Utilidad del octreotide en la prevención de la hemorragia digestiva no variceal en cirrosis hepática: descripción de 2 casos / Usefulness of octreotride in preventing non-variceal gastroinetestinal bleeding in liver cirrhosis: A report of two cases

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Diagnostic accuracy of abdominal ultrasound in the screening of esophageal varices in patients with cirrhosis.

BACKGROUND: Abdominal ultrasound (US) may provide data on the presence of esophageal varices in cirrhosis. We assess the diagnostic accuracy of this procedure. PATIENTS AND METHODS: Retrospective recording of clinical data was carried out in cirrhotic patients who underwent abdominal US and upper gastrointestinal endoscopy. We compared patients with and without large varices and assessed the value of US in predicting the presence of these lesions as well as other significant variables. RESULTS: Of the 353 patients included, 123 (35%) had esophageal varices. The presence of US signs of portal hypertension independently predicted the existence of esophageal varices with a sensitivity of 87.9%, a specificity of 34.9%, a positive predictive value of 40.6%, and a negative predictive value of 85.1%, which could increase to 91.5% if the patient presented plasma albumin and platelet concentrations above the mean values (3.1 g/dl and 122×10 cells/l, respectively). Plasma albumin and platelet concentrations were the two other variables with independent predictive capacity. Applying these selection criteria, up to 30% of screening endoscopies may not be necessary, and up to 43% in patients with compensated cirrhosis. In patients with decompensated cirrhosis, however, US does not have predictive capacity. The results obtained are comparable with those reported for transient elastography. CONCLUSION: Abdominal US is a highly reliable technique for detecting patients with a low risk of presenting esophageal varices. Its use may avoid up to 43% of screening endoscopies in patients with compensated cirrhosis. The results obtained are similar to those observed using transient elastography.

How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be efficacious to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, the target patients, the type of NSAID, the route of administration and the time of drug delivery remain unclear, as well as the potential efficacy in reducing the severity of pancreatitis, length of hospital stay and mortality. The objective of the study was to evaluate these questions by performing a systematic review and meta-analysis. METHODS: Multiple searches were performed in the main databases. Randomized controlled trials (RCTs) comparing NSAIDs vs. placebo in the prevention of post-ERCP pancreatitis were included. Primary endpoint of the study was the efficacy for pancreatitis prevention. Sub-analyses were performed to determine the risk reduction in high and low risk patients, and to define optimal time, route of administration, and type of NSAID. Secondary endpoints were safety, moderate to severe pancreatitis prevention and reduction of hospital stay and mortality. RESULTS: Nine RCTs enrolling 2133 patients were included. The risk of pancreatitis was lower in the NSAID group than in the placebo group (RR 0.51; 95%CI 0.39-0.66). The number needed to treat was 14. The risk of moderate to severe pancreatitis was also lower in the NSAID group. (RR 0.46; 95%CI 0.28-0.76). No adverse events related to NSAID use were reported. NSAIDs were effective in both high-risk and unselected patients (RR 0.53; 95%CI 0.30-0.93 and RR 0.57; 95%CI 0.37-0.88). In the subanalyses, only rectal administration of either indomethacin (RR 0.54; 95%CI 0.38-0.75) or diclofenac (RR 0.42; 95%CI 0.21-0.84) was shown to be effective. There were not enough data to perform a meta-analysis in hospital stay reduction. No deaths occurred. CONCLUSION: A single rectal dose of indomethacin or diclofenac before or immediately after ERCP is safe and prevents procedure-related pancreatitis both in high risk and in unselected patients.

Coste del cribado del hepatocarcinoma en pacientes cirróticos: un estudio prospectivo / Cost of screening for hepatocarcinoma in patients with cirrhosis: a prospective study

Introducción Las guías clínicas actuales recomiendan realizar un cribado semestral del hepatocarcinoma en pacientes cirróticos; sin embargo, desconocemos el coste de esta actividad preventiva.ObjetivoConocer el coste del cribado ecográfico del hepatocarcinoma en pacientes cirróticos.Pacientes y métodoRecopilación prospectiva de pacientes diagnosticados de cirrosis hepática en una población de 245.042 habitantes; se contabilizaron las pruebas realizadas para el cribado y diagnóstico de hepatocarcinomas durante el seguimiento anual. El coste de estas pruebas se valoró según las tarifas que abonan las entidades aseguradoras para la cobertura sanitaria de los colectivos de funcionarios públicos.ResultadosDurante el 2009 se registraron 374 pacientes con cirrosis; de ellos, 99 tenían edad > 80 años, performance status > 2 o comorbilidades asociadas. Durante el seguimiento anual se realizaron a los pacientes restantes un total de 602 visitas (ecografía abdominal y analítica), 4 TC con contraste, 9 resonancias magnéticas, 2 gammagrafías, 4 punciones aspirativas, 4 radiografías y 6 ecografías con contraste. En nuestro medio, el coste total estimado de estas exploraciones fue de 37.946 €. Ello indica que el coste de un programa de cribado del hepatocarcinoma según los criterios de selección indicados anteriormente es de 0,155 € por habitante y año. Si se consideran sólo los cirróticos susceptibles de cribado, el coste anual del cribado es de 138 € por paciente.ConclusiónEl coste de un programa de cribado ecográfico del hepatocarcinoma es de 0,155 € por habitante y año. Estos datos deben tenerse en cuenta cuando se plantean programas de ámbito poblacional(AU)

Introduction Current clinical guidelines recommend biannual screening for hepatocarcinoma in cirrhotic patients; however, the cost of this preventive activity is unknown.ObjectiveTo determine the cost of ultrasound screening for hepatocarcinoma in patients with cirrhosis.Patients and methodData on patients diagnosed with liver cirrhosis in a population of 245,042 inhabitants were prospectively gathered. The screening tests performed and cases of hepatocarcinoma diagnosed during the annual follow-up were included in the analysis. The cost of these tests was calculated based on the tariffs paid by insurance companies for health coverage of civil servants.ResultsIn 2009, there were 374 patients with cirrhosis; of these, 99 were aged > 80 years, with a performance status of >2 or associated comorbidities. During the annual follow-up, the remaining patients underwent a total of 602 visits (abdominal ultrasound, blood test), four contrast-enhanced computed tomography scans, nine magnetic resonance scans, two scintigraphies, four aspiration biopsies, four radiographs and six contrast ultrasound scans. In our environment, the total estimated cost of these procedures was 37,946 €, indicating that the cost of a screening program for hepatocellular carcinoma according to the above-mentioned selection criteria is 0.155 € per inhabitant/year. If only cirrhotic patients suitable for screening are included, the annual cost of screening is 138 € per patient.ConclusionThe cost of an ultrasound screening program for hepatocarcinoma is 0.155 € per inhabitant/year. These data should be taken into account when considering population-based screening programs(AU)

[Cost of screening for hepatocarcinoma in patients with cirrhosis: a prospective study]. / Coste del cribado del hepatocarcinoma en pacientes cirróticos: un estudio prospectivo.

INTRODUCTION: Current clinical guidelines recommend biannual screening for hepatocarcinoma in cirrhotic patients; however, the cost of this preventive activity is unknown. OBJECTIVE: To determine the cost of ultrasound screening for hepatocarcinoma in patients with cirrhosis. PATIENTS AND METHOD: Data on patients diagnosed with liver cirrhosis in a population of 245,042 inhabitants were prospectively gathered. The screening tests performed and cases of hepatocarcinoma diagnosed during the annual follow-up were included in the analysis. The cost of these tests was calculated based on the tariffs paid by insurance companies for health coverage of civil servants. RESULTS: In 2009, there were 374 patients with cirrhosis; of these, 99 were aged > 80 years, with a performance status of >2 or associated comorbidities. During the annual follow-up, the remaining patients underwent a total of 602 visits (abdominal ultrasound, blood test), four contrast-enhanced computed tomography scans, nine magnetic resonance scans, two scintigraphies, four aspiration biopsies, four radiographs and six contrast ultrasound scans. In our environment, the total estimated cost of these procedures was 37,946 €, indicating that the cost of a screening program for hepatocellular carcinoma according to the above-mentioned selection criteria is 0.155 € per inhabitant/year. If only cirrhotic patients suitable for screening are included, the annual cost of screening is 138 € per patient. CONCLUSION: The cost of an ultrasound screening program for hepatocarcinoma is 0.155 € per inhabitant/year. These data should be taken into account when considering population-based screening programs.

Hepatitis autoinmune tras una infección por citomegalovirus / Autoimmune hepatitis folowing cytomegalovirus infection

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