G. Caracciolo

Early prediction of response to sorafenib in patients with advanced hepatocellular carcinoma: The role of dynamic contrast enhanced ultrasound

BACKGROUND & AIMS Sorafenib has become the standard first-line treatment for patients with advanced HCC and acts by inducing alterations in tumor vascularity. We wanted to evaluate the feasibility of dynamic CEUS (D-CEUS) as a predictor of early tumor response to sorafenib and to correlate functional parameters with clinical efficacy end points. METHODS Twenty-eight HCC patients treated with sorafenib 400mg bid were prospectively enrolled. CEUS was performed at baseline (T0) and after 15 (T1) and 30 (T2) days of treatment. Tumor vasculature was assessed in a specific harmonic mode associated with a perfusion and quantification software (Q-Lab, Philips). Variations between T1/T2 and T0 were calculated for five D-CEUS functional parameters (peak intensity, PI; time to PI, TP; area under the curve, AUC; slope of wash in, Pw; mean transit time, MTT) and were compared for responders and non-responders. The correlation between D-CEUS parameters, overall survival (OS), and progression-free survival (PFS) was also assessed. A p value <0.05 was considered statistically significant. RESULTS The percentage variation at T1 significantly correlated with response in three D-CEUS parameters (AUC, PI and Pw; p=0.002, <0.001, and 0.003, respectively). A decrease of AUC (p=0.045) and an increased/unchanged value of TP (p=0.029) and MTT (p=0.010) were associated with longer survival. Three D-CEUS parameters (AUC, TP, Pw) were significantly associated with PFS. CONCLUSIONS D-CEUS provides a reliable and early measure of efficacy for anti-angiogenic therapies and could be an excellent tool for selecting patients who will benefit from treatment.

Diagnosis of bowel diseases: The role of imaging and ultrasonography

Examinations with a visualisation of the anatomy and pathology of the gastrointestinal (GI) tract are often necessary for the diagnosis of GI diseases. Traditional radiology played a crucial role for many years. Endoscopy, despite some limitations, remains the main technique in the differential diagnosis and treatment of GI diseases. In the last decades, the introduction of, and advances in, non-invasive cross-sectional imaging modalities, including ultrasound (US), computed tomography (CT), positron-emission tomography (PET), and magnetic resonance imaging, as well as improvements in the resolution of imaging data, the acquisition of 3D images, and the introduction of contrast-enhancement, have modified the approach to the examination of the GI tract. Moreover, additional co-registration techniques, such as PET-CT and PET-MRI, allow multimodal data acquisition with better sensitivity and specificity in the study of tissue pathology. US has had a growing role in the development and application of the techniques for diagnosis and management of GI diseases because it is inexpensive, non-invasive, and more comfortable for the patient, and it has sufficient diagnostic accuracy to provide the clinician with image data of high temporal and spatial resolution. Moreover, Doppler and contrast-enhanced ultrasound (CEUS) add important information about blood flow. This article provides a general review of the current literature regarding imaging modalities used for the evaluation of bowel diseases, highlighting the role of US and recent developments in CEUS.

Late Development of Splenic Artery Aneurysm After Orthotopic Liver Transplantation: A Case Report

Splenic artery aneurysm (SAA) is a rare complication after orthotopic liver transplantation (OLT). Although SAAs are often incidental findings, in some cases they present with signs and symptoms of abdominal mass or intra-abdominal hemorrhage. The diagnosis requires Doppler ultrasound and confirmation with computed tomography, magnetic resonance, or angiography. Endovascular techniques are preferred to surgery for the treatment of most SAAs. A variable interval from 6 days to 11 years has been reported between OLT and the diagnosis of SAA, justifying a lifelong scheduled surveillance of abdominal vessels by ultrasound after OLT. Herein we have reported a case of SAA that developed 16 years after OLT. This pathological condition was totally asymptomatic. Only routine abdominal ultrasound allowed its detection and subsequent successful treatment.

Su1468 Downstaging Therapy in Patients With Intermediate Stage HCC (BCLC B) as Bridge for Transplantation: The Hepatocatt Experience

Partially Hydrolyzed Guar Gum (PHGG) Attenuates Nonalcoholic Steatohepatitis (NASH) in Mice Through the Gut-Liver Axis Kazuhiro Katada, Yuji Naito, Tomohisa Takagi, Katsura Mizushima, Yasuki Higashimura, Tetsuya Okayama, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiko Uchiyama, Ishikawa Takeshi, Osamu Handa, Hideyuki Konishi, Nobuaki Yagi, Hiroshi Ichikawa, Zenta Yasukawa, Makoto Tokunaga, Tsutomu Okubo, Lekh R. Juneja, Yoshito Itoh

Sa1007 The Role of Dynamic Contrast Enhanced Ultrasound in Focal Liver Lesion Characterization: Preliminary Results

Background: Recent publications have shown that performing fibroscan of the spleen (fibrospleen) can predict the development of esophageal varices in patients with cirrhosis of the liver. The aim of the present study was to evaluate the fibrospleen as a diagnostic tool in a broader cohort of patients with liver diseases with and without cirrhosis. Methods: 182 consecutive patients [80 female and 102 male, median age 51.8 years] who underwent a fibroscan test at the University Hospital of Essen, Germany, from September 1st to October 10th received a fibroscan of the spleen after obtaining informed consent. The test was performed using Fibroscan touch™ (Echosens™, France). 46 patients were liver transplant recipients, 57 had a viral hepatitis, 28 an autoimmune and 26 a fatty liver disease, further 19 patients suffered from vascular or genetic liver diseases. The patients were further divided in 3 groups regarding their fibroscan of the liver ( 14 kPa n=63). The fibrospleen was correlated to the flow velocity of the portal vein and spleen size. Statistical analyses were performed using GraphPad Prism v 6.0. Results: In a total of 108 patients a valid fibrospleen was possible. The fibrospleen resulted in generally higher values than the fibroscan of the liver. Between the three groups the mean value increased from 28.8 to 33.4 to 52.2 kPa, respectively. The ratio between fibroscan of the liver and fibrospleen increased from 0.33 to 0.44 to 1.15 between the three groups. These differences were statistically significant. The fibrospleen correlated significantly with fibroscan of the liver (pearson coefficient 0.49; p=0.0001) and the size of the spleen (pearson coefficient 0.57; p<0.0001). There was no correlation to the portal flow velocity. The strongest correlation was seen in patients with viral hepatitis, the weakest correlation was seen in patients with a fibroscan of the liver between 7-14 kPa. Conclusion: The fibrospleen shows a linear correlation to liver stiffness in all stages of liver diseases. It correlates to the size of the spleen and is independent of the portal flow velocity. This suggests that fibrospleen may offer further information in the staging of liver disease and a valuable addition to the fibroscan. Prospective analyses are required to evaluate the potential of the fibrospleen in the diagnosis of liver diseases and its complications.

A pilot study of capsule endoscopy after a standard meal for the detection and grading of oesophageal varices in cirrhotic patients

BACKGROUND Capsule endoscopy has been proposed as an alternative to fibreoptic endoscopy for oesophageal varices evaluation in cirrhotics. However, it shows only moderate sensitivity compared to fibreoptic endoscopy. AIM To compare post-meal capsule endoscopy to fibreoptic endoscopy, based on the hypothesis that meal-induced increase of portal pressure can enhance its sensitivity. METHODS Twenty-five patients were submitted to fibreoptic endoscopy and, after a standard meal, capsule endoscopy. RESULTS Post-meal capsule endoscopy detected varices in the 18 patients in whom fibreoptic endoscopy detected varices plus 3 more subjects (sensitivity 100%, specificity 70%); large varices in the 4 patients in whom fibreoptic endoscopy graded varices as large, plus 5 more subjects; red markers in the 5 patients in whom fibreoptic endoscopy detected red markers, plus 3 more subjects. High-risk varices were identified in 11 patients by post-meal capsule endoscopy and in 10 by fibreoptic endoscopy (sensitivity 100%, specificity 93.8%). CONCLUSIONS Post-meal capsule endoscopy identified more varices, large varices and red markers than fibreoptic endoscopy. The two methods detected similar proportions of high-risk varices. These data suggest that a standard meal can enhance the sensitivity of capsule endoscopy in the detection and grading of oesophageal varices in cirrhotics.

Su1224 Single-Step Balloon-Occluded Percutaneous Radio-Frequency Thermal Ablation (RFA) Plus Transcatheter Arterial Chemoembolization (TACE) for Treatment of “Complex” Unresectable Hepatocellular Carcinoma

New Therapeutic Perspectives for Management of Advanced Hepatocellular Carcinoma With Hepatic Arteriovenous Fistula: Balloon-Occluded Percutaneous Radio-Frequency Thermal Ablation (RFA) Plus Transcatheter Arterial Chemoembolization (TACE) Roberto Iezzi, Valentina Cesario, Mariachiara Campanale, Silvia Pecere, Federico Barbaro, Emanuele Rinninella, Francesca Romana Ponziani, Michele La Torre, Brigida E. Annicchiarico, Massimo Siciliano, Maurizio Pompili, Antonio Grieco, Luca Miele, Gian Ludovico Rapaccini, Laura Riccardi, Maria Assunta Zocco, Alessandro Milani, Anna Maria De Gaetano, Giovanni B. Gasbarrini, Lorenzo Bonomo, Antonio Gasbarrini

239 SUSTAINED VIROLOGICAL RESPONSE PREVENTS DEVELOPMENT AND DELAYS PROGRESSION OF PORTAL HYPERTENSION IN HCV-RELATED LIVER CIRROSIS

239 SUSTAINED VIROLOGICAL RESPONSE PREVENTS DEVELOPMENT AND DELAYS PROGRESSION OF PORTAL HYPERTENSION IN HCV-RELATED LIVER CIRROSIS B.E. Annicchiarico, M. Siciliano, A. Iacobellis, A.W. Avolio, G. Caracciolo, A. Andriulli, G. Bombardieri. Internal Medicine, Sacred Heart Catholic University, Roma, Gastroenterology, Casa Sollievo della Sofferenza Hospital, Foggia, Liver Transplantation Unit, Sacred Heart Catholic University, Roma, Italy E-mail: terapiamedica@tin.it

183 MELD CLASS AND LONG-TERM SURVIVAL BENEFIT OF LIVER TRANSPLANTATION: AN INTENTION-TO-TREAT ANALYSIS

MELD is today the reference method to score and classify end-stage liver disease in relation to the need of transplantation in the majority of transplant programmes. Even if several studies emphasized the prognostic significance of MELD in patients listed for liver transplantation (LTx), few of them used the intention-to-treat (ITT) analysis. Patients and methods. We reviewed patients who entered liver transplant waiting list (LWL) in relation to the ITT analysis during the last 3 years. Patients with hepatocellular carcinoma were included. One hundred and twenty-six consecutive adult patients were classified in two classes in according to their MELD score as follows: LOW MELD class (MELD 6–15, N = 81) and HIGH MELD class (MELD 16–40, N = 45). Results. Patients with LOW MELD presented ITT survival better than patient with HIGH MELD (84 vs. 64%; 76% vs. 61% and 66% vs. 61% at 12, 24 and 36 months, respectively, p < 0.05; Fig. A). In both classes, outcomes were also analysed in relation to LTx. In the LOW MELD class, the patients who remained on the LWL presented better outcome than the LTx patients (91% vs. 76%; 91% vs. 71% and 75% vs. 71% at 12, 24 and 36 months, respectively; Fig. B). In HIGH MELD class, the patients on the LWL presented better outcome than the LTx patients only during the first five postoperative months, but an opposite behaviour was observed at the sixth month (77% vs. 53%; 69% vs. 32% and 64% vs. 32% at 12, 24 and 36 months, respectively; Fig. C).