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Background: In patients with chronic liver diseases (CLDs), hepatitis C virus (HCV) infection in particular may cause various metabolic disorders. We previously reported that the value of the ratio of branched-chain amino acids to tyrosine (BTR) decreased with the progression of liver fibrosis. Objectives: We investigated the changes in clinical variables during interferon (IFN) treatment and assessed whether HCV eradication improved the amino acid imbalance in HCV infected patients. Patients and Methods: We retrospectively collected the clinical data of HCV-related CLD patients whose BTR values had been measured both pre- and post-IFN treatment. A total of 17 patients with a sustained viral response (SVR) (mean observational period: 1085.0 days) and 19 patients without an SVR (Non-SVR) (mean observational period: 1002.5 days) were studied. Results: In patients with an SVR, the serum levels of aminotransferases were decreased after HCV eradication. Although general liver functional tests (albumin and total bilirubin) did not significantly change, the BTR values significantly increased. However, in patients without an SVR, an improvement in the BTR value was not observed after IFN treatment. Conclusions: HCV eradication can improve the amino acid imbalance in HCV infected patients. [ABSTRACT FROM AUTHOR]

The article presents a study which compares the prognostic ability of different prognostic systems for hepatocellular carcinoma (HCC) patients who underwent sorafenib therapy.

In the present era of entecavir (ETV) use for chronic hepatitis B (CHB), the prognostic factors in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remain unclear. The aims of the present study were to investigate the prognostic factors in patients with HBV-related HCC treated with ETV who underwent curative therapy. A total of 74 HBV-related HCC patients treated with ETV who underwent curative therapy were analyzed. Predictive factors associated with overall survival (OS) and recurrence-free survival (RFS) were examined using univariate and multi-variate analysis. Our study population included 49 males and 25 females with a median age of 62 years. The median observation period was 3.4 years (range, 0.2-11.5 years). The 1-, 3- and 5-year cumulative OS rates were 100, 89.8 and 89.8%, respectively. The corresponding RFS rates were 82.8, 52.1 and 25.6%, respectively. In this study, 73 patients (98.6%) achieved an HBV DNA level of <400 copies/ml during the follow-up period. No viral breakthrough hepatitis, as defined by 1 log increase from nadir, was observed during ETV therapy. According to multivariate analysis, only hepatitis B e antigen (HBeAg) positivity was significantly associated with OS [hazard ratio (HR), 0.058; 95% confidence interval (CI), 0.005-0.645; P=0.020)], whereas HCC stage (HR, 0.359; 95% CI, 0.150-0.859; P=0.021), HBeAg positivity (HR, 0.202; 95% CI, 0.088-0.463; P<0.001) and γ-glutamyl transpep-tidase >50 IU/l (HR, 0.340; 95% CI, 0.152-0.760; P=0.009) were significant predictive factors linked to RFS. In conclusion, HBeAg positivity was significantly associated with OS and RFS in HBV-related HCC patients treated with ETV who underwent curative therapy. In such patients, close observation is required, even after curative therapy for HCC. [ABSTRACT FROM AUTHOR]

This article discusses a case of acute upper gastrointestinal bleeding caused by Dieulafoy's lesion (DL), a rare condition characterized by sudden and massive bleeding. DLs are typically found in the stomach but are relatively rare in the duodenum. Early diagnosis and treatment are crucial due to the life-threatening nature of DL bleeding. Endoscopy is recommended for diagnosis, and endoscopic treatment options include hemoclips, band ligation, argon plasma coagulation, epinephrine injection, or their combination. The mortality rate associated with DL bleeding has been reduced with the development of endoscopic treatment. In some cases, repeated endoscopy may be necessary to detect missed DLs. [Extracted from the article]

Background: If the guidewire becomes kinked by the needle, guidewire manipulation may be difficult, and can cause complications such as guidewire shearing or injury during endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). To overcome this matter, we have previously described a technical tip for preventing guidewire injury, termed ‘liver impaction technique’. However, its technical feasibility has been not reported in the setting of a large patient cohort. Objectives: The aim of study was to evaluate the clinical usefulness of the liver impaction technique during EUS-HGS. Design: Retrospective, single-center study. Methods: This retrospective study included consecutive patients who underwent EUS-HGS between April 2018 and September 2022. The primary outcome of this study was the technical success rate of guidewire insertion using the liver impaction technique. Results: A total of 166 patients were enrolled in this study. Initial successful guidewire insertion without using liver impaction technique was obtained in 108 patients (65.1%). Among 58 patients in whom guidewire insertion failed initially, guidewire advancement into the periphery of the bile duct was observed in 32 patients (55.2%) and into a non-interest bile duct branch was observed in 26 patients (44.8%). Liver impaction technique contributed to increasing the technical success rate of guidewire insertion from 65.1% to 95.8%. Overall, adverse events were observed in 12 patients (7.2%; bile peritonitis 푛=9, cholangitis 푛=3), and these adverse events were Grade I. Among patients who underwent liver impaction technique (푛=58), adverse events were observed in two patients (3.4%; bile peritonitis). Also, guidewire sharing was not observed in any patients during liver impaction technique. Conclusions: In conclusion, the liver impaction technique may be helpful during EUS-HGS to obtain successful guidewire insertion into the biliary tract of interest. Conclusions: In conclusion, the liver impaction technique may be helpful during EUS-HGS to obtain successful guidewire insertion into the biliary tract of interest. [ABSTRACT FROM AUTHOR]

Background: Technical tips for device insertion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) have not been reported. To improve the technical success rate of device insertion without unnecessary tract dilation, the pushing force should be transmitted directly from the channel of the echoendoscope to the intrahepatic bile duct. Objectives: We developed a novel technique, termed the ‘moving scope technique’, the feasibility of which during EUS-HGS is described. Design: Retrospective study. Methods: The primary outcome of this study was the technical success rate of dilation device insertion without electrocautery dilation after the moving scope technique. The initial technical success rate of dilation device insertion was defined as successful insertion into the biliary tract. If dilation device insertion failed, the moving scope technique was attempted. Results: A total of 143 patients were enrolled in this study. The initial technical success rate for device insertion was 80.4% (115/143). The moving scope technique was therefore attempted in 28 patients. The mean angle between the intrahepatic bile duct and the guidewire was improved to 141.0° and resulted in a technical success rate of 100% (28/28). The area under the ROC curve (AUC) was 0.88, and 120° predicted successful dilation device insertion with sensitivity of 88.0% and specificity of 78.8%. Bile peritonitis (푛 = 8) and cholangitis (푛 = 2) were observed as adverse events, but were not severe. Conclusion: In conclusion, the moving scope technique may be helpful during EUS-HGS to achieve successful insertion of the dilation device into the biliary tract. These results should be evaluated in a prospective randomized controlled trial. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 56-year-old man with symptomatic chronic pancreatitis and a challenging pancreatic duct cannulation due to an intradiverticular papilla. Topics discussed include technical approaches like the two-devices-in-one-channel method, cap-assisted cannulation, and use of submucosal saline injection or peptide hemostatic gel for mucosal elevation.

Aim: To compare the nutritional status between alcoholic compensated cirrhotic patients and hepatitis C virus (HCV)-related cirrhotic patients with portal hypertension., Methods: A total of 21 patients with compensated cirrhosis (14 with HCV-related cirrhosis and seven with alcoholic cirrhosis) who had risky esophageal varices were investigated. In addition to physical variables, including the body mass index, triceps skinfold thickness, and arm-muscle circumference, the nutritional status was also assessed using the levels of pre-albumin (pre-ALB), retinol-binding protein (RBP) and non-protein respiratory quotient (NPRQ) measured with an indirect calorimeter., Results: A general assessment for the nutritional status with physical examinations did not show a significant difference between HCV-related cirrhosis and alcoholic cirrhosis. However, the levels of pre-ALB and RBP in alcoholic compensated cirrhotic patients were significantly higher than those in HCV-related compensated cirrhotic patients. In addition, the frequency of having a normal nutritional status (NPRQ ≥ 0.85 and ALB value > 3.5 g/dL) in alcoholic compensated cirrhotic patients was significantly higher than that in HCV-related compensated cirrhotic patients., Conclusion: According to our small scale study, alcoholic compensated cirrhotic patients can develop severe portal hypertension even with a relatively well-maintained liver function and nutritional status compared with HCV-related cirrhosis.