Correlation of Spleen Stiffness with Esophageo-gastric Variceal Bleeding in Patients with Non-cirrhotic Portal Hypertension.

Background: Bleeding from esophageo-gastric varices is a serious complication related to portal hypertension. In patients with cirrhosis, liver and splenic stiffness measurements (LSM and SSM) are useful to predict high-risk varices, bleeding and decompensation. Data regarding the utility of SSM for predicting bleeding in patients with non-cirrhotic portal hypertension (NCPH) is scarce.

Efficacy and Safety of Carvedilol in Cirrhosis Patients With New-Onset Uncomplicated Ascites Without High-Risk Esophageal Varices (CARVE-AS Trial).

Introduction: Carvedilol is effective in the prevention of bleeding in patients with cirrhosis and high-risk varices. Although it reduces drivers of clinical decompensation (portal pressure, systemic inflammation, and bacterial translocation), the data on its use for prevention of ascites-related complications are limited.

Methods: In this open-label randomized control tria, patients having uncomplicated new-onset ascites with no or low-risk esophageal varices were randomized (n = 104) to receive carvedilol (group A, n = 52) or no carvedilol (group B, n = 52) in addition to standard treatment.

TIPS Is Superior to SEMS in the Management of Refractory VARICEAL Bleed in Advanced Cirrhosis Patients (TIPSEMS-VB Trial).

Background: Refractory upper GI bleed is seen in up to 15%-20% of the patients with acute variceal bleed. There are no data comparing the efficacy of oesophageal self-expandable metal stent (SEMS) placement with TIPS in refractory acute variceal bleed in cirrhosis patients.

Patients And Methods: In an open-label randomised controlled trial (RCT), cirrhosis with refractory oesophageal variceal bleed or post-endoscopic variceal band ligation (EVL) ulcer bleed, and who were not controlled by endoscopic endotherapy or rebled after therapy, were randomised to TIPS (n = 20) or SEMS (n = 21) placement.

Addition of midodrine to albumin reduces the incidence of complications of large-volume paracentesis: an RCT comparing midodrine, terlipressin, and albumin.

Background And Aims: Large-volume paracentesis (LVP), a therapeutic procedure for cirrhosis patients with refractory ascites, is associated with paracentesis-induced circulatory dysfunction (PICD). While albumin infusion is known to prevent PICD, it is unknown whether the addition of vasoconstrictors to albumin reduces complications of LVP.

Methods: Cirrhosis patients undergoing LVP for refractory ascites were randomized to receive albumin alone (Gr.

Stereotactic Body Radiation Therapy in Advanced Intrahepatic Cholangiocarcinoma: Real-world Outcomes from an Indian Cohort.

Background: Intrahepatic cholangiocarcinoma (iCCA), the second most common primary liver malignancy, accounts for 3% of gastrointestinal cancers. While surgical resection offers a five-year overall survival (OS) of 25-40%, only 12-30% of cases are resectable. Advanced or metastatic iCCA often necessitates systemic therapy combined with loco-regional treatments such as stereotactic body radiation therapy (SBRT).

Comparison of relaxed verses standard cut-offs of rotational thromboelastometry for guiding blood product use before invasive procedures in advanced cirrhosis: a randomized controlled trial.

Background: The cut-offs of viscoelastic hemostatic assays used for guiding blood products transfusion in patients with cirrhosis undergoing invasive procedures are arbitrary. The aim of this study was to evaluate the efficacy and safety of two different ROTEM thresholds ["relaxed" ROTEM thresholds vs. "conventional" thresholds used in liver transplantation] for prophylactic blood product transfusion for invasive procedures in advanced cirrhosis patients with impaired traditional coagulation.

Predictive Factors and Nomogram (MAP-BNP) for Post Stereotactic Body Radiotherapy Survival in Advanced Hepatocellular Carcinoma Patients.

Background: Stereotactic body radiation therapy (SBRT) is a widely recognized approach for managing hepatocellular carcinoma (HCC), particularly in its advanced stages, with prognosis highly dependent on tumour burden and baseline liver function. This study aimed to develop a predictive model and nomogram that incorporates these factors to improve survival outcomes in advanced HCC patients treated with SBRT and systemic therapy.

Methods: We retrospectively reviewed records of 110 patients with advanced HCC treated with SBRT between May 2020 and April 2023.

Low Hepatitis B vaccination coverage in New Delhi, India: urgent call for Universal Adult Hepatitis B vaccination.

Introduction: Eliminating Hepatitis B by 2030 is achievable through vaccination. However, despite the safety of the Hepatitis B vaccine, vaccination coverage among adults in India is suboptimal.

Methods: From April 2021 to August 2022, a study in New Delhi, India assessed Hepatitis B vaccination status, willingness to be vaccinated, and awareness of vaccination importance among adults.

Predictors of Non-response to Atezolizumab Plus Bevacizumab in Patients With Unresectable Hepatocellular Carcinoma: A Multicentre Real World Study (HCC-AB Study).

Background: The approved immunotherapies for patients with advanced HCC are Atezolizumab and Bevacizumab. However, patients in India present late and healthcare is often available through self-financing. To rationalise the therapy, we conducted a large multicentre study to identify the baseline predictors of non-response to atezolizumab and bevacizumab in advanced unresectable HCC.

Outcomes with radiotherapy in multimodality treatment for hepatocellular carcinoma with portal vein tumour thrombosis.

Objectives: The purpose of the present study was to evaluate outcomes with radiation therapy (RT) in multimodality treatment for inoperable hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT).

Methods: The present retrospective study included 24 patients without extrahepatic metastases. The patients had received drug eluting beads - transarterial chemoembolization (DEB-TACE) ( = 10) and systemic treatment ( = 14) before RT.

Performance evaluation of NeuMoDx 96, a random access system for CMV DNA quantitation.

Cytomegalovirus (CMV) poses a significant risk to immunocompromised individuals, particularly in post-transplant settings, leading to substantial morbidity and occasional mortality. Early and accurate quantification of CMV DNA is essential for timely intervention. This retrospective study evaluated the performance of the NeuMoDx 96 platform, a random-access CMV assay, compared to the COBAS® AmpliPrep/COBAS® TaqMan® CMV assay, a batch testing platform.

Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012.

Perihilar and Intrahepatic Cholangiocarcinoma after Resection: Clinicopathological Characteristics, Outcomes, and Implications for Addition of Chemoradiotherapy.

Background: The purpose of the present study was to evaluate clinicopathological characteristics, patterns of recurrence, survival outcomes, and implications for the addition of chemoradiotherapy for patients with resected perihilar and intrahepatic cholangiocarcinoma (CCA).

Materials And Methods: For the present retrospective study, we identified 38 and 10 patients with resected perihilar and intrahepatic CCA. In perihilar CCA, adjuvant treatment was given as chemotherapy ( = 13) or chemoradiotherapy ( = 10).

Bowel Colonization With Carbapenem-Resistant Bacteria Is Associated With Short-Term Outcomes in Patients With Acute-On-Chronic Liver Failure.

Background: Bowel colonization with antimicrobial-resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute-on-chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem-resistant gram-negative bacteria (CR-GNB) among patients with ACLF affects short-term outcomes.

Methods: Patients of APASL-ACLF (n = 339) were screened between June 2020 and December 2021, and 150 were included.

Derivation of Splenic Stiffness in Subjects with Normal Liver Stiffness and No Vascular Liver Disease Using Transient Elastography with a Spleen-Dedicated Module: A Large Cross Sectional Study.

Background: Liver and splenic stiffness measurements (LSM and SSM) are useful to predict varices and clinical decompensation in cirrhosis. SSM values are highly variable and overlapping and no guidelines exists on what constitutes normal SSM, that might limit interpretation of results.

Methods: Consecutive subjects with LSM < 6 kPa and reliable SSM (FibroScan630 Expert device with spleen-dedicated module) and no vascular liver disease were analysed for significant correlations of SSM values with age, sex, BMI, portal and splenic vein diameter, splenic diameter, liver fat and diabetes.

Granulocyte Colony-Stimulating Factor Improves Prednisolone Responsiveness and 90-Day Survival in Steroid-Eligible Severe Alcohol-Associated Hepatitis: The GPreAH Study a Randomized Trial.

Introduction: Severe alcohol-associated hepatitis (SAH) carries high 1-month mortality. Corticosteroids provide a modest 28-day but not 90-day survival benefit, due to development of infections and organ failures. Granulocyte colony-stimulating factor (GCSF) has shown promise in patients with SAH by its immunomodulatory and regenerative capabilities.

Impact of educational interventions on hepatitis B and C awareness among school students of Delhi NCR, India.

Background: Viral hepatitis, particularly B and C, is a major cause of liver cirrhosis and cancer, leading to about 1.4 million deaths annually. Alarmingly, less than 20% of those with hepatitis are aware of their status, with only 6.

Combination of carvedilol with variceal band ligation in prevention of first variceal bleed in Child-Turcotte-Pugh B and C cirrhosis with high-risk oesophageal varices: the 'CAVARLY TRIAL'.

Objectives: Beta-blockers and endoscopic variceal band ligation (VBL) have been preferred therapies for primary prophylaxis of variceal bleeding. However, the choice of therapy in patients with advanced liver disease with high-risk varices is not clear. A comparison of these therapies alone or in combination to prevent the first variceal bleed in advanced cirrhosis patients was carried out.

Treatment Response and Survival with Chemotherapy for Unresectable, Nonmetastatic Cholangiocarcinoma.

Background And Objectives: Limited studies have dwelt upon the treatment of unresectable, nonmetastatic cholangiocarcinoma as a separate entity. Hence, the management protocols are not clearly defined for this subgroup of patients. We aimed to analyze patients treated for unresectable, nonmetastatic cholangiocarcinoma.

Impact of coagulopathy assessment with thromboelastography and thromboelastometry on transfusion requirements in critically ill cirrhosis with nonvariceal bleeding: A prospective observational study.

Background: Viscoelastic tests are now routinely used for coagulopathy correction in patients with cirrhosis. Thromboelastography (TEG) and rotational thromboelastometry (RoTEM®) are the most widely studied tests in this population. However, they have not been compared with each other in critically ill patients with liver disease presenting with nonvariceal bleed.

Therapeutic plasma exchange provides native liver survival benefit in children with acute liver failure: A propensity score-matched analysis.

Objectives: This study aimed to evaluate the safety and efficacy of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF).

Methods: All children aged 2-18 years with PALF were included. The intervention cohort included a subset of PALF patients undergoing complete three sessions of TPE, whereas the matching controls were derived by propensity score matching from the patient cohort who did not receive any TPE.