esophageal varices (0 of 26; 0%) with pre-contrast ECDUS. Color flow images of perforating veins were detected in 22 (75.9%) of the 29 patients with recurrent esophageal varices after Levovist contrast. On the other hand, color flow images of perforating veins were not detected in any of the 26 patients without recurrent esophageal varices after Levovist contrast. Type 1 perforating veins were recognized in 6 (20.7%) of the 29 patients, type 2 in 2 (6.9%) of the 29, and type 3 in 1 (3.4%) of the 29 prior to the use of contrast. After the enhanced ECDUS, type 1 perforating veins were recognized in 13 (44.8%) of the 29 patients, type 2 in 6 (20.7%) of the 29, and type 3 in 3 (10.3%) of the 29. All color-flow images detected with pre-contrast ECDUS were enhanced after Levovist contrast., Conclusions: Perforating veins can be detected at a high rate by ECDUS with Levovist in patients with recurrent esophageal varices after endoscopic therapy., (Copyright 2004 Springer-Verlag)