Characterizing Hepatitis Delta in Spain and the gaps in its management.

BACKGROUND AND AIMS: Chronic hepatitis D (CHD) is a severe form of chronic viral hepatitis. The estimated HDV prevalence in Spain is around 5% of patients with hepatitis B. Reimbursement of new antiviral therapies (Bulevirtide, BLV) was delayed in our country until February 2024. We aimed to characterize the clinical profile of patients with HDV/HBV infection in Spain and current barriers in their management at the time of BLV approval. METHOD: Multicenter registry including patients with positive anti-HDV serology actively monitored in 30 Spanish centers. Epidemiological, clinical and virological variables were recorded at the start of follow-up and at the last visit. RESULTS: We identified 329 anti-HDV patients, 41% were female with median age 51 years. The most common geographical origin was Spain (53%) and East Europe (24%). Patients from Spain were older and had HCV and HIV coinfection probably associated to past drug injection (p<0.01). HDV-RNA was positive in 138 of 221 assessed (62%). Liver cirrhosis was present at diagnosis in 33% and it was more frequent among viremic patients (58% vs 25%, p<0.01). After a median follow-up of 6 (3-12) years, 44 (16%) resolved infection (18 spontaneously and 26 after Peg-INF). An additional 10% of patients developed cirrhosis (n=137) during follow-up (45% had portal hypertension and 14% liver decompensation). Liver disease progression was associated to persisting viremia. CONCLUSION: One-third of the patients with CHD already have cirrhosis at diagnosis. Persistence of positive viremia is associated to rapid liver disease progression. Importantly, barriers to locally determine/quantify HDV-RNA were present.

Inserción endoscópica de prótesis metálicas autoexpandibles en obstrucciones tumorales del colon / Endoscopic insertion of self-expanding metal stents in malignant colonic obstructions

Antecedentes y objetivo: Las prótesis metálicas autoexpandibles se están utilizando, cada vez con más frecuencia, para resolver la obstrucción colónica tumoral. Después, los pacientes pueden intervenirse de forma electiva o bien, en casos no aptos para la cirugía, la prótesis sirve como tratamiento paliativo definitivo. Presentamos la experiencia de esta técnica en un hospital de nivel II del Sistema Nacional de Salud. Pacientes y métodos: Estudio retrospectivo de un período de 42 meses (desde mayo de 2002 hasta octubre de 2005), durante el cual se trató de resolver la obstrucción colónica en 43 ocasiones a 40 pacientes, mediante la inserción endoscópica de prótesis. Resultados: La inserción fue técnicamente posible en 41 intentos (95%) y se obtuvo un buen resultado clínico en 37 ocasiones (86%). Se utilizó sólo endoscopia 23 veces (53,5%), y en las otras 20 (46,5%) también fluoroscopia. De los 38 pacientes en que se obtuvo un buen resultado con la inserción, 34 lograron un éxito clínico total. Se intervino de forma electiva a 24 (63%) pacientes y la prótesis se consideró un tratamiento paliativo definitivo en 14 (37%). Hubo que intervenir finalmente a uno de estos pacientes por una fístula colovesical. Además de esta complicación, hubo otras 8: 3 prótesis migraron, una se obstruyó, 2 pacientes tuvieron tenesmo, otro presentó una bacteriemia tras la inserción, y se descubrió una perforación silente por la prótesis en una cirugía electiva. No hubo mortalidad derivada de las complica ciones. Conclusiones: En nuestra experiencia, la inserción endoscópica de prótesis parece un método seguro y eficaz en el tratamiento inicial de la obstrucción colónica tumoral

Background and objective: Self-expanding metal stents are being increasingly used to resolve malignant colonic obstruction. Subsequently, patients can either undergo elective surgery, or the stent can serve as a definitive palliative treatment in patients unfit for surgery. We present our experience with this technique in our hospital, a level II center within the Spanish National Health Service, which can be considered a community hospital. Patients and methods: A retrospective study was performed of a 42-month period (May 2002 to October 2005), during which malignant colonic obstruction was treated by means of endoscopically inserted stents on 43 occasions in 40 patients. Results: Stent insertion was successfully performed in 41 attempts (95%) and good clinical results were obtained on 37 occasions (86%). Endoscopic means alone were used on 23 occasions (53.5%) and in the remaining 20 (46.5%), both endoscopy and fluoroscopy were employed. Of 38 patients with successfully inserted stents, clinical success was achieved, as a whole, in 34. Twenty-four of these patients (63%) subsequently underwent elective surgery while the stent served as a definitive palliative treatment in the remaining 14 (37%). One of these patients had to undergo further surgery due to a fistula between the colon and the bladder. There were eight other complications: three stent migrations and one stent obstruction occurred, two patients had tenesmus, one patient developed bacteremia after stent insertion, and a silent bowel perforation by the stent was found in an elective surgical procedure. There was no mortality. Conclusions: In our experience, endoscopically inserted stents seem to be a safe and effective method for the initial treatment of malignant colonic obstruction

[Endoscopic insertion of self-expanding metal stents in malignant colonic obstructions]. / Inserción endoscópica de prótesis metálicas autoexpandibles en obstrucciones tumorales del colon.

BACKGROUND AND OBJECTIVE: Self-expanding metal stents are being increasingly used to resolve malignant colonic obstruction. Subsequently, patients can either undergo elective surgery, or the stent can serve as a definitive palliative treatment in patients unfit for surgery. We present our experience with this technique in our hospital, a level II center within the Spanish National Health Service, which can be considered a community hospital. PATIENTS AND METHODS: A retrospective study was performed of a 42-month period (May 2002 to October 2005), during which malignant colonic obstruction was treated by means of endoscopically inserted stents on 43 occasions in 40 patients. RESULTS: Stent insertion was successfully performed in 41 attempts (95%) and good clinical results were obtained on 37 occasions (86%). Endoscopic means alone were used on 23 occasions (53.5%) and in the remaining 20 (46.5%), both endoscopy and fluoroscopy were employed. Of 38 patients with successfully inserted stents, clinical success was achieved, as a whole, in 34. Twenty-four of these patients (63%) subsequently underwent elective surgery while the stent served as a definitive palliative treatment in the remaining 14 (37%). One of these patients had to undergo further surgery due to a fistula between the colon and the bladder. There were eight other complications: three stent migrations and one stent obstruction occurred, two patients had tenesmus, one patient developed bacteremia after stent insertion, and a silent bowel perforation by the stent was found in an elective surgical procedure. There was no mortality. CONCLUSIONS: In our experience, endoscopically inserted stents seem to be a safe and effective method for the initial treatment of malignant colonic obstruction.