Endoscopic ultrasound-guided liver biopsy (EUS-LB) has been proposed as a novel technique that could offer some advantages over traditional methods, especially regarding specimen adequacy. A ...systematic review that included 32 studies evaluating the quality of percutaneous hepatic biopsies (PC-LB) demonstrated that the average number of portal tracts with this technique was 7.5 +/-3.4. (1) The objective of our study was to determine if EUS-LBs meet AASLD quality criteria, defined by the presence of more than 11 portal tracts.
A retrospective study was carried out from a prospectively created EUS-LB database. The primary objective was to evaluate the sample quality, using as a parameter the number of portal tracts. The secondary objective was to determine the security profile of the procedure and evaluate the rate of complications.
82 patients were included (average age 55). The main indication for tissue acquisition was elevated transaminases. Steatosis/steatohepatitis was the most common histological diagnosis. The average number of portal tracts was 19.23 +/- 7.2. All the samples had at least 11 portal tracts. The rate of adverse events was 9.75%. The majority were minor complications (post-procedure pain). Only one patient presented a severe complication, bleeding secondary to an arterio-biliary fistula, that required embolization by interventional radiology.
EUS-LBs meet quality criteria established by AASLD, have an excellent security profile, and might be considered the method of choice for liver tissue acquisition in the centers where the resource is available.
ABSTRACT Early gastric cancer is defined as gastric cancer confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic submucosal dissection is a standard treatment of ...early gastric cancer. The nonextension sign consists of a protrusion of the surrounding mucosa into the lumen, resembling a trapezoidal shape. This phenomenon occurs when massive submucosal invasion by a cancer increases the thickness and rigidity of the gastric wall and may be useful to differentiate between mucosal or microinvasive submucosal and invasive submucosal cancers. Our case demonstrates the usefulness of the absence of the conventional endoscopic nonextension sign as a marker to decide the adequate approach for mucosal lesions.
Early gastric cancer is defined as gastric cancer confined to the mucosa or submucosa, irrespective of lymph node metastasis. Endoscopic submucosal dissection is a standard treatment of early gastric ...cancer. The nonextension sign consists of a protrusion of the surrounding mucosa into the lumen, resembling a trapezoidal shape. This phenomenon occurs when massive submucosal invasion by a cancer increases the thickness and rigidity of the gastric wall and may be useful to differentiate between mucosal or microinvasive submucosal and invasive submucosal cancers. Our case demonstrates the usefulness of the absence of the conventional endoscopic nonextension sign as a marker to decide the adequate approach for mucosal lesions.
Probiotic bacteria are widely used to prepare pharmaceutical products and functional foods because they promote and sustain health. Nonetheless, probiotic viability is prone to decrease under ...gastrointestinal conditions. In this investigation, Lactiplantibacillus plantarum spp. CM-CNRG TB98 was entrapped in a gelatin−poly (vinyl alcohol) (Gel−PVA) hydrogel which was prepared by a “green” route using microbial transglutaminase (mTGase), which acts as a crosslinking agent. The hydrogel was fully characterized and its ability to entrap and protect L. plantarum from the lyophilization process and under simulated gastric and intestine conditions was explored. The Gel−PVA hydrogel showed a high probiotic loading efficiency (>90%) and survivability from the lyophilization process (91%) of the total bacteria entrapped. Under gastric conditions, no disintegration of the hydrogel was observed, keeping L. plantarum protected with a survival rate of >94%. While in the intestinal fluid the hydrogel is completely dissolved, helping to release probiotics. A Gel−PVA hydrogel is suitable for a probiotic oral administration system due to its physicochemical properties, lack of cytotoxicity, and the protection it offers L. plantarum under gastric conditions.
Mccullough published in 1983 a series of 3 cases from the Mayo Clinic and nine from the rest of the world, proposing a specific clinical entity of Wilson´s disease (WD) with a fatal outcome if not ...transplanted. Costa Rica has the highest incidence of Wilson´s disease in the world (5.2/100.000 inhabit); we found in a total population of patients, 5.8% of fulminant Wilson (FW) (7/120 patients), and in a pediatric population, 14.7% (5/34 children). This study aimed to define FW as an entity by its clinical, biochemical, histological and genetic characteristics to diagnose earlier because of its high mortality.
We analyze the publications and cases of WF from Costa Rica up to 2020 and also review the literature around the world.
WF is diagnosed principally in patients without the previous diagnosis of WD, principally in female patients (90%), with an onset between 10 and 21 years of age. Manifestations usually start with encephalopathy in the first eight weeks of symptoms, associated with fever peaks higher than 38°C, rapidly progressing jaundice, significant leukocytosis, sudden coombs negative hemolytic anemia, with total hyperbilirubinemia greater than 35 mg/dl, mild elevation of transaminases and alkaline phosphatase, prothrombin less than 20%, acute renal failure, ceruloplasminemia less than 10mg/dl, urinary cooper greater than 1000µg and elevated serum cooper. Micro vesicular steatosis, submassive necrosis, regenerative nodules, canalicular cholelithiasis, levels greater than 600ug/g dry weight in the liver, and hemoglobinuric necrosis in the kidney are also seen. Genetically all with a homozygous Pn1270 S mutation. With a fatal clinical course if not transplanted.
Patients with fulminant liver failure with coombs negative hemolytic anemia and clinical, biochemical, histological and genetic characteristics define FW, therefore, requesting priority one liver transplantation in identified patients it's a necessity.
It's common to include alfa 1 antitrypsin deficiency (AATD) in the diagnostic workup of children with cirrhosis, unlike in adults, where we seldom test for it. Some of its characteristics are unusual ...and we can miss them as it tends to have a silent clinical course, showing advanced indirect signs due to portal hypertension. This study aimed to establishing the biochemical, clinical, molecular, and genetic characteristics that can lead to the diagnosis of cirrhosis due to ATTD.
We analyzed 26 cases of adults with AATD related disease in Costa Rica. We establish presentation based on age, gender, AAT levels, phenotype genetic characteristics and clinical, biochemical and histological features.
26 patients had either hepatic or pulmonary chronic diseases in relation to AAT enzyme alterations, The proportion by sex was 1:1 and the mean age of diagnosis was 42. Of 21 patients with phenotyping, 9 were homozygous PI*ZZ (7) or PI: NullNull (2). Only this last group had the pulmonary disease. The ones homozygous for the PI*ZZ mutation all developed hepatic disease. Nonetheless, we also found that seven were heterozygous for PI*MNull, 4 for PI*MZ and 1 was PI*SZ. ATT levels were measured in 20 patients, 20% of them had normal levels and 15% were nondetectable. When a biopsy was obtained, the PAS staining was positive in 100% of cases. Several patients had liver steatosis instead of cirrhosis which was handled as NASH due to the similarity in clinical characteristics.
AATD can't only be screened through AAT levels as they can be normal in up to 20% of patients. We should establish the phenotype and keep in mind that heterozygous can develop clinical disease. The association with other forms of liver disease, especially such as MAFLD, is high and so we should screen for AATD in search of possible decompensation.
Gastric varices affect approximately 20% of patients with portal hypertension; bleeding appears in 50-80%, with a mortality of 45%. There are two therapeutic options, cyanoacrylate and TIPS. The ...latter, due to its complexity, is limited. Cyanoacrylate is a more accessible technique, which can be performed conventionally by upper endoscopy (EGD) with direct visualization of the varices or guided by endoscopic ultrasound (EUS). This study aimed to compare the EUS-guided coil plus cyanoacrylate vs. the conventional technique of injection of cyanoacrylate in the management of acute gastric variceal bleeding.
Twenty-three cases of acute gastric variceal bleeding that received cyanoacrylate either by EUS-guided or conventional technique due to active or recent bleeding were analyzed, assessing their ability to stop it and the presence of bleeding at the same admission.
Two groups were similar; 10 patients were male and 13 female. The type of gastric varices found was GOV1 in 12 patients (52.1%), GOV2 in 8 patients (34.7%) and in 3 patients (13.2%) both types were documented. At the time of EGD, 21.7% had active bleeding and bleeding was successfully controlled in all patients. There was one case of re-bleeding in the group of conventional cyanoacrylate technique that was controlled with EUS-guided embolization. The average number of injections was lower with EUS-guided therapy.
Cyanoacrylate is essential in the approach to acute bleeding from gastric varices. The EUS method seems to be safer. However, it requires training in the EUS, in addition to being more expensive. In bleeding without being able to visualize gastric varices veins by direct visualization, the EUS is the best option. Any endoscopy unit that handles digestive bleeding requires personnel and equipment trained to have both techniques.
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