6 research outputs found
Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience
Abstract BackgroundâEndoscopic resection has developed over the years. The main complications are perforation and bleeding. This study aimed to evaluate safety and effectiveness of digestive endoscopic resection in patients with cirrhosis. MethodsâThis retrospective, open-label, single-center study included all consecutive patients with cirrhosis who were admitted for endoscopic resection between 2009 and 2016. Safety, efficacy, and risk factors for delayed bleeding were analyzed. Resultsâ126 patients undergoing 164 procedures were included: 65 endoscopic resections (49 patients) in the upper gastrointestinal tract (esophagus 34, stomach 20, duodenum 11) and 99 in the lower gastrointestinal tract (77 patients). Mean Model for End-Stage Liver Disease score was 9.9 (standard deviation 4.5). Esophageal varices were present in 50 patients, and 21 patients had decompensated cirrhosis. The overall curative rate of endoscopic resection was 84.0â%. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1â%, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (Pâ<â0.01), antiplatelet medication (Pâ=â0.02), and lower glomerular filtration rate (GFR) (Pâ=â0.01) in univariate analysis. Duodenal location and lower GFR remained statistically significant in multivariate analysis, with respective odds ratios for bleeding of 52.12 and 1.04. No liver decompensation occurred after endoscopic resection. ConclusionsâEndoscopic resection was safe and effective in patients with mild (ChildâââPugh class A/B) cirrhosis, and should be proposed as a first option for treatment of superficial neoplasia. Additional data in patients with severe cirrhosis are needed to confirm the safety in this population
Methylprednisolone liver toxicity: A new case and a French regional pharmacovigilance survey
Anastomotic bilio-biliary stricture after adult liver transplantation: A retrospective study over 20 years in a single center
Immunosuppressive regimen and risk for de novo malignancies after liver transplantation for alcoholic liver disease
International audienc
Natural History of Recurrent AlcoholâRelated Cirrhosis After Liver Transplantation: Fast and Furious
International audienceAlcohol-related liver disease (ALD) is one of the main indications for liver transplantation (LT). Severe alcohol relapse can rapidly lead to recurrent alcohol-related cirrhosis (RAC) for the graft. The aim of this study was to describe the natural history of RAC and the overall survival after LT and after an RAC diagnosis. From 1992 to 2012, 812 patients underwent primary LT for ALD in 5 French transplant centers. All patients with severe alcohol relapse and an RAC diagnosis on the graft were included. The diagnosis of cirrhosis was based on the analysis of liver biopsy or on the association of clinical, biological, radiological, and/or endoscopic features of cirrhosis. RAC was diagnosed in 57/162 patients (35.2%) with severe alcohol relapse, and 31 (54.4%) of those patients had at least 1 episode of liver decompensation. The main types of decompensation were ascites (70.9%), jaundice (58.0%), and hepatic encephalopathy (9.6%). The cumulative probability of decompensation was 23.8% at 5Â years, 50.1% at 10Â years, and 69.9% at 15Â years after LT. During the follow-up, 36 (63.2%) patients died, the main cause of death being liver failure (61.1%). After diagnosis of cirrhosis, the survival rate was 66.3% at 1Â year, 37.8% at 5Â years, and 20.6% at 10Â years. In conclusion, RAC is associated with a high risk of liver decompensation and a poor prognosis. Prevention of severe alcohol relapse after LT is a major goal to improve patient survival