A fatal case of progressive steatohepatitis, possibly chemotherapy- associated steatohepatitis related to gemcitabine

金沢大学医薬保健研究域医学系We report the case of an 80-year-old female suffering from pancreatic cancer who developed severe non-alcoholic steatohepatitis (NASH) resulting in fatal hepatic failure after anti-cancer chemotherapy with gemcitabine. Hepatic encephalopathy appeared 1 year after the chemotherapy, and the patient developed progressive liver failure and eventually died. Radiological examination showed severe fatty liver. Histopathological examination of a liver needle necropsy showed almost panlobular macrovesicular fatty change. Ballooning degeneration and necrosis of hepatocytes accompanying neutrophil infiltration, Mallory bodies, and a few bile plugs were found in zone 3. Marked perivenular and pericellular/perisinusoidal fibrosis and extensive bridging fibrosis were also found. Together, these findings indicated steatohepatitis at a precirrhotic stage. Because the patient had no history of drinking in excess, we made a diagnosis of NASH, in particular, chemotherapy-associated steatohepatitis (CASH). Gemcitabine is a pyrimidine nucleoside antimetabolite with anti-cancer activity. A few reports have mentioned fatal hepatotoxicity caused by gemcitabine, but, to our knowledge, this is the first report of steatohepatitis, possibly associated with gemcitabine. Physicians treating patients with this drug should be aware of the possibility of steatohepatitis. © Springer 2010

Prevention and management of ERCP-related complications

Endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures are established as necessary and indispensable techniques in the diagnosis and treatment of bilio-pancreatic diseases. However, these procedures are associated with a high risk of complications, and caution is needed as the complications may occasionally follow a fatal course. The primary complications are pancreatitis, bleeding, perforation, and issues associated with biliary stents and lithiasis treatment. Endoscopists must perform ERCP with a strong understanding of the mechanisms of each of these complications and should be familiar with the prevention and countermeasures