Recent treatment advances and practical management of hepatitis D virus.

Hepatitis D virus (HDV), also referred to as hepatitis delta virus, is the smallest virus capable of causing human disease. It is unable to replicate on its own and can only propagate in the presence of hepatitis B virus (HBV). Infection with both HBV and HDV frequently results in more severe disease than HBV alone, with higher instances of cirrhosis, liver failure and hepatocellular carcinoma (HCC). Thus, there is a need for effective treatment for HDV; however, currently approved treatment options are very limited both in terms of their efficacy and availability. This makes the management of HDV a challenge for physicians. In this review, we look at the background, diagnosis and treatment of HDV, informed by our hospital data, to set out the optimal management of HDV; we also explore novel treatment options for this disease.

Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature.

INTRODUCTION: Duodenal neuroendocrine tumours (dNETs) comprise about 2% of all the NETs. Treatment of dNETs involves resection of the tumour either by endoscopic or surgical resection. Surgical or endoscopic local resection of the lesion is usually a more conservative and less morbid option compared with a more radical pancreaticoduodenectomy. However, inadequate clearance by local resection might result in recurrent disease with reduced overall survival. METHODS: The current systematic review compared the differences in outcomes of endoscopic resection (ER), local resection (LR) and pancreaticoduodenectomy (PD) in the management of dNETs. Searches were performed on MEDLINE, PubMed, Embase and Cochrane databases using MeSH keyword combinations: 'duodenal', AND, 'neuroendocrine tumours'. All relevant articles published up to 2016 were included. Post-operative morbidity, R0 resection status and recurrence rates were the outcomes assessed. RESULTS: Eight non-randomised retrospective studies with 335 participants were included (LR = 122; PD = 118; ER = 64). While PD was associated with higher morbidity compared with LR (27/64 vs. 10/74; P = 0.002), PD was associated with a higher incidence of an R0 resection (3/97 vs. 15/97; P = 0.007) as well as lower recurrence rates (3/51 vs. 6/46; P = 0.21). ER was associated with a higher positive resection margin status versus LR (22/51 vs. 14/91; P = 0.0002). Recurrence at follow-up was not different among patients with dNETs who underwent PD versus LR. CONCLUSIONS: Radical surgical resection in the form of PD was associated with higher post-operative morbidity among patients with dNETs yet provided better margin clearance. Patients with dNETs need systematic evaluation with a view to obtain most of the information about the prognostic factors in order to tailor the treatment options.