GE Portuguese Journal of Gastroenterology最新文献

{"title":"Incidental Uptake in Gastrointestinal Tract on 18F-FDG-PET/CT: Is It Worth to Investigate? A Study with 371 Patients.","authors":"Luís Correia Gomes, Davide Fraga, Pedro Lage, Lucília Salgado, Isabel Claro","doi":"10.1159/000541209","DOIUrl":"10.1159/000541209","url":null,"abstract":"<p><strong>Background and study aims: </strong>Positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG (FDG) has been increasingly used to detect or monitor neoplasms. Gastrointestinal tract (GIT) is one of the most common sites of FDG uptake, leading to increasing requests for endoscopic examinations. We aimed to evaluate the nature and significance of unexpected PET/CT-FDG findings in the GIT.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 371 consecutive patients with incidental GIT findings on PET/CT-FDG between June 2016 and October 2021 who were subsequently referred to endoscopic examinations. Demographic data, PET/CT-FDG results, endoscopic findings, and histological analysis were analyzed.</p><p><strong>Results: </strong>Of 194 colonic incidental uptakes, 102 (52.6%) corresponded to at least premalignant lesions, being 57 (29.4%) advanced adenomas and 23 (11.9%) adenocarcinomas. Of 193 upper GIT incidental uptakes, there were 11 (13.8%) esophageal and 14 (14.4%) gastric malignant/premalignant lesions. The maximum standardized uptake value (SUVmax) significantly varied according to the nature of the lesion, being higher in malignant lesions (in the esophagus, stomach, and colon). However, an optimal SUVmax cutoff was only found for stomach (SUVmax 8.2; sensitivity of 79% and specificity of 76%). There was a significant association between the site of uptake and the nature of the lesion - left colon and gastric body uptake were associated with neoplastic origin whereas rectum and lower esophagus were associated with inflammatory or no endoscopic changes.</p><p><strong>Conclusions: </strong>Any incidental uptake in the lower GIT should be investigated provided that patients are suitable for further treatment. However, in the upper GIT the characteristics of uptake on ¹⁸F-FDG-PET/CT may allow to select those who need endoscopic examination.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 3","pages":"174-184"},"PeriodicalIF":1.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-Guided Drainage of Pelvic Fluid Collections with Lumen-Apposing Metal Stents.","authors":"Marco Pereira, Ana Caldeira, Joana Barreiro, Mafalda Almeida, António Banhudo","doi":"10.1159/000541273","DOIUrl":"10.1159/000541273","url":null,"abstract":"<p><strong>Introduction: </strong>A pelvic abscess is a potential life-threatening condition that should be managed conservatively whenever possible. Currently, computed tomography or ultrasound-guided percutaneous drainage is still the gold standard approach for pelvic fluid collections (PFCs) requiring intervention. More recently, endoscopic ultrasound (EUS) drainage using lumen-apposing metal stents (LAMSs) has been used off-label in PFCs with similar efficacy, a favorable safety profile, better quality of life, and generally a shorter duration of treatment when compared to the gold standard treatment.</p><p><strong>Methods: </strong>An observational retrospective analysis of 6 patients who underwent EUS-guided PFC drainage with LAMS at our institution was conducted. Records were reviewed to identify etiology, size of the collection, number of endoscopic procedures required until complete resolution, stent indwelling time, concomitant surgical or percutaneous associated procedures, successful removal and resolution.</p><p><strong>Results: </strong>The 6 patients included had an average age of 69 years old and 5 (83.3%) were male. The average size of the PFCs was 72.5 mm. All patients (100%) had successful drainage following LAMS placement, though 1 patient had an early recurrence. The mean stent indwelling time in our study was 6.7 days. An additional percutaneous or surgical drainage intervention was not required in any of the participants. Also, no adverse events related to the procedure were reported during the follow-up period.</p><p><strong>Conclusion: </strong>EUS-guided drainage of PFCs with LAMS is a safe and minimally invasive technique, which allows rapid PFC resolution, with no need for percutaneous or surgical drainage interventions.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 4","pages":"251-256"},"PeriodicalIF":0.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Portuguese Version of IBD-Control Questionnaire and Comparison with IBD-Disk.","authors":"Tânia Carvalho, Joana Franco, Andreia Guimarães, José Damasceno Costa, Sofia Mendes, Tiago Leal, Ana Rebelo, Bruno Arroja, Raquel Gonçalves, João Bruno Soares","doi":"10.1159/000541219","DOIUrl":"10.1159/000541219","url":null,"abstract":"<p><strong>Introduction: </strong>The IBD-Control questionnaire and IBD-Disk are two patient-reported outcome measures designed to evaluate the impact of inflammatory bowel disease (IBD) on different health domains. Unlike IBD-Disk, there is no fully published validated Portuguese version of IBD-Control. Furthermore, the two instruments have not yet been compared. We aimed to translate and validate IBD-Control in Portugal and compare it with IBD-Disk.</p><p><strong>Methods: </strong>After translation into Portuguese, the IBD-Control was administered to IBD patients, at baseline (T0), after 1-4 weeks (T1), and >3 months (T2). Patients also completed the Portuguese versions of the PRO2, EQ-5D, SIBDQ, and IBD-Disk. We assessed the reliability, validity, responsiveness, and interpretability of IBD-Control. We compared the usability (3 questions) and the ability to identify good disease control (area under the curve [AUC]) of IBD-Control and IBD-Disk.</p><p><strong>Results: </strong>At T0, the IBD-Control was completed by 142 patients (108 Crohn's disease, 34 ulcerative colitis). At T1 and T2, 68 and 101 patients completed the questionnaire, respectively. Factor analysis confirmed the one-dimensionality of the scale with 8 items (IBD-Control-8). Internal consistency (Cronbach's alpha) was 0.80. Test-retest reproducibility for stable patients (<i>n</i> = 54) was high (intraclass correlation coefficient-0.86). IBD-Control-8 significantly correlated (r between 0.55 and 0.82; <i>p</i> ≤ 0.001) with PRO2, EQ-5D, SIBDQ and IBD-Disk. The variation in IBD-Control-8 between T0 and T2 correlated significantly (r between 0.48 and 0.53; <i>p</i> ≤ 0.01) with the variation in PRO2 (only for Crohn's disease), SIBDQ and IBD-Disk. The IBD-Control-8 significantly discriminated between well and poorly controlled disease (15 ± 2 vs. 11 ± 4; <i>p</i> < 0.001). No significant differences were observed between IBD-Control-8 and IBD-Disk regarding usability and the ability to identify good disease control (AUC: -0.79 vs. 0.76, respectively).</p><p><strong>Conclusions: </strong>The IBD-Control is reliable and valid for measuring disease control from the perspective of patients with IBD in Portugal, presenting no significant differences regarding usability and assessment of disease control when compared to IBD-Disk.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 3","pages":"185-196"},"PeriodicalIF":1.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under the Hood: An Easy Method for Lesions Retrieval.","authors":"João Pedro Pereira, Leonor Guedes-Novais, Pedro Antunes, Masami Omae, Henrik Maltzman, Francisco Baldaque-Silva","doi":"10.1159/000541246","DOIUrl":"10.1159/000541246","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"124-126"},"PeriodicalIF":1.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disorder of Glucose Metabolism and Therapy: Implications on the Natural History of Advanced Chronic Liver Disease.","authors":"Sofia Garcês Soares, Tereza Frazão, Célia Tuna, Margarida Montes, Ana Rocha, Lígia Rodrigues Santos, Paulo Carrola, Sónia Carvalho, Inês Pinho, Luís Nogueira, Manuel Marques-Cruz, José Presa","doi":"10.1159/000541211","DOIUrl":"10.1159/000541211","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatogenous diabetes (HD) is a disorder of glucose metabolism (DGM) that develops as a complication of advanced chronic liver disease (ACLD) with an estimated prevalence of 20-70%. It appears to be associated with a larger number of decompensations, but its impact on the natural history of the disease is unclear. The treatment of DGM is hampered by the fact that some therapeutic agents are associated with a risk of complications in ACLD. The aim of this work was to study DGM in a population of patients with ACLD: prevalence, liver disease decompensation episodes, mortality analysis and study of the impact of antidiabetic therapies in patients with ACLD who developed DGM.</p><p><strong>Materials and methods: </strong>A cohort of consecutive patients with ACLD without previous DGM, who attended a Hepatology clinic in the period of January to June 2015 was selected. Follow-up was carried out for 5 years. Data on age, gender, date of diagnosis and etiology of ACLD, Child-Pugh and MELD-Na classifications at enrollment, development of DGM, and antidiabetic therapy were collected. Logistic regression models for hospitalizations due to decompensated ACLD, ascites, hepatic encephalopathy (HE), upper gastrointestinal bleeding (UGB), hepatocellular carcinoma (HCC), portal vein thrombosis (PVT), infectious complications, acute-on-chronic liver failure (ACLF), and death were built. A survival analysis for patients with and without DGM was also performed. Treatment effectiveness for patients with DGM was assessed.</p><p><strong>Results: </strong>Initially, 221 patients were included, 154 (69.7%) of whom developed DGM after the diagnosis of ACLD. DGM patients presented a significantly higher number of hospitalizations. Odds ratio (OR) for death was not significantly related with DGM. At 5 years of follow-up, 68.9% of patients with DGM were alive, against 81.8% without DGM (<i>p</i> = 0.087). From the 154 patients who were diagnosed with DGM, 42.9% were not receiving pharmacological treatment for DGM. Treated patients were prescribed with either biguanides (34.8%), a SGLT2 inhibitor (8.6%), or insulin (7.7%). Only 1 patient was treated with a GLP-1 analogue. A tendency of OR favoring treatment was observed for biguanides and SGLT2 inhibitors in all outcomes except ascites. In the univariable analysis, the use of biguanides was associated with lower risk of death (OR: 0.84 [95% CI: 0.73-0.96]) and HE (OR: 0.85 [95% CI: 0.73-0.98]).</p><p><strong>Conclusion: </strong>DGM occurs with high prevalence in patients with ACLD and it seems to be related to more hospitalizations, which highlights the importance of its early identification and appropriate therapeutic approach. In the absence of contraindications, biguanides should be considered for treatment of patients with ACLD and DGM as they appear to be associated with a tendency to better outcomes and may present some advantage in terms of survival.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 4","pages":"242-250"},"PeriodicalIF":0.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertrichosis Lanuginosa Acquisita: When Hair Unravels the Unseen.","authors":"Joana Revés, Catarina Bexiga, Alexandra Chaveiro, Catarina Ferreira Gouveia","doi":"10.1159/000541214","DOIUrl":"10.1159/000541214","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"131-133"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive <i>Yersinia</i> Serology and Colonic Cobblestone Pattern: A Diversion or Main Culprit?","authors":"Joana Revés, Catarina Frias-Gomes, Lídia Roque Ramos, Luísa Glória","doi":"10.1159/000541220","DOIUrl":"10.1159/000541220","url":null,"abstract":"<p><p><i>Yersinia enterocolitica</i> infection, the third most prevalent gastrointestinal infection in Europe, poses a diagnostic challenge due to its resemblance to other common conditions such as acute appendicitis, Crohn's disease, and malignancy. We report the case of a 48-year-old female patient who sought medical attention for abdominal pain and diarrhoea. Her endoscopic examination revealed a cobblestone pattern affecting the entire colon, more pronounced in the right colon, but with normal mucosa in the terminal ileum. This unique presentation created a challenge in distinguishing Yersiniosis from Crohn's disease. This case report aimed to highlight this atypical endoscopic manifestation of <i>Y. enterocolitica</i> infection. We underline the subacute nature of the symptoms, which can last up to 4-6 weeks. This reinforces the importance of considering <i>Y. enterocolitica</i> infection as a diagnostic possibility, even when the endoscopic appearance closely resembles other chronic intestinal diseases.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"143-150"},"PeriodicalIF":1.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time Gastric Juice Analysis in Cirrhotic Patients: Can We Avoid Unrewarding Gastric Biopsies?","authors":"Sergio Peralta, Vincenza Calvaruso, Francesca Di Giorgio, Marco Peralta, Vincenzo Di Martino, Ada Maria Florena, Angelo Zullo","doi":"10.1159/000540698","DOIUrl":"10.1159/000540698","url":null,"abstract":"<p><strong>Background: </strong>To search for <i>H. pylori</i> infection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies.</p><p><strong>Methods: </strong>This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster^®) that test ammonium concentration for <i>H. pylori</i> diagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both <i>H. pylori</i> infection and extensive precancerous lesions on gastric mucosa.</p><p><strong>Results: </strong>A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster^® results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out <i>H. pylori</i> and extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%.</p><p><strong>Conclusions: </strong>This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"118-123"},"PeriodicalIF":1.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review.","authors":"Sofia Bizarro Ponte, Joana Oliveira, Andreia Rei, Paulo Salgueiro","doi":"10.1159/000540702","DOIUrl":"10.1159/000540702","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews specifically addressing this topic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six studies were included - 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/fissure (1-17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25% within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without significant adverse events, at the cost of a 40% recurrence rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges previous concerns regarding significant bleeding after office-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam ","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"95-108"},"PeriodicalIF":1.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Hepatocellular Carcinoma in a Portuguese Population after Hepatitis C Cure: Comparative Accuracy of Noninvasive Tests (Transient Elastography, FIB-4, and aMAP).","authors":"André Mascarenhas, Juliana Serrazina, Sérgio Bronze, Helena Cortez-Pinto, José Presa, Ana Barreira, Paulo Carrola, Francisco Vara-Luiz, Alexandra Rosu-Pires, Pedro Lages Martins, Rita Prata, Joana Revés, Catarina Bravo, Catarina Nascimento, Catarina Gouveia, Ana Rita Franco, Pedro Lima, Catarina O'Neill, Raquel R Mendes, Inês Rodrigues Simão, Inês Costa Santos, André Ruge Gonçalves, Pedro Barreiro, Rui Mendo, Rita Barosa, Pedro Figueiredo, Cristina Chagas","doi":"10.1159/000540700","DOIUrl":"10.1159/000540700","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic infection with hepatitis C virus (HCV) causes 25% of hepatocellular carcinoma (HCC) cases worldwide, a major cause of morbimortality even after sustained virologic response (SVR). Universal screening to all patients with advanced liver fibrosis is currently recommended. A risk-based strategy could improve the detection rate of early HCC and diminish the surveillance burden. Although several risk prediction models exist, exclusion of a subgroup of patients from surveillance has not yet been recommended. The objective of this study was the comparison of the predictive accuracy of transient elastography, FIB-4, and aMAP for HCC in HCV patients after SVR in Portugal.</p><p><strong>Methods: </strong>This was a multicentric retrospective study including patients with HCV after SVR. Comparative, univariate, multivariate, area under the ROC (receiver-operating characteristic) curve (AUC), and Youden's J-statistic analysis were performed.</p><p><strong>Results: </strong>HCC incidence was 4.2% (1.3/100 patient-years) after a median follow-up of 31 months with inclusion of 337 patients. All patients had a liver stiffness measurement (LSM) before SVR (considered the baseline), but only 148 (43.9%) had a transient elastography after SVR. FIB-4 and aMAP post-SVR were calculated in all patients. Multiple parameters positively correlated with HCC, but only age and baseline transient elastography remained as independent predictors in the multivariate analysis. The optimal cutoffs for prediction of HCC were baseline transient elastography 13.7 kPa, post-SVR transient elastography 16.5 and 15.8 kPa (first and last measurements, respectively), FIB-4 1.6, and aMAP 58. Baseline transient elastography revealed a fair accuracy in predicting HCC (AUC 0.776, <i>p</i> < 0.001), with the cutoff of 13.7 kPa presenting a sensitivity of 85% and a specificity of 69%. Regarding patients who were F3-4 at baseline (<i>n</i> = 162), almost one-third had a baseline LSM ≤13.7 kPa (<i>n</i> = 51, 31.5%), an FIB-4 ≤1.6 (<i>n</i> = 50, 30.9%), and an aMAP score ≤58 (<i>n</i> = 48, 29.6%), and these cutoffs presented an NPV of 98%, 94%, and 96%, respectively, when considering HCC development.</p><p><strong>Conclusion: </strong>Transient elastography (FibroScan) before SVR was a fair predictor of HCC, being more accurate than FIB-4 and aMAP. Transient elastography values ≤13.7 kPa at baseline, FIB-4 ≤1.6 and aMAP ≤58 were the cutoffs considered of low risk for HCC in a Portuguese cohort of HCV patients after SVR with advanced fibrosis. aMAP score is a risk-based surveillance tool that could improve the current HCC screening strategy, but further validation is needed.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 3","pages":"161-173"},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}