Search

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an important therapy for complications of portal hypertension but remains underutilised in regional settings. Aims: The aim of this study is to explore the demographics, indications, outcomes and complications in patients undergoing TIPS in two regional hepatology centres. Methods: Retrospective analysis was undertaken of all patients undergoing TIPS at two regional centres between January 2017 and March 2023. The primary outcome measures were efficacy and complications of TIPS. Patient demographics (such as age, baseline liver severity scores and aetiology of liver disease) and indications for TIPS are detailed. Results: Forty‐eight patients underwent TIPS. Median age was 56 years (interquartile range (IQR): 46–65). The most common indications for TIPS were refractory ascites (n = 17) and failure of secondary prophylaxis of variceal bleeding (n = 13). Cumulative survival at 3 months and 1 year was 93% and 77% respectively. There was no significant difference in outcomes based on TIPS indication. The median number of paracenteses in patients undergoing TIPS for refractory ascites 1 year pre‐ and post‐TIPS were 10 (IQR: 4.5–16) and 2 (IQR: 0–4) respectively (P < 0.001). There were no procedure‐related deaths. Inpatient management of liver disease complications had a mean cost of $32 874.67 (SEM: 7779) in 1 year pre‐TIPS compared with $12 304.70 (SEM: 3531.1) in 1 year post‐TIPS (P < 0.001). Conclusions: TIPS is a safe and effective treatment to reduce complications of portal hypertension and can be performed successfully in the regional setting. [ABSTRACT FROM AUTHOR]

Non-invasive tests (NITs) are a potential alternative to screening oesophagogastroduodenoscopy (OGD) for ruling out high-risk varices (HRVs) in patients with compensated advanced chronic liver disease (cACLD). This retrospective study aimed to externally validate and compare various NITs in a multi-centre Australian cohort. Patients with cACLD were enrolled between January 2013 and December 2022. Liver stiffness measurements (LSMs), clinicopathological data, and OGD results were collected. A total of 210 patients were included. The median age was 57 years and 65.7% were male. The main aetiology of cACLD was hepatitis C (41.9%), and 91.9% of patients were Child–Pugh A. HRV prevalence was 12.4%. The Baveno VI criteria (B6C) was the only NIT that could safely reduce the need for OGDs across all aetiologies of cACLD, with a negative predictive value of 98.6 and spared OGD in 33.8%. The FIB-4 would have avoided the most OGDs (71%); however, the HRV miss rate was 6%. The results suggest that the B6C is the best performing NIT in our cohort and reliably excludes HRVs in cACLD patients, regardless of aetiology. This study confirms that the Baveno VI criteria can be applied in an Australian, mixed aetiology cohort to avoid unnecessary screening OGD. [ABSTRACT FROM AUTHOR]

Severe strictures only occurred in patients with an ER defect >= 90 % (22.6 %, 7/31), with none occurring in patients with an ER defect of < 90 %. In patients underdoing colorectal ESD, Hayashi et al. reported stricture formation in 0.49 % of all patients, and in 11.1 % of those with an ER defect >= 90 % [32]. Stricture prevalence and severity In the final cohort of 916 patients, the circumferential extent of the ER defect was >= 90 % in 31/916 patients (3.4 %), 60 %-89 % in 88/916 (9.6 %), and < 60 % in 797/916 (87.0 %). Graph Introduction Large (>= 20 mm) nonpedunculated colorectal polyps (LNPCPs) are effectively and safely managed by endoscopic resection (ER). [Extracted from the article]

Introduction Methods Results Conclusions The recently developed Freiburg Index of Post‐TIPS Survival (FIPS) allows improved risk classification of patients with decompensated cirrhosis allocated to transjugular intrahepatic portosystemic shunt (TIPS) implantation. This study investigated the prognostic value of the FIPS in patients hospitalized with acute decompensation of cirrhosis (AD), outside the setting of TIPS implantation.A total of 1133 patients with AD were included in a retrospective, multi‐centre study. Ninety‐day, 180‐day and 1‐year mortality were recorded and the FIPS' performance in predicting mortality at these time points was analysed using ROC analyses.Ninety‐day, 180‐day and 1‐year mortality were 17.7%, 24.4% and 30.8%. Uni‐ and multivariable Cox regression models showed that the FIPS independently predicted 1‐year mortality in the study cohort (HR 1.806, 95% CI 1.632–1.998, p < .0001). In ROC analyses, the FIPS offered consistently high performance in the prediction of mortality within 1 year after AD (area under the receiver operator characteristic [AUROC]: 1‐year mortality .712 [.679–.746], 180‐day mortality .740 [.705–.775] and 90‐day mortality .761 [.721–.801]). In fact, in the subgroup of patients presenting with variceal bleeding, the FIPS even showed significantly improved discriminatory performance in the prediction of long‐term mortality (AUROC 1‐year mortality: .782 [.724–.839]) in comparison with established prognostic scores, such as the CLIF‐C AD score (.724 [.660–.788], p = .0071) or MELD 3.0 (.726 [.662–.790], p = .0042).The FIPS accurately predicts mortality in patients with AD and seems to offer superior prognostication of long‐term mortality in patients with variceal bleeding. [ABSTRACT FROM AUTHOR]

Background and study aims Because of concerns about peri-procedural adverse events (AEs), guidelines recommend anesthetist-managed sedation (AMS) for long and complex endoscopic procedures. The safety and efficacy of physician-administered balanced sedation (PA-BS) for endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) ≥20 mm is unknown. Patients and methods We compared PA-BS with AMS in a retrospective study of prospectively collected data from consecutive patients referred for management of LNPCPs (NCT01368289; NCT02000141). A per-patient propensity analysis was performed following a 1:2 nearest-neighbor (Greedy-type) match, based on age, gender, Charlson comorbidity index, and lesion size. The primary outcome was any peri-procedural AE, which included hypotension, hypertension, tachycardia, bradycardia, hypoxia, and new arrhythmia. Secondary outcomes were unplanned admissions, 28-day re-presentation, technical success, and recurrence. Results Between January 2016 and June 2020, 700 patients underwent EMR for LNPCPs, of whom 638 received PA-BS. Among them, the median age was 70 years (interquartile range [IQR] 62-76 years), size 35 mm (IQR 25-45 mm), and duration 35 minutes (IQR 25-60 minutes). Peri-procedural AEs occurred in 149 (23.4%), most commonly bradycardia (116; 18.2%). Only five (0.8%) required an unplanned sedation-related admission due to AEs (2 hypotension, 1 arrhythmia, 1 bradycardia, 1 hypoxia), with a median inpatient stay of 1 day (IQR 1-3 days). After propensity-score matching, there were no differences between PA-BS and AMS in peri-procedural AEs, unplanned admissions, 28-day re-presentation rates, technical success or recurrence. Conclusions Physician-administered balanced sedation for the EMR of LNPCPs is safe. Peri-procedural AEs are infrequent, transient, rarely require admission (<1%), and are experienced in similar frequencies to those receiving anesthetist-managed sedation., Competing Interests: Conflict of Interest Michael J. Bourke: research support from Olympus Medical, Cook Medical and Boston Scientific. The remaining authors have no conflicts of interest to disclose., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)