studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 587A
757
Acute kidney injury predicts mortality in cirrhotic
patients with gastric variceal bleeding
Yun-Cheng Hsieh, Kuei-Chuan Lee, Ping-Hsien Chen, Chien-Wei
Su, Ming-Chih Hou, Han-Chieh Lin; Taipei Veterans General hospital,
Taipei, Taiwan
Backgrounds and Aims: Acute kidney injury (AKI) is an important
complication in patients with cirrhosis. However, the role
of AKI in patients with gastric variceal (GV) bleeding remained
unknown. Recently, the international club of ascites (ICA) proposed
the new definition of AKI in cirrhotic patients. We aim at
evaluating the ICA criteria and their association with the prognosis
of cirrhotic patients with GV bleeding. Methods: From
January 2005 to August 2011, 103 cirrhotic patients admitted
to Taipei Veterans General hospital due to acute GV bleeding
were analyzed retrospectively. Results: Forty-one (39.8%)
patients fulfilled the ICA criteria of AKI, 26 patients (25.2%) in
stage1, 13 patients (12.6%) in stage 2 and 2 patients (1.9%)
in stage3, respectively. The severity of liver disease (Child-Pugh
scores or its component, and MELD scores), shock at admission,
hematemesis, increased transfusion blood units, elevated
CRP and the development of infection were associated with the
occurrence of AKI. Among patients with AKI stage 1 and 2, 8
(20.5%) progressed to a higher AKI stage. The patients with
progressed AKI stages had higher child-pugh scores, lower
serum sodium and higher CRP level. The overall 6-week and
3-month mortality were 15.5% (n=16) and 20.4% (n=21),
respectively. In multivariate analysis, the occurrence of AKI
was significantly associated with a higher 6-week mortality
rate (34.1% vs. 3.2%, p=0.049). AKI stages were independent
predictors of 3-month survival (8.1% in patients without AKI,
30.1% in stage 1, 53.3% in stage 2+3, p=0.002). Conclusions:
The occurrence of AKI defined by the ICA criteria is high
in cirrhotic patients with acute GV bleeding. The presence AKI
was associated with 6-week mortality and the stages of AKI
further predict 3-month survival.
Six-week (A) and 3-month (B) mortality in patients with gastric variceal
bleeding stratified by acute kidney injury (AKI)
Disclosures:
The following authors have nothing to disclose: Yun-Cheng Hsieh, Kuei-Chuan
Lee, Ping-Hsien Chen, Chien-Wei Su, Ming-Chih Hou, Han-Chieh Lin
758
Argon Plasma Coagulation Versus Endoscopic Band
Ligation for Management of Severe Portal Hypertensive
Gastropathy
Mohamed M. El-Saadany; Internal Medicine, Mansoura University,
Mansoura City, Egypt
INTRODUCTION: Portal hypertensive gastropathy ( PHG )
occurs as a complication of cirrhotic or non-cirrhotic portal
hypertension. PHG is clinically important since it may cause
insidious or acute severe blood loss. It is characterized
endoscopically by presence of gastric mucosa abnormality
described as mosaic-like pattern of snake skin with or without
red spots. Argon Plasma Coagulation ( APC ) has been used
as the first therapeutic endoscopic treatment of severe PHG.
AIM OF STUDY: In this work, Endoscopic Band Ligation ( EBL
) of affected gastric mucosa has been evaluated as a new
modality for the treatment of bleeding PHG in comparison with
the commonly used APC. PATIENTS and METHOD: This is a
single center, prospective and randomized study included 18
patients with post-HCV cirrhosis (100%) presented with upper
GI bleeding admitted at Mansoura University Emergency Hospital
form Jan.1 st 2013 to Feb.28 th 2014 and were followed
up for 6 months after complete eradication of PHG. The 18
patients were randomized 2:1 into group 1 (APC) including 12
patients: 7 males and 5 females with age (meana± SD) 58.33
±9.61years and group 2 (EBL) including 6 patients 1 male and
5 females with age (mean± SD) 62.67±4.55 years. RESULTS:
The efficacy to eradicate PHG was 83.3% in APC group and
100% in EBL group (ρ. > 0.05). The number of endoscopic sessions
needed to eradicate PHG was significantly (ρ. 0.03) less
in EBL group (3.17±0.75) than in APC group (4.08±0.79) and
the duration of endoscopic procedures was also significantely
( ρ.0.001) shorter in EBL group (275.5±35.5 sec.) than in
APC group (469.75±60.22 sec.). Adverse events like duration
of distention was significantly (ρ.0.001) less in EBL group
(3.0 ±3.29 min.) than in APC group (25.0±12.75 min.) and
duration of nausea was significantly (0.02) less in EBL group
(3.0±3.29 min.) than APC group (12.0±8.0 min.). However,
gastric ulcers were found in 2 patients in EBL group and none
in APC group (ρ.0.03) while gastric polyps were more common
in APC group (41.7%) than in EBL group (ρ.0.06). CON-
CLUSION: There is no significant difference in the efficacy
to ablate PHG using either APC or EBL. However, EBL could
achieve early ablation of PHG with less number of endoscopic
sessions and fewer adverse effects.
Disclosures:
The following authors have nothing to disclose: Mohamed M. El-Saadany
759
The impact of esophagogastric varices on the prognosis
of patients with hepatocellular carcinoma
Chien-Wei Su 1,2 , Ping-Hsien Chen 3,2 , Yi-Hsiang Huang 1,4 , Teh-Ia
Huo 1,5 , Ming-Chih Hou 3,2 , Han-Chieh Lin 1,2 , Jaw-Ching Wu 4,6 ;
1 Division of Gastroenterology, Department of Medicine, Taipei
Veterans General Hospital, Taipei, Taiwan; 2 Faculty of Medicine,
School of Medicine, National Yang-Ming University, Taipei, Taiwan;
3 Endoscopy Center for Diagnosis and Treatment, Taipei
Veterans General Hospital, Taipei, Taiwan; 4 Institute of Clinical
Medicine, School of Medicine, National Yang-Ming University,
Taipei, Taiwan; 5 Institute of Pharmacology, National Yang-Ming
University, Taipei, Taiwan; 6 Division of Translational Research,
Department of Medical Research, Taipei Veterans General Hospital,
Taipei, Taiwan
Background: Esophagogastric varices (EGV) is an important
prognostic factor for patients with advanced liver disease, but
whether it could determine the outcomes of patients with hepatocellular
carcinoma (HCC) is still obscure. Aims: To assess the
impact of EGV on the prognosis of patients with HCC. Methods:
We enrolled 990 treatment-naïve HCC patients who also
received esophagogastroduodenoscopy at the time of HCC
diagnosis from 2007 to 2012. Results: A total of 480 (48.5%)
patients had EGV, including 399 patients had esophageal
varices (EV) alone, 12 had gastric varices (GV) alone, and
69 had both EV and GV. Compared to those without EGV,
patients with EGV were younger in age, and had poorer liver