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Background and AimsThe aMAP score was recently devised to predict hepatocellular carcinoma (HCC) development. However, its performance was not tested in alcohol-related cirrhosis (ALC). We aimed to validate the aMAP score in a cohort of ALC patients.MethodStudy participants with ALC from a prior genome-wide association study were included. All participants had a history of high alcohol consumption. Cirrhosis was defined clinically, using fibroscan and/or histology. Patients were followed until the last liver imaging, HCC, liver transplantation (LT) or death with the latter two adjusted as competing risks.ResultsA total of 269 ALC patients were included: male (72.5%), Caucasian (98.9%), median age 56 years, and median Child-Pugh score 7. The median aMAP score was 60: 12.3% low-risk, 35.3% medium-risk and 52.4% high-risk. After a median follow-up of 41 months, 14 patients developed HCC, 27 received LT and 104 died. The aMAP score predicted HCC development (hazard ratio 1.12 per point increase, P < .001) with good separation of cumulative incidence function between risk groups. The area under the time-dependent receiver operating characteristics curve for predicting HCC development was 0.83 at 1 year and 0.82 at 5 years which was similar to ADRESS-HCC and Veterans Affairs Healthcare System scores respectively.ConclusionsWe validated the excellent performance of the aMAP score in ALC and affirm its applicability across wider aetiologies.

Introduction Bowel preparation (BP) is a fundament for high-quality colonoscopy. Current guidelines suggest repeating colonoscopy within 1 year in case of inadequate bowel preparation (IBP). Up to 83% of individuals does not repeat the examination, with cecal intubation (CI) . Concurrently, in UK, endoscopists attempt full colonoscopy even if the BP is inadequate, so as to avoid being penalized with low CI rate. The implications of this practice remain unknown. Methods In a cohort of outpatients with IBP, we aimed to investigate the effect of CI at index colonoscopy on early repeat the examination, and to describe the implications on detecting colorectal neoplasia. Over a 2-year period (2013–2014), all outpatients who underwent colonoscopy in our center IBP, were identified. Endoscopic records were reviewed as per BP quality, limit of examination, timing between colonoscopies as well as the identification of polyps (size, type, number) and cancer for a minimum 3-year period. BP quality was dichotomized as adequate or inadequate as per the 2012 U.S. Multi-Society Task Force definition for IBP. Multivariate analysis performed to identify factors associated with early repeat colonoscopy. Results Of 12.948 colonoscopies, IBP was identified in 944. Over the follow-up period, colonoscopy was repeated in 396 (41.9%) individuals. The mean time (standard deviation) interval between index and repeat colonoscopy was 412 (517) days. At index colonoscopy, CI was achieved in 654 cases (69.6%). Adenomas (A) were identified in 128 cases advanced neoplasia [62 advanced adenomas (AA)and 41 cancers (c)]. Being on a screening/surveillance program [sig: .00, Exp(B): .34, 95% C.I.: .24-.48)] and reaching the caecum at index procedure were negatively associated with early repeating colonoscopy. [sig: .00, Exp(B): .46, 95% C.I.: .34-.62)] Among outpatients CI at index examination, 253 had a repeat colonoscopy. 125 A, 17 AA and 2 c were only seen on the second examination, corresponding to a miss rate of 38.8%, 20.5% and 8.33% respectively. Conclusion 2 out of 5 outpatients with IBP colonoscopy within 3 years. Miss rates for neoplasia is high for colonoscopies with IBP. CI is an independent predictor for not repeating coloscopy in the subsequent 3-year period. Considering that endoscopists are urged to reach the caecum in each colonoscopy, guidelines need to define how to deal with the cases of IBP, so as to ensure high-quality examinations and an early repeat colonoscopy.

Background: A meta-analysis comparing drug-eluting beads transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (cTACE) has recently been published. On balance, no significant differences were found in terms of objective response and overall survival. The impact on healthcare costs had been studied in small series based on a hypothetical model and was in favor of DEB-TACE. We aimed to evaluate and compare healthcare costs and effectiveness of both modalities in a cohort of patients from Nottingham, UK.Methods: Using a dedicated radiology database, we identified all patients who had undergone cTACE or DEB-TACE between 2006 and 2012 at a single tertiary referral center based in Nottingham. We collected clinical data, including treatment response, postprocedure complications and 30-day mortality. Costing models were constructed to present both our local hospital perspective as well as the national health service position.Results: During our study period, 101 procedures were performed on 43 patients (76 cTACE procedures on 26 patients and 25 DEB-TACE procedures on 17 patients). Overall, 11/26 in cTACE and 5/17 in DEB-TACE group had progressive disease (p=0.52). Adverse events were seen in 6/76 cTACE compared with 7/25 DEB-TACE group (p=0.16). Based on the predetermined standard pathway there was an unadjusted average cost difference of £3770.30 (TACE =£9070.44, DEB-TACE =£5300.14) in favor of the DEB-TACE. Results from our costing models indicated a £2715.33 (95% CI £580.88–4849.77) cost difference in favor of the same procedure.Conclusions: Even when the extra costs of DEB-TACE were considered, the overall treatment costs per patient were lower in relation to cTACE.

Waleed Fateen,Stephen D Ryder NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK Abstract: Hepatocellular carcinoma (HCC) develops on the background of liver cirrhosis often from multiple, simultaneous factors. The diagnosis of a single small HCC comes with good prognosis and provides a potential for cure. In contrast, the diagnosis of multifocal, large HCC has high mortality and poor prognosis. Unfortunately, the majority of HCC is diagnosed at such late stages. A surveillance program endorsed by regional liver societies involves six-monthly ultrasound surveillance of at-risk patients. This had been in action for the last two decades. It has led to marked increase in the proportion of patients presenting with small unifocal nodules found on surveillance. The development of tools to enhance our ability in optimizing available surveillance is likely to improve the prognosis of patients with HCC. In this review, we discuss the difficulties in utilizing HCC surveillance and possible means of improvement. Keywords: hepatocellular carcinoma, surveillance, screening, risk stratification&nbsp