Sofosbuvir-based antiviral therapy in patients with recurrent HCV infection after liver transplant: A real-life experience.

INTRODUCTION AND AIM: Recurrent HCV infection after liver transplant (LT) has a negative impact on graft and patient survival. The aim of this study is to describe the efficacy and safety of sofosbuvir (SOF-based) regimens in the treatment of recurrent HCV after liver transplant (LT). MATERIALS AND METHODS: This retrospective study included 68 adults with recurrent HCV infection after LT, treated with different SOF-based regimens between March 2015 and December 2016. The choice of regimens, their duration and use of ribavirin (RBV) was made by the treating physician. The efficacy of antiviral treatment was assessed based on the sustained viral response obtained 12 weeks after the end of treatment (SVR12), according to an intention-to-treat analysis. RESULTS: The most frequent HCV genotypes were 1 and 3 (n=35, 51.4% and n=31, 45.6%, respectively). Only 22 patients were treatment naïve (32.3%) and 7 had cirrhosis (10.2%). SOF+daclatasvir (DCV) was the most commonly used regimen (n=63, 92.6%). Most patients used RBV (n=56, 82.3%) and were treated for 12 weeks (n=66, 97%). Overall SVR12 was 95.5% (65/68 patients). Three patients had virologic failure. Three patients had serious adverse events, however, no one discontinued treatment prematurely. RBV-related anaemia was the most frequent adverse event (n=34, 50%). Four patients had severe cellular graft rejection after HCV elimination, while immunosuppression remained stable. CONCLUSION: SOF-based therapy is highly effective and safe to treat HCV recurrence after LT. Cellular graft rejection following the successful treatment of HCV needs further investigation.

[Frequency, clinical profile and mortality of acute-on-chronic liver failure in a public hospital of Lima - Peru]. / Frecuencia, perfil clínico y mortalidad de la insuficiencia hepática crónica reagudizada en un hospital público de Lima ­ Perú.

INTRODUCTION: A condition of high short-term mortality in the cirrhotic patient is Acute-on-Chronic Liver Failure (ACLF), characterized by organ failure (s) and usually preceded by acute decompensation (AD). OBJECTIVE: To determine the frequency, clinical profile, and mortality in cirrhotic patients hospitalized with ACLF. MATERIALS AND METHODS: This is an observational analytical study conducted from July 2016 to June 2017. We established the ACLF condition through the criteria of the CANONIC study. RESULTS: The study population was 118 patients, of whom 34 (28.8%) presented ACLF, 14 (41%) were Grade 1, 16 (47%) Grade 2 and 4 (11.9%) Grade 3. The average age was 61.5 years old, alcoholism being the most frequent etiology with 18 patients (53%) and mostly without episodes of AD (64.7%). The most frequent precipitating factors were: Digestive hemorrhage (41%) and infections (29.4%). The groups with and without ACLF were statistically significant in the Child-Turcot-Pugh score (CTP) (11.4 ± 1.8 vs. 8.69 ± 2.04; p < 0.0001 ). MELD score (26.4 ± 8.1 vs. 14.4 ± 4.6; p < 0.0001), leukocytes (11,809.7 +/- 6,906.3 per mm3 vs. 8,434.01 ± 5,434.9 per mm3; p: 0.006) and 28-day mortality (76.5% vs. 21.4%, p < 0.0001), with a relative risk (RR) of 3.5. CONCLUSIONS: The frecuency of ACLF was 28.8%, similar to that of the CANONIC study (30.9%). The digestive hemorrhage being the main precipitating factor. The CTP, MELD and leukocyte scores were highest in this group. Mortality in patients with ACLF was 3.5 times more frequent than in patients without ACLF.

[Fulminating ischemic hepatitis induced by severe cardiac dysfunction: case report]. / Hepatitis isquémica fulminante inducida por disfunción cardiaca severa: reporte de caso.

Ischemic Hepatitis is an uncommon entity in daily clinical practice with a prevalence of 0.16 to 0.5% among patients admitted to a critical care unit, associated with an approximate 60% mortality rate. This liver disease is characterized by a rapid and marked increase (more than 20 times the normal value) of the level of transaminases secondary to a severe and persistent hepatic hypoperfusion caused by multiple etiologies, which may be transient when the triggering cause is timely identified and appropiately treated. The case of an elderly adult patient with a clinical, epidemiological and biochemical profile compatible with ischemic hepatitis secondary to severe cardiac dysfunction is presented below.

[Prevalence and severity of the hepatopulmonar syndrome in patients with liver cirrhosis attended at Cayetano Heredia Hospital, between January and December 2015]. / Prevalencia y severidad del síndrome hepatopulmonar en pacientes concirrosis hepática del Hospital Nacional Cayetano Heredia, entre enero y diciembre del 2015.

INTRODUCTION: The hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis (LC) which significantly diminishes the quality of life for people who suffer. OBJECTIVES: To determine the prevalence and severity of HPS in patients with CH treated at the Cayetano Heredia (HCH) Hospital in the period from January to December 2015. MATERIALS AND METHODS: Cross-sectional study with sample size needed to determine the point prevalence calculated in 297 patients. RESULTS: The prevalence of HPS in 0.7% and the identified cases were classified as mild and severe SHP. CONCLUSION: The prevalence of HPS is very low in the population of patients with liver cirrhosis treated at the Cayetano Heredia Hospital.

[Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report]. / Porfiria cutánea tarda como manifestación extrahepática de hepatitis Ccrónica: reporte de un caso.

The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.

[Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru]. / Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú.

INTRODUCTION: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). OBJECTIVE: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. MATERIAL AND METHODS: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. RESULTS: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). CONCLUSION: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia.

[AIMS65 score validation for upper gastrointestinal bleeding in the National Hospital Cayetano Heredia]. / Validación del score AIMS65 para hemorragia digestiva alta en el Hospital Nacional Cayetano Heredia.

OBJECTIVE: To validate the score AIMS65 in patients with upper gastrointestinal bleeding, in terms of mortality and rebleeding a 30-day event. MATERIAL AND METHODS: Patients included were those with higher age to 18 years attending the Hospital Nacional Cayetano Heredia during the period May 2013 to December 2014, by upper gastrointestinal bleeding. Data were analyzed using ROC curve (Receiver Operating Characteristic) and the area was obtained under the curve (AUC) to properly qualify the score AIMS65. RESULTS: 209 patients were included, 66.03% were male, with an average age of 58.02 years. The mortality rate was 7.65%, the multiorgan failure the most common cause of death. Plus 3.82% of the patients had recurrent bleeding and 11% required a transfusion of more than 2 units of blood. When analyzing the ROC curve with AIMS65 and mortality score a value of 0.9122 is reported; identifying it as cutoff greater than or equal to 3 value in the score AIMS65 to discriminate patients at high risk of death, likewise the ROC curve was analyzed for recurrence of bleeding with a value of 0.6266 and the need to Transfusion of packed red blood cells over two a value of 0.7421. And it was determined the average hospital stay with a value of 4.8 days, however, no correlation was found with the score AIMS65. CONCLUSIONS: AIMS65 score is a good predictor of mortality, and is useful for predicting the need for transfusion of more than 2 globular packages. However it is not a good predictor for recurrence of bleeding, or hospital stay.

[Endoscopic pancreatic necrosectomy]. / Necrosectomía pancreática endoscópica.

The endoscopic pancreatic necrosectomy is a minimally invasive treatment option to remove pancreatic necrosis. This is one of the first applications of transluminal endoscopic surgery through a natural orifice (NOTES). This review will reveal the technical effectiveness, clinical effectiveness, indications, limitations and complications of endoscopic pancreatic necrosectomy.

[Mortality and readmission in hospitalized cirrhotic patients in a General Hospital from Lima, Peru]. / Mortalidad y readmisión en pacientes cirróticos hospitalizados en un hospital general de Lima, Perú

UNLABELLED: Liver cirrhosis is a public health problem. In Peru, is the leading cause of death in liver diseases. In addition, patients with chronic liver disease and cirrhosis are at increased risk for readmission. OBJECTIVES: To determine the frequency of mortality and readmission at 3 months, and clinical-epidemiological characteristics of hospitalized cirrhotic patients in a general hospital. MATERIALS AND METHODS: Data were collected prospectively of hospitalized cirrhotic patients in the Hospital Nacional Cayetano Heredia,Lima,Peru, from October 2011 to October 2012; telephone follow-up was at 3 months after hospital discharge. RESULTS: The study included 96 patients. The mean age was 59.2 years. The most common etiology of cirrhosis was alcohol (45.8%) and the main reason for hospitalization was upper gastrointestinal bleeding (29.2%). Global mortality was 39.6% (38 patients), from them, 63.2% (24/38) were inpatients, its main cause was septic shock 31.5% (12/38). Forty-four percent of the deceased had infection as complication. Hospital readmission was 42.8% (33/77) and 36.3% of them died. CONCLUSIONS: Hospitalized cirrhotic patients showed high mortality at 3 months, these patients at discharge revealed a high readmission within 3 months of follow up.

Frecuencia, perfil clínico y mortalidad de la insuficiencia hepática crónica reagudizada en un hospital público de Lima - Perú / Frequency, clinical profile and mortality of acute-on-chronic liver failure in a public hospital of Lima - Peru

Introducción: Una condición de alta mortalidad a corto plazo en el cirrótico es la Insuficiencia hepática crónica reagudizada (ACLF por sus siglas en inglés), caracterizada por la falla de órgano(s) y precedida habitualmente por una descompensación aguda (DA). Objetivo: Determinar la frecuencia, el perfil clínico y la mortalidad en los cirróticos hospitalizados con ACLF. Materiales y métodos: Estudio analítico observacional realizado de julio 2016 a junio 2017. Se estableció la condición de ACLF según los criterios del estudio CANONIC. Resultados: Se reclutaron 118 pacientes cirróticos, 34 (28,8%) de los cuales presentaron ACLF, con grado 1: 14 (41%), grado 2: 16 (47%) y grado 3: 4 (12%) pacientes. La edad promedio fue 61,5 años; siendo la etiología más frecuente el alcoholismo en 18 pacientes (53%) y la mayoría no tenían historia previa de DA (64,7%). Los factores precipitantes más frecuentes fueron: la hemorragia digestiva (41%) y las infecciones (29,4%). Los grupos con y sin ACLF tuvieron una diferencia estadísticamente significativa en el puntaje Child-Turcotte-Pugh (CTP) (11,4 ± 1,8 vs 8,69 ± 2,04; p<0,0001), puntaje MELD (26,4 ± 8,1 vs 14,4 ± 4,6; p<0,0001), leucocitos (11 809,7 ± 6906,3/mm3 vs 8434,01 ± 5434,9/mm3; p: 0,006) y mortalidad a 28 días (76,5% vs 21,4%; p<0,0001), con un riesgo relativo (RR) de 3,5. Conclusiones: La frecuencia de ACLF fue 28,8%, similar a la del estudio CANONIC (30,9%). El principal factor precipitante fue la hemorragia digestiva. Los puntajes CTP, MELD y leucocitos fueron más altos en el grupo con ACLF, observándose una mortalidad a 28 días de 76,5% (3,5 veces mayor que en los pacientes sin ACLF).

Introduction: A condition of high short-term mortality in the cirrhotic patient is Acute-on-Chronic Liver Failure (ACLF), characterized by organ failure (s) and usually preceded by acute decompensation (AD). Objective: To determine the frequency, clinical profile, and mortality in cirrhotic patients hospitalized with ACLF. Materials and methods: This is an observational analytical study conducted from July 2016 to June 2017. We established the ACLF condition through the criteria of the CANONIC study. Results: The study population was 118 patients, of whom 34 (28.8%) presented ACLF, 14 (41%) were Grade 1, 16 (47%) Grade 2 and 4 (11.9%) Grade 3. The average age was 61.5 years old, alcoholism being the most frequent etiology with 18 patients (53%) and mostly without episodes of AD (64.7%). The most frequent precipitating factors were: Digestive hemorrhage (41%) and infections (29.4%). The groups with and without ACLF were statistically significant in the Child-Turcot- Pugh score (CTP) (11.4 ± 1.8 vs. 8.69 ± 2.04; p < 0.0001), MELD score (26.4 ± 8.1 vs. 14.4 ± 4.6; p < 0.0001), leukocytes (11,809.7 +/- 6,906.3 per mm3 vs. 8,434.01 ± 5,434.9 per mm3; p: 0.006) and 28-day mortality (76.5% vs. 21.4%, p < 0.0001), with a relative risk (RR) of 3.5. Conclusions: The frecuency of ACLF was 28.8%, similar to that of the CANONIC study (30.9%). The digestive hemorrhage being the main precipitating factor. The CTP, MELD and leukocyte scores were highest in this group. Mortality in patients with ACLF was 3.5 times more frequent than in patients without ACLF.

Hepatitis isquémica fulminante inducida por disfunción cardiaca severa: reporte de caso / Fulminating ischemic hepatitis induced by severe cardiac dysfunction: case report

La hepatitis isquémica es una entidad infrecuente en la práctica clínica diaria con una prevalencia de 0,16 a 0,5% entre los pacientes admitidos en unidad de cuidados críticos, asociado a una mortalidad aproximada en el 60% de los casos. Esta hepatopatía se caracteriza por un incremento rápido y marcado (más de 20 veces el valor normal) del nivel de transaminasas secundario a una hipoperfusión hepática severa y persistente ocasionada por múltiples etiologías, que puede ser transitoria de identificarse y tratar la causa desencadenante oportunamente. A continuación presentamos el caso de un paciente adulto mayor con un cuadro clínico, epidemiológico y bioquímico compatible con hepatitis isquémica secundario a disfunción cardiaca severa.

Ischemic Hepatitis is an uncommon entity in daily clinical practice with a prevalence of 0.16 to 0.5% among patients admitted to a critical care unit, associated with an approximate 60% mortality rate. This liver disease is characterized by a rapid and marked increase (more than 20 times the normal value) of the level of transaminases secondary to a severe and persistent hepatic hypoperfusion caused by multiple etiologies, which may be transient when the triggering cause is timely identified and appropiately treated. The case of an elderly adult patient with a clinical, epidemiological and biochemical profile compatible with ischemic hepatitis secondary to severe cardiac dysfunction is presented below.

Prevalencia y severidad del síndrome hepatopulmonar en pacientes con cirrosis hepática del Hospital Nacional Cayetano Heredia, entre enero y diciembre del 2015 / Prevalence and severity of the hepatopulmonar syndrome in patients with liver cirrhosis attended at Cayetano Heredia Hospital, between January and December 2015

Introducción: El sindrome hepatopulmonar (SHP) es una complicación poco frecuente de la cirrosis hepática (CH) que disminuye considerablemente la calidad de vida de las personas que la padecen. Objetivos: Determinar la prevalencia y severidad del SHP en los pacientes con CH atendidos en el Hospital Nacional Cayetano Heredia (HCH) en el periodo comprendido entre enero a diciembre del 2015. Material y métodos: Estudio transversal, con tamaño de muestra necesario para determinar la prevalencia puntual calculado en 297 pacientes. Resultados: La prevalencia del SHP fue de 0,7% y los casos identificados se clasificaron como SHP leve y severo. Conclusión: La prevalencia del SHP es muy baja en la población de pacientes con cirrosis hepática atendidos en el Hospital Nacional Cayetano Heredia

Introduction: The hepatopulmonary syndrome (HPS) is a rare complication of liver cirrhosis (LC) which significantly diminishes the quality of life for people who suffer. Objectives: To determine the prevalence and severity of HPS in patients with CH treated at the Cayetano Heredia (HCH) Hospital in the period from January to December 2015. Materials and methods: Cross-sectional study with sample size needed to determine the point prevalence calculated in 297 patients. Results: The prevalence of HPS in 0.7% and the identified cases were classified as mild and severe SHP. Conclusion: The prevalence of HPS is very low in the population of patients with liver cirrhosis treated at the Cayetano Heredia Hospital

Porfiria cutánea tarda como manifestación extrahepática de hepatitis C crónica: reporte de un caso / Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report

Se presenta el caso de un paciente varón de 56 años quien es evaluado por presentar a nivel del dorso de ambas manos cicatrices hiperpigmentadas e hipopigmentadas, asociadas a quistes de milia. Se le realizó estudios del metabolismo de las porfirinas y biopsia cutánea de las lesiones los cuales resultaron compatibles con porfiria cutánea tarda. En el laboratorio inicial se encontró elevación de los valores de transaminasas, identificándose posteriormente infección crónica por virus de hepatitis C. Con la finalidad de tratar la infección viral y resolver el compromiso dérmico, considerado como manifestación extrahepática del virus hepatitis C, se inició tratamiento con interferón pegilado y ribavirina evolucionando favorablemente con respuesta viral rápida, carga viral no detectable hasta la actualidad (36 semanas de tratamiento), disminución del nivel de transaminasas séricas y mejoría de las lesiones dérmicas.

The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.

Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú / Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru

La valoración del pronóstico es una parte esencial en la evaluación de todo paciente con cirrosis hepática. En la actualidad se sigue desarrollando nuevos modelos para optimizar la precisión del pronóstico de mortalidad que se calcula mediante el score Child-Turcotte-Pugh (CTP) y el modelo para la enfermedad hepática en etapa terminal (MELD). Objetivo: Comparar la precisión pronóstica de mortalidad hospitalaria y mortalidad a corto plazo del CTP, MELD y demás modelos en pacientes con cirrosis hepática descompensada. Material y Métodos: Estudio descriptivo prospectivo, el cual incluyó 84 pacientes. El score CTP, MELD y demás modelos fueron calculados en el primer día de hospitalización. La precisión pronóstica de mortalidad se evaluó mediante el área bajo la curva ROC (AUROCs) del score CTP, MELD y los demás modelos. Resultados: La mortalidad hospitalaria y la mortalidad en el seguimiento a corto plazo fue de 20 (23,8%) y 44 (52,4%), respectivamente. Los AUROCs del CTP, MELD, MELD Na, MESO, iMELD, RefitMELD y RefitMELD Na para predecir mortalidad hospitalaria fue de 0,4488, 0,5645, 0,5426, 0,5578, 0,5719, 0,5598 y 0,5754; y para predecir mortalidad a corto plazo fue de 0,5386, 0,5747, 0,5770, 0,5781, 0,5631, 0,5881 y 0,5693, respectivamente. Al comparar entre si los AUROCs del score CTP, MELD y demás modelos ninguno mostró ser mejor que el otro (p>0,05). Conclusiones: El presente estudio no ha demostrado la utilidad predictiva del score CTP, MELD y los otros modelos (MELD Na, MESO, iMELD, Refit MELD y Refit MELD Na) para la evaluar la mortalidad hospitalaria o mortalidad a corto plazo en una muestra de pacientes con cirrosis hepática descompensada del Hospital Cayetano Heredia...

Introduction: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). Objective: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. Material and Methods: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. Results: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). Conclusion: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia...

Mortalidad y readmisión en pacientes cirróticos hospitalizados en un hospital general de Lima, Perú / Mortality and readmission in hospitalized cirrhotic patients in a General Hospital from Lima, Peru

La cirrosis hepática es un problema de salud pública. En el Perú, es la primera causa de muerte dentro de las enfermedades hepáticas. Además, los pacientes con enfermedad hepática crónica y cirrosis tienen mayor riesgo para readmisión. Objetivos: Determinar la frecuencia de mortalidad y readmisión a los 3 meses, así como las características epidemiológicas-clínicas de los pacientes cirróticos hospitalizados en un hospital general. Materiales y métodos: Se recolectaron prospectivamente los datos de los pacientes cirróticos hospitalizados en el Hospital Nacional Cayetano Heredia, Lima, Perú, desde octubre 2011 a octubre 2012, el seguimiento fue vía telefónica a los 3 meses luego del alta hospitalaria. Resultados: El estudio incluyó 96 pacientes. La edad media fue 59,2 años. La etiología de cirrosis más frecuente fue alcohol (45,8%) y el principal motivo de hospitalización fue hemorragia digestiva alta (29,2%). La mortalidad total fue 39,6% (n: 38), de la cual 63,2% (24/38) fue hospitalaria, siendo la causa principal el choque séptico con 31,5% (12/38). De los fallecidos 44,7% presentó infección como complicación. La readmisión hospitalaria fue 42,8% (33/77) y de ellos, falleció el 36,3 % (12/33). Conclusión: Los pacientes cirróticos hospitalizados presentaron una alta mortalidad a los 3 meses; estos pacientes al alta hospitalaria revelaron una elevada readmisión en los 3 meses de seguimiento...

Liver cirrhosis is a public health problem. In Peru, is the leading cause of death in liver diseases. In addition, patients with chronic liver disease and cirrhosis are at increased risk for readmission. Objectives: To determine the frequency of mortality and readmission at 3 months, and clinical-epidemiological characteristics of hospitalized cirrhotic patients in a general hospital. Materials and methods: Data were collected prospectively of hospitalized cirrhotic patients in the Hospital Nacional Cayetano Heredia, Lima, Peru, from October 2011 to October 2012; telephone follow-up was at 3 months after hospital discharge. Results: The study included 96 patients. The mean age was 59.2 years. The most common etiology of cirrhosis was alcohol (45.8%) and the main reason for hospitalization was upper gastrointestinal bleeding (29.2%). Global mortality was 39.6% (38 patients), from them, 63.2% (24/38) were inpatients, its main cause was septic shock 31.5% (12/38). Forty-four percent of the deceased had infection as complication. Hospital readmission was 42.8% (33/77) and 36.3% of them died. Conclusions: Hospitalized cirrhotic patients showed high mortality at 3 months, these patients at discharge revealed a high readmission within 3 months of follow up...

Necrosectomía pancreática endoscópica / Endoscopic pancreatic necrosectomy

La necrosectomía pancreática endoscópica es una opción de tratamiento mínimamente invasivo para remover la necrosis pancreática. Esta es una de las primeras aplicaciones de la cirugía endoscópica transluminal a través de un orificio natural (NOTES). Esta revisión permitirá conocer la efectividad técnica, efectividad clínica, indicaciones, limitaciones y complicaciones de la necrosectomía pancreática endoscópica...

The endoscopic pancreatic necrosectomy is a minimally invasive treatment option to remove pancreatic necrosis. This is one of the first applications of transluminal endoscopic surgery through a natural orifice (NOTES). This review will reveal the technical effectiveness, clinical effectiveness, indications, limitations and complications of endoscopic pancreatic necrosectomy...