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Transarterial chemoembolization (TACE) is, currently, the recommended treatment for hepatocellular carcinoma (HCC). However, long-term chemoembolization triggers the inflammatory response and may lead to postembolization syndrome (PES). Although several types of degradable microspheres have been developed to reduce drug toxicity and PES incidence, the clinical outcomes remain unsatisfactory. Previously, we have developed a new type of spherical, calibrated, biodegradable, radiopaque microspheres (SCBRM) and demonstrated their safety and efficacy in a pig model. Thus, the goal of this feasibility study was to determine the clinical safety and efficacy of the new SCBRM in intermediate-stage HCC patients. In this study, 12 intermediate-stage HCC patients underwent TACE using SCBRM with a calibrated size of 100–250 μm. The disease control rates at 1 month and 3 months after TACE-SCBRM treatment were 100% and 75.0%, respectively. The objective response rates at 1 month and 3 months after treatment were 66.7% and 58.3%, respectively. Very few adverse events were observed with one patient developing nausea. One day after the treatment, alanine aminotransferase, alanine aminotransferase, and total bilirubin levels were slightly elevated in the patients, but all returned to baseline on day 7. The median and mean overall survival times were 33 months (interquartile range, 12.8–42.0) and 29.2 ± 14.3 months, respectively. The 1-year and 2-year survival rates were 91.7% and 58.3%, respectively. In conclusion, TACE with the new SCBRM microspheres is clinically safe and effective, and it represents a promising approach in the management of intermediate-stage HCC.

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality in Taiwan. To help clinical physicians to manage patients with HCC, the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan produced the management consensus guideline for HCC. Methods: The recommendations focus on nine important issues on management of HCC, including surveillance, diagnosis, staging, surgery, local ablation, transarterial chemoembolization/transarterial radioembolization/hepatic arterial infusion chemotherapy, systemic therapy, radiotherapy, and prevention. Results: The consensus statements were discussed, debated and got consensus in each expert team. And then the statements were sent to all of the experts for further discussion and refinement. Finally, all of the experts were invited to vote for the statements, including the level of evidence and recommendation. Conclusion: With the development of the management consensus guideline, HCC patients could benefit from the optimal therapeutic modality. Keywords: Diagnosis, Hepatocellular carcinoma, Staging, Surveillance, Treatment

Background/aims: To determine whether severity of Helicobacter pylori (H. pylori) infection is aggravated during acute duodenal ulcer bleeding and related to bleeding severity., Methodology: One hundred and thirty-eight patients with H. pylori-infected bleeding duodenal ulcer and 112 non-bleeding cases were included in the study. A comparison was made of the anti-H. pylori IgG titer, endoscopic finding, density of H. pylori (range: 1-5) in the antrum, and severity of antral gastritis (score: 0-3) between bleeding and non-bleeding cases. The role of H. pylori in bleeding cases was further analyzed to survey its relationship to the severity of bleeding judged by clinical parameters. The H. pylori status of patients with rebleeding within the first week was compared to that of the non-rebleeding cases as well., Results: The anti-H. pylori IgG titer and H. pylori density of the non-bleeding group were lower than those of the bleeding group (0.466+/-0.288 vs. 0.912+/-0.559, p<0.001; 2.13+/-1.02 vs. 3.34+/-1.32, p<0.001). The percentages of bleeding ulcers in the study cases increased in a trend as the density of H. pylori increased (density: 1-5; 32.7%, 33.8%, 57.4%, 81.3%, 91.4%, p<0.001). Although the severity of gastritis and density of H. pylori disclosed an upward trend as bleeding severity increased, only ulcer size was significantly associated with bleeding severity (p<0.05). The 10 cases with recurrent bleeding had higher bacterial density and serological titer than the 128 non-rebleeding cases (p<0.005)., Conclusions: Heavy bacterial loads of H. pylori infection may precipitate bleeding episodes of duodenal ulcer. However, in bleeding duodenal ulcer, the status of H. pylori infection is not strongly associated with initial bleeding severity before therapeutic endoscopy. With the aim of enhancing hemostasis and preventing rebleeding, further studies could focus on diminishing the bacterial load of H. pylori during bleeding episodes.