Endoscopic Management Using Novel Haemostatic Agents for Immediate Bleeding during Endoscopic Retrograde Cholangio-Pancreatography.

Bleeding after endoscopic sphincterotomy (ES) remains as a major challenge during ERCP procedure. Standard endoscopic haemostatic procedures have demonstrated good performance for bleeding control. Novel endoscopic haemostatic agents have also been widely used in gastrointestinal bleeding management. Regardless, there is still a paucity of high-quality evidence evaluating the practicality of these agents in ERCP. This case series study was performed on the patients who underwent ERCP procedure in a tertiary referral private hospital within 2 years period. Post-ES immediate bleeding is defined as the onset of bleeding at the time of sphincterotomy. Treatment groups for post-ES bleeding are divided into (1) standard haemostatic methods and (2) novel haemostatic agents. There were 40 patients who received standard haemostatic treatment and 60 patients who received novel haemostatic agents. Initial haemostasis was achieved in all patients. Two patients who received standard haemostatic treatment had rebleeding. Meanwhile, no patients in novel haemostatic treatment group had rebleeding. In conclusion, novel haemostatic agent can be considered as an easy and practical method in daily practice, especially when an ERCP procedure is performed. Further studies with larger sample size which, if possible, can also include a cost-effectiveness analysis are still required to implement these agents as a standard procedure in clinical practice. (This abstract has been presented at the American College of Gastroenterology meeting October 2021).

Clinical significance of isolated gastric varices in liver cirrhotic patients: A single-referral-centre retrospective cohort study.

INTRODUCTION: Gastric varices (GVs) occur in 10-30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. OBJECTIVE: To determine the clinical significance of IGVs in liver cirrhotic patients. METHODS: This was a retrospective cohort endoscopy database study within a 2-year period (2016-2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. RESULTS: A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro-OVs were found in 28 (18.30%) patients. Child-Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15-25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95-31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1-year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01-119.34, P 0.001). CONCLUSION: The presence of IGVs has no clinical significance in the occurrence of 1-year rebleeding and in patient survival.

Hyperuricemia as an independent risk factor for non-alcoholic fatty liver disease (NAFLD) progression evaluated using controlled attenuation parameter-transient elastography: Lesson learnt from tertiary referral center.

BACKGROUND AND AIM: Hyperuricemia is one of the metabolic parameter which has been considered to play an important role in non-alcoholic fatty liver disease (NAFLD). However, there is still lack of studies about association between serum uric acid with liver disease progression in NAFLD. This study aimed to know the association between hyperuricemia with moderate to severe steatosis and significant fibrosis along with other metabolic factors in NAFLD patients evaluated using Controlled Attenuation Parameter (CAP) - Transient Elastography (TE). METHODS: This is a prospective study in NAFLD patients who came to our tertiary referral center University hospital hepatobiliary outpatient's clinic. All patients underwent metabolic parameters measurement including serum uric acid level and CAP-TE examination. Cutoff value used for significant liver fibrosis ≥7 kPa and ≥285 dB/m for moderate-severe steatosis. RESULTS: Of 113 NAFLD patients, there were 45 patients with moderate-severe steatosis and 34 patients with significant fibrosis. Multivariate analysis showed only high level of fasting blood glucose (OR 2756; 95% CI 1.131-6.717) and low HDL level (OR 4.196, 95% CI 1.22-14.430) to be independent risk factors of moderate-severe steatosis. High level of fasting blood glucose (OR 3.98, 95% CI 1.105-14.389) and hyperuricemia (OR 2.501, 95% CI 1.095-5.714) were found to be independent risk factors for significant liver fibrosis. CONCLUSION: Hyperuricemia is found to be an independent risk factor for significant liver fibrosis.