Hepatocellular carcinoma in South America: Evaluation of risk factors, demographics and therapy.

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Most studies addressing the epidemiology of HCC originate from developed countries. This study reports the preliminary findings of a multinational approach to characterize HCC in South America. METHODS: We evaluated 1336 HCC patients seen at 14 centres in six South American countries using a retrospective study design with participating centres completing a template chart of patient characteristics. The diagnosis of HCC was made radiographically or histologically for all cases according to institutional standards. Methodology of surveillance for each centre was following AASLD or EASL recommendations. RESULTS: Sixty-eight percent of individuals were male with a median age of 64 years at time of diagnosis. The most common risk factor for HCC was hepatitis C infection (HCV, 48%), followed by alcoholic cirrhosis (22%), Hepatitis B infection (HBV, 14%) and NAFLD (9%). We found that among individuals with HBV-related HCC, 38% were diagnosed before age 50. The most commonly provided therapy was transarterial chemoembolization (35% of HCCs) with few individuals being considered for liver transplant (<20%). Only 47% of HCCs were diagnosed during surveillance, and there was no difference in age of diagnosis between those diagnosed incidentally vs by surveillance. Nonetheless, being diagnosed during surveillance was associated with improved overall survival (P = .01). CONCLUSIONS: Our study represents the largest cohort to date reporting characteristics and outcomes of HCC across South America. We found an important number of HCCs diagnosed outside of surveillance programmes, with associated increased mortality in those patients.

Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography.

Selective biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) is required to perform all therapeutic biliary procedures. Despite major advances in imaging, guidewires and sphincterotome catheter designs, the success rate for biliary cannulation by experienced endoscopists during ERCP is approximately 85% when standard cannulation techniques are applied. Precut sphincterotomy, also known as access sphincterotomy, is performed when standard techniques fail to achieve selective biliary cannulation. Precut sphincterotomy significantly increases the rate of biliary cannulation up to 98%. However, precut sphincterotomy has traditionally been considered a risk factor for adverse events following ERCP, especially concerning is post-ERCP pancreatitis which results in significant morbidity and financial burden. Recent evidence suggests that precut sphincterotomy alone may not be a risk factor for pancreatitis; rather repeated attempts ( ≥ 10) at biliary cannulation prior to precut sphincterotomy may be the actual cause of post-ERCP pancreatitis. In this paper, we review the different variations of the precut sphincterotomy technique and their corresponding rates of success and adverse events.