A prospective, multicentre study in acute non-cirrhotic, non-malignant portal vein thrombosis: comparison of medical and interventional treatment.

BACKGROUND: To evaluate medical versus interventional treatment (transjugular thrombus fragmentation, local thrombolysis with or without stent implantation) in patients with acute non-cirrhotic, non-malignant portal vein thrombosis (PVT). METHODS: This prospective, observational study enrolled 65 patients with acute (<28 days since begin of symptoms, no cavernoma) PVT in nine centres. Thirty patients received medical treatment and 35 patients received interventional treatment. PVT was graded into grade 1: short thrombosis and incomplete occlusion of the vessel lumen and grade 2: extended thrombosis or complete occlusion. Treatment response was classified as partial or complete, if thrombosis was reduced by one grade or to <25% of the vessel diameter respectively. RESULTS: Partial and complete response rates were 7% and 30% in the medical compared to 17% and 54% (P < 0.001) in the interventional treatment group. In the multivariate analysis, interventional treatment showed a strong positive (OR 4.32, P < 0.016) and a myeloproliferative aetiology a negative (OR 0.09, P = 0.006) prediction of complete response. Complications were rare in the medical group and consisted of septicaemia and upper gastrointestinal bleeding of unknown origin in one patient each. Interventional treatment was accompanied by mild and self-limiting bleeding complications in nine patients, moderate intra-abdominal bleeding requiring transfusions (2 units) in one patient and peritoneal bleeding requiring surgical rescue in one patient. Four patients in each group developed intestinal gangrene requiring surgery. One patient died 52 days after unsuccessful interventional treatment. CONCLUSIONS: Compared to medical treatment alone, interventional treatment doubled response rates at the cost of increased bleeding complications.

Endoscopic treatment of obesity and complications after bariatric surgery.

Prevalence and incidence of obesity in the population has been increasing for decades. Due to associated comorbidities, treatment of obesity has become a global health topic and should be addressed with multimodal strategies. As conservative treatment has high rates of failure, bariatric surgery is often performed, especially in cases of severe obesity. However, interventional endoscopic options are gaining importance as less invasive approach. Intragastric balloons and duodenojejunal bypass liners are the most frequent applied endoscopic therapies. Besides primary bariatric intervention, endoscopy may also help bridging towards surgery. Management of postsurgical adverse events (e.g. leakage, stenosis) can be handled endoscopically as well. This article summarizes current knowledge and available endoscopic treatment options for obesity.

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection.

AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers. METHODS: Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30) or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured. RESULTS: BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN: 0.76 (0.53-0.99); LS: 0.96 (0.62-1.23) g/cm(2)). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P = 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P = 0.09). CONCLUSION: There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.

Clinical value of a new fecal elastase test for detection of chronic pancreatitis.

INTRODUCTION: Several pancreatic function tests exist, but their role in the diagnosis of chronic pancreatitis is controversial. Here we analyzed the clinical value of a newly available fecal elastase assay. MATERIALS AND METHODS: Fecal samples from 212 patients treated in our hospital from January to September 2002 were taken. Chronic pancreatitis was assumed when ductal alterations were present in ERCP. The severity of disease was assessed according to the Cambridge classification. Elastase (test from ScheBo, Germany) and chymotrypsin (Roche Diagnostics) were measured. As a new parameter an elastase ELISA from BIOSERV (Rostock, Germany) was employed. Specificity, sensitivity, and accuracy of each test as well as the ROC curves were calculated. RESULTS: In 45 patients (21.2%) chronic pancreatitis was diagnosed. The sensitivities of elastase from ScheBo, elastase from BIOSERV and chymotrypsin were 68.9%, 77.8%, and 57.8%, respectively. The corresponding specificities were 77.2%, 76.0%, and 52.7%. When a cut-off for the elastase tests of 100 U/ml was used the sensitivities (57.8%) and the specificities (89.2%) for both elastase tests were similar. The areas under the ROC curves for the ScheBo elastase, BIOSERV elastase, and chymotrypsin were 0.805, 0.840, and 0.628, respectively. The higher AUC of the BIOSERV test was maintained when patients with mild-moderate chronic pancreatitis (Cambridge I-II) were analyzed separately. CONCLUSION: The new elastase assay could probably replace the older test and was also much better than chymotrypsin.