Role of EUS in detection of liver metastasis not seen by computed tomography or magnetic resonance imaging during staging of pancreatic, gastrointestinal, and thoracic malignancies.

BACKGROUND AND OBJECTIVES: Liver metastases might not be detected by computed tomography (CT) and magnetic resonance imaging (MRI) due to their small size, but they can be detected by EUS. Furthermore, EUS-FNA has a significant impact on improving the diagnostic accuracy of EUS. The purpose of this study was to assess the feasibility of EUS in detection of occult small hepatic focal lesions at the time of primary tumor staging, not seen by CT or MRI. METHODS: This prospective study included 730 patients who underwent EUS for staging or sampling of gastrointestinal, pancreatic, or thoracic malignancy. The liver was examined thoroughly for detection of occult lesions. CT or MRI was done within 1 week of EUS examination. RESULTS: EUS examination of the liver detected focal lesions in 150 patients (20.5%) and metastases in 118 patients (16.2%); meanwhile, CT and MRI detected focal lesions in 99 patients (13.6%) and metastases in 82 patients (11.2%). EUS missed focal lesions in 7 patients, 6 of which were liver metastases (1.0% and 0.8%, respectively), while CT and MRI missed focal lesions in 58 patients, 42 of which were metastases (7.9% and 5.8%, respectively), which were detected by EUS. CONCLUSION: Thorough dedicated EUS examination of the liver is a feasible useful tool for detection of small hepatic lesions missed by CT and MRI. It is not considered an extra financial burden to the patient or health-care system because those patients are indicated for EUS examination for evaluation of their original lesion in the first place. Furthermore, EUS-FNA can add another advantage in diagnosing the etiology of such lesions.

Ability of the Short Physical Performance Battery Frailty Index to Predict Mortality and Hospital Readmission in Patients with Liver Cirrhosis.

BACKGROUND/AIMS: Unplanned hospitalisation is a marker of poor prognosis and a major financial burden in patients with cirrhosis. Frailty-screening tools could determine the risk for unplanned hospital admissions and death. The study aims to evaluate the bedside frailty-screening tool (Short Physical Performance Battery (SPPB)) in prediction of mortality in patients with liver cirrhosis. METHODS: One hundred forty-five patients with liver cirrhosis were recruited from Cairo University Hospital. Clinical assessment and routine laboratory tests were performed, and the SPPB frailty index, Child score, and model for end-stage liver disease (MELD) score were calculated on admission. These metrics were compared to assess mortality outcomes over the course of 90 days. RESULTS: The mean age of the patients was 60 ± 7 years, and frailty index score (SD) was 6 ± 3. The overall 90-day readmission rate was 43.4%, while the overall 90-day mortality rate was 18.6%. SPPB scores differed significantly between survivors (4.1 ± 1.4) and nonsurvivors (6.47 ± 2.8) (P value ≤ 0.001) as well as between readmitted patients (7.5 ± 2.9) and patients who were not readmitted (4.5 ± 1.9) (P value ≤ 0.001), while the Child and MELD scores showed no associations with patient outcomes. SPPB performed better with a specificity of 72.3% and a sensitivity of 72.2% for predicting mortality. CONCLUSIONS: SPPB could be a screening tool used to detect frailty and excelled over traditional scores as a predictor of death. A low SPPB frailty score among hospitalised patients with cirrhosis is associated with poor outcomes.