Wen-Chi Chen

Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis

BACKGROUND The value of band ligation for prevention of the first episode of variceal bleeding has not been fully evaluated. This study compared the efficacy and safety of band ligation vs. treatment with a beta-blocker for the prophylactic prevention of first bleeding in patients with cirrhosis and high-risk esophageal varices. METHODS A total of 100 patients with cirrhosis and endoscopically determined high-risk esophageal varices but no history of bleeding were randomized to band ligation (50 patients) or treatment with nadolol (50 patients). In the ligation group, two to 4 elastic bands were deployed during each session. Ligation was repeated at intervals of 3 to 4 weeks until variceal obliteration was achieved. In the nadolol group, the dose of the drug, administered once daily, was sufficient to reduce the pulse rate by 25%. RESULTS In the ligation group, variceal obliteration was achieved in 41 patients (82%), at a mean of 2.7 (1.1) ligation sessions. In the nadolol group, the mean daily dose of nadolol administered was 60 (20) mg. During follow-up (median approximately 22 months), 10 patients (20%) in the ligation group and 16 (32%) in the nadolol group had upper-GI bleeding (p=0.23). Esophageal variceal bleeding occurred in 5 patients (10%) in the ligation group and 9 (18%) in the nadolol group (p=0.31). By multivariate Cox analysis, Child-Pugh class was the only factor predictive of variceal bleeding. Minor complications were noted in 9 patients (18%) in the ligation group and 4 (8%) in the nadolol group (p=0.35). No serious complication was encountered. Twelve patients in the ligation group and 11 in the nadolol group died (p=0.62). One patient in the ligation group and 3 in the nadolol group died from uncontrollable variceal hemorrhage. CONCLUSIONS Variceal ligation is as effective and as safe as treatment with nadolol for prevention of first variceal bleeding in patients with cirrhosis.

Eradication of Helicobacter pylori prevents ulcer development in patients with ulcer-like functional dyspepsia

Although the eradication of Helicobacter pylori infection benefits patients with gastric or duodenal ulcers, the value of eradicating the infection in the patients with functional dyspepsia (FD) remains controversial.

The characteristics and the prognosis for patients presenting with actively bleeding esophageal varices at endoscopy

BACKGROUND It remains unresolved whether the prognosis is worse for patients who present with actively bleeding varices at endoscopy compared with those in whom variceal bleeding has stopped. METHODS Patients with acute esophageal variceal bleeding were enrolled in this study and were divided into two groups: an active bleeding group and an inactive bleeding group. All patients had band ligation shortly after endoscopic examination and underwent elective ligation procedures until the varices were obliterated. Patients were followed for 1 year or until death. Short- and long-term prognoses were compared. RESULTS The active bleeding group included 54 patients and the inactive bleeding included 251 patients. Initial hemostasis was achieved in 93% in the active group and 99% in the inactive group ( p = not significant). The rate of recurrent variceal bleeding within 30 days was 24% in the active bleeding group vs. 12% in the inactive bleeding group ( p = 0.01); the mortality rates were 18% and 8%, respectively ( p = 0.03 in a single statistical test; however, Bonferroni correction for the multiple testing of data removed this significance). The rate of recurrent variceal bleeding within 1 year was 37% in the active bleeding group and 27% in the inactive bleeding group ( p = 0.06); the mortality rates were 22% and 21%, respectively ( p = not significant). CONCLUSIONS Whether variceal bleeding is active or inactive at endoscopy, variceal ligation is equally effective for control of bleeding. The rates of recurrent bleeding and mortality at 1 month were significantly higher among patients with active bleeding. However, the mortality rate was similar for both groups at 1 year.

Clinical trial: percutaneous acetic acid injection vs. percutaneous ethanol injection for small hepatocellular carcinoma--a long-term follow-up study.

Aliment Pharmacol Ther 28, 304–311

Hepatoblastoma in a Male Adult: Report of a Case

Hepatoblastoma is a rare malignant tumor of the liver, usually occurring in the first three years of life. Hepatoblastomas in adults are unusual and are an exceptional cause of primary malignant liver tumor in adult patients. An 84-year-old man suffered from progressively poor appetite and weight loss for 5 months. Magnetic resonance examination revealed a tumor was enhanced in the arterial phase and washed out in the late phase on dynamic studies. Hepatocellular carcinoma was diagnosed by the radiologists. Serum α-fetoprotein level was 8849 ng/ml. Subsequently, a S5 segmentectomy was performed. To our surprise, pathologic examination of the resected liver tumor confirmed the diagnosis of hepatoblastoma of a mixed epithelial and mesenchymal type with teratoid features. We concluded that hepatoblastoma should be included in the differential diagnostic list of malignant liver tumor in adults.

Efficacy of Peginterferon Alfa Plus Ribavirin Treatment for Chronic Hepatitis C Virus Infection in Cirrhotic Patients

Objective: Hepatitis C virus (HCV)-related cirrhotic patients have a poor prognosis with 5% annual risk of hepatic decompensation. Eradicating HCV may prevent disease progression of cirrhotic patients. The aims of this retrospective study were to investigate the efficacy of peginterferon-α plus ribavirin treatment for chronic HCV infection in cirrhotic patients and to compare the efficacies of the combined therapy between patients with and without cirrhosis. Method: From September 2003 to November 2009, cirrhotic and non-cirrhotic HCV-infected patients receiving ribavirin plus peginterferon-α therapy were included. The baseline characteristics, virological response and incidence of adverse events were compared between the patients with and without cirrhosis. Results: Fifteen cirrhotic and 121 non-cirrhotic patients receiving ribavirin plus peginterferon-α therapy were included. The baseline HCV RNA levels, genotype, age, and gender were comparable between groups. Cirrhotic patients had a lower rapid virological response (RVR) rate than non-cirrhotic patients (57.1% vs. 92.5%, P=0.035). The end-of-treatment response (ETR) rate and sustained virological response (SVR) in cirrhotic patients (86.7% and 60.0%, respectively) were slightly lower than those in non-cirrhotic patients (89.8% and 68.6%) but both differences didn’t reach statistic significance (P = 0.659 and 0.562, respectively). Additionally, there were no significant differences in the frequencies of adverse events between cirrhotic and non-cirrhotic patients. Conclusions: Those cirrhotic patients who received standard treatment with ribavirin plus peginterferon-α might achieved an acceptable SVR rate in Taiwan.

Endoscopic Tissue Glue Injection in a Pregnant Woman with Acute Cardiac Variceal Bleding: Report of a Case

Gastric variceal bleeding (GVB) in pregnancy is very rare and makes management more difficult than those without pregnancy. Endoscopic tissue glue obturation is the first choice of endoscopic therapy for GVB but it carries a risk of embolization, infection and huge ulceration. We report a first case of GVB in pregnancy in which endoscopic tissue glue obturation successfully controlled the bleeding. The available therapies for GVB and the efficacy and safety of endoscopic tissue glue obturation are also discussed.

Endoscopic Hemoclipping for Bleeding Duodenal Ulcer in a Patient with Dengue Hemorrhagic Fever: Report of a Case

Dengue fever and dengue hemorrhagic fever are the most important re-emergent arbovirus diseases of human, transmitted with four viral serotypes, dengue virus 1, 2, 3 and 4. Gastrointestinal bleeding is the most common complication of severe dengue hemorrhagic fever. The incidence of upper gastrointestinal (UGI) bleeding in patients with dengue fever varied from 8.4% to 58.5% in Taiwan. Adequate blood transfusion to correct the bleeding tendency, coagulation disorder and hypovolemia is the mainstay of medical treatment of UGI bleeding in dengue patients. However, the role of endoscopic treatment in UGI bleeding of dengue patients is still unknown. We report a serologically confirmed dengue patient with UGI bleeding. Successful hemostasis was achieved after application of endoscopic hemoclip. Our experience on this dengue-related UGI bleeding patient may suggest that endoscopic hemoclipping is helpful for similar cases.