The Prognostic Value Of The ART Score Before The Second Transarterial Chemoembolization.

The transarterial chemoembolization (TACE) is a firstline therapeutic option for advanced hepatocellular carcinoma (HCC). Their indications are clearly defined by learned societies but the challenge is to determine the optimal number of TACE sessions that will benefit patients before switching to other therapies. For this reason, the Assessment for Retreatment with Transarterial chemoembolization (ART) score has been developed. The objective of our work is to show the prognostic value of the ART score before the second TACE. METHODS: This is a retrospective and prospective study of patients with hepatocellular carcinoma on cirrhosis liver who received a TACE between January 2012 to July 2019. The diagnosis of HCC was made according to the non-invasive criteria of EASL with the use of histology for doubtful cases. The ART score was calculated after the first chemoembolization. Patients were divided into 2groups: group A with an ART score between 0 and 1.5 and group B with a score =2.5. RESULTS: During the study period, 58 patients with HCC on cirrhosis liver received a TACE: 55.17% had an ART score between 0 - 1.5 before the second session and 44.8% had an ART score =2,5. Both groups were comparable regarding age, circumstances of discovery and Child's score. The size of the HCC as well as the value of the AFP was further increased in the group B. We observed a significant difference in the radiological response, the Child score and aspartate transaminase rate between the two groups after the first TACE. The overall survival rate at 3 years was 81% in group A versus 19% in group B. CONCLUSION: The ART score has an independent prognostic value and should be taken into account in the therapeutic strategy before the second TACE.

Esophageal variceal ligation in the secondary prevention of variceal bleeding: Result of long term follow-up.

INTRODUCTION: Long-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco. METHODS: Over 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months. RESULTS: One hundred twenty five patients were followed up for a mean of 31 months (range 12-107 months). Obliteration of the varices was achieved in 89.6 % (N = 112) of patients, with 3 +/-1.99 (range 1-8) endoscopy sessions over a period of 14 + /-6.8 weeks (range 3-28). The percentage of variceal recurrence during follow-up after ligation was 20.5 % (N = 23). Recurrence were observed in a mean of 22 months +/- 7.3 (range 3-48). Bleeding rate from recurrent varices was 30.4 % (7/23). Rebleeding from esophageal ulcers occurred in 5.6 % (7/125) of patients. Portal hypertensive gastropathy before and after eradication of varices was 17.6% (N = 22) and 44.6% (N = 50) respectively; p< 0.05. Fundal gastric varices was 30.4% (N = 38) and 35.7% (N = 40) before and after eradication of varices respectively; p> 0.05. The overall mortality was 4 % (N = 5). CONCLUSION: Band ligation was an effective technical approach for variceal obliteration with low rates of variceal recurrence, rebleeding and development of gastric varices. Furthermore, it was associated with frequent development of portal hypertensive gastropathy.

Esophageal variceal ligation for hemostasis of acute variceal bleeding: efficacy and safety.

INTRODUCTION: Endoscopic variceal ligation is widely accepted as the optimum endoscopic treatment for esophageal variceal hemorrhage. In Morocco, there are no data regarding the efficacy of this technique. Our aim was to evaluate the effectiveness and safety of endoscopic variceal ligation in the management of oesophageal variceal bleeding in cirrhosis in a located population in Morocco. METHODS: Via a retrospective study over 118 months (December 2001- October 2011), cirrhotic patients with endoscopically proven esophageal variceal hemorrhage were treated by endoscopic variceal ligation. We studied the rate of haemostasis, rebleeding, complications and mortality. RESULTS: 360 cirrhotic patients were included and 378 haemostatic variceal ligations were performed. Primary haemostasis was obtained in 96.5 % (N=365) of cases. Thirty three patients (8.7%) bled during follow-up. The rate of minor complications was 15.3 % (N=58). Retrosternal pain, fever, dysphagia and Overtube's migration developed in 8.4 % (N=32); 2.6 % (N=10); 3,7 % (N=14) and 0.5 % (N=2) of the patients respectively. Severity of these complications was mild and transient. The rate of oesophageal ulcers was 5 % (N=19), while the mortality rate by haemorrhage was 5 % (N=18). CONCLUSION: Our data showed that band ligation is an effective and safe treatment modality of esophageal variceal bleeding with low rates of rebleeding and complications.