Clinical characteristics of liver transplant recipients with COVID-19 and analysis of risk factors for the severe disease.

INTRODUCTION: Liver transplant (LT) recipients were at a high risk of infection during the coronavirus disease 2019 (COVID-19) pandemic. Our purpose was to compare the clinical characteristics of severe and non-severe groups of LT recipients with COVID-19, and to analyze their risk factors for severe disease. METHODOLOGY: 79 LT recipients with COVID-19 were divided into a non-severe group (n = 60) and a severe group (n = 19), and differences in clinical characteristics, laboratory tests, and chest computed tomography (CT) performance were analyzed. Logistic regression was used to identify risk factors with severe COVID-19. Receiver operating characteristic (ROC) curves were plotted and the area under curve (AUC) values were calculated to assess the predictive value for severe COVID-19. RESULTS: Age was statistically different (p < 0.001) between the two groups. The difference in neutrophil-to-lymphocyte ratio (NLR), serum creatinine (Scr), D-dimer, urea, C-reactive protein (CRP), lactate dehydrogenase (LDH), and the number of lung segments involved in inflammation between the two groups were statistically significant (p < 0.05). The results revealed that age (OR = 1.255, 95% CI 1.079-1.460), NLR (OR = 1.172, 95% CI 1.019-1.348), and Scr (OR = 1.041, 95% CI 1.016-1.066) were independent risk factors for severe COVID-19. The ROC results showed that high values for age, NLR and Scr predicted severe COVID-19, with AUC values of 0.775, 0.841 and 0.820, respectively, and 0.925 for the three factors combined. CONCLUSIONS: Advanced age, and elevated NLR and Scr are independent risk factors for severe COVID-19 in LT recipients.

Efficacy and safety of EUS-guided coil embolization in combination with cyanoacrylate injection versus conventional endoscopic cyanoacrylate injection in the treatment of gastric varices with spontaneous portosystemic shunts.

Background: Gastric varices (GV) with spontaneous portosystemic shunts (SPSS) pose considerable risks and challenges for administering endoscopic cyanoacrylate (CYA) injection. This study aimed to evaluate the efficacy and safety of EUS-guided coil embolization in combination with CYA injection compared to conventional endoscopic CYA injection for managing GV with SPSS. Methods: This retrospective analysis included patients with SPSS treated with either EUS-guided coil embolization in combination with CYA injection or conventional CYA injection for gastric variceal bleeding at Ningbo Medical Center Lihuili Hospital (Zhejiang, China) between January 2018 and March 2023. Patient demographics, procedural details, and follow-up results were reviewed. Results: The study evaluated 57 patients: 21 in the combined treatment group undergoing EUS-guided coil embolization in combination with CYA injection and 36 in the conventional group receiving conventional endoscopic CYA injection. Both cohorts achieved a 100% technical success rate. The mean volume of CYA used was significantly lower in the combined group (1.64 ± 0.67 mL) than in the conventional group (2.38 ± 0.72 mL; P < 0.001). Early GV rebleeding rates did not differ significantly between the groups; in contrast, the combined treatment group exhibited a considerably lower incidence of late GV rebleeding than the conventional group (4.8% vs 27.8%, P = 0.041). Conclusions: EUS-guided coil embolization in combination with CYA injection demonstrated superiority over conventional endoscopic CYA injection in reducing late GV rebleeding in treating GV with SPSS.

Efficacy and safety of precutting endoscopic mucosal resection versus endoscopic submucosal dissection for non-ampullary superficial duodenal lesions.

BACKGROUND: Endoscopic treatments for non-ampullary superficial duodenal lesions (NASDLs) are yet to be standardized. Endoscopic submucosal dissection (ESD) for NASDLs demands advanced techniques and a long procedure time to prevent perforation and bleeding. Precutting endoscopic mucosal resection (EMR) is a technical modification of ESD that overcomes the limitations of ESD. This study aimed to compare the efficacy and safety of precutting EMR versus ESD for NASDLs. METHODS: We conducted a retrospective analysis of patients with NASDLs treated with either precutting EMR or ESD from January 2015 to March 2023. RESULTS: A total of 90 patients with NASDLs were analyzed, with 44 patients in the precutting EMR group and 46 patients in the ESD group. The endoscopic procedure achieved satisfactory outcomes in both groups, with en block resection rate of 100.0 %. The R0 resection rates in the precutting EMR and ESD groups were 95.5 % and 93.5 %, respectively. No delayed perforation occurred postoperatively in either group. There were no significant differences between the two groups in age, gender, lesion location, layer of lesion origin, macroscopic type, and lesion size. The procedure time was significantly shorter in the precutting EMR group than in the ESD group (22.9 ± 7.1 min vs 36.0 ± 10.6 min, p<0.001). The intraoperative perforation rate was significantly lower in the precutting EMR group compared to ESD group (4.5% vs 19.6 %, p = 0.030). CONCLUSIONS: Precutting EMR is comparable to ESD for NASDLs, demonstrating a lower intraoperative perforation rate and shorter procedure time compared to ESD.

Predictive Value of Spectral Computed Tomography Parameters in Esophageal Variceal Rupture and Bleeding in Cirrhosis.

BACKGROUND: To evaluate the value of the spectral CT parameters in predicting the risk of esophageal variceal bleeding in cirrhosis with portal hypertension and to provide a reference for clinical diagnosis and treatment. METHODS: Seventy-eight patients were divided into an esophageal variceal bleeding group and a non- esophageal variceal bleeding group. A comparison of variables including age, gender, platelet count, Child-Pugh classification, and spectral parameters between the 2 groups was done. Baseline model and spectral model were constructed with conventional parameters and conventional parameters coupled with spectral parameters, respectively. The 2 models were analyzed by the Receiver Operating Characteristic (ROC) curve. RESULTS: The baseline model was established based on 4 conventional parameters and evaluated by ROC curve analysis. The spectral model was constructed based on the variables in the baseline combined with normalized iodine density in the liver parenchyma for the arterial phase, normalized iodine density in the liver parenchyma for the portal phase, normalized iodine density in the splenic parenchyma for the portal phase, diameter of the main portal vein, diameter of the splenic vein, and normalized iodine density of the left gastric vein. Normalized iodine density of the left gastric vein, normalized iodine density in the liver parenchyma for the portal phase, and Child-Pugh classification were the influencing factors of esophageal variceal bleeding in cirrhosis patients. The Area Under Curve (AUC) for the baseline and spectral models were compared (0.664 vs. 0.860) and the difference was found to be statistically significant (P < .001). CONCLUSIONS: The use of spectral CT parameters in consort with the conventional parameters can improve the diagnostic effectiveness of esophageal variceal bleeding in cirrhosis cases and screen for high-risk esophageal variceal bleeding patients. It may also provide an objective basis for the clinical prevention and treatment of esophageal variceal bleeding.