Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases:A systematic review and meta-analysis

BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Non-pulmonary involvement in COVID-19:A systemic disease rather than a pure respiratory infection

During the early phase of the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),diagnosis was difficult due to the diversity in symptoms and imaging findings and the variability of disease presentation.Pulmonary manifestations are reportedly the main clinical presentations of COVID-19 patients.Scientists are working hard on a myriad of clinical,epidemiological,and biological aspects to better understand SARS-CoV-2 infection,aiming to mitigate the ongoing disaster.Many reports have documented the involvement of various body systems and organs apart from the respiratory tract including the gastrointestinal,liver,immune system,renal,and neurological systems.Such involvement will result in diverse presentations related to effects on these systems.Other presentations such as coagulation defects and cutaneous manifestation may also occur.Patients with specific comorbidities including obesity,diabetes,and hypertension have increased morbidity and mortality risks with COVID-19.

Low Serum Free Triiodothyronine Is Associated with Increased Risk of Decompensation and Hepatocellular Carcinoma Development in Patients with Liver Cirrhosis

Background: FT3 levels in plasma may provide a marker for liver status in cirrhosis. Aim: The aim is to correlate thyroid functions with hepatic status in compensated and decompensated cirrhosis, and to study their effect on development of HCC. Settings and Design: Prospective controlled cohort study. A total of 58 patients with liver cirrhosis were recruited from Kasr AlAiny ER and outpatient clinics. Patients were categorised into compensated (11), decompensated (39) and patients with hepatocellular carcinoma (8). The study also included 12 healthy controls. Methods and Material: Liver function tests, TSH, FT4 and FT3 and abdominal ultrasound and triphasic computed tomography abdominal scans were done. Statistical Analysis Used: Chi-square and unpaired t-tests were used for comparison. One way ANOVA and Kruskal Wallis tests were used to compare more than two groups. Spearman Correlation followed by logistic regression analysis of significant variables was used to find predictors of dependent variables. Results: The frequency of patients with low FT3 was significantly higher in patients with liver cirrhosis (48%), and HCC (50%) than control subjects (12%) (p-value < 0.001). Mean serum FT3 was lowest among decompensated patients (2 pg/ml ± 0.7), followed by patients with HCC (2.5 pg/ml ± 0.7) and highest among compensated patients (3.7 pg/ml ± 0.4), p-value < 0.001. Logistic regression analysis showed that low FT3, male gender, ulcer bleeding and encephalopathy were independently associated with the development of HCC (OR, 95% CI: 1.1, 0.3 - 8). Conclusions: Low FT3 is common among patients with decompensated liver cirrhosis and HCC. FT3 shows a significant negative correlation with severity of liver disease and deterioration of liver function. Low FT3 shows a significant independent association with HCC.

Cystic pancreatic lesions,the endless dilemma

Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions.The proper diagnosis,differentiation,and staging of these cystic lesions are considered a crucial issue in planning further management.There are great challenges for their diagnostic models.In our time,new emerging methods for this diagnosis have been discovered.Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needlebased confocal laser endomicroscopy,through the needle microforceps biopsy,and single-operator cho-langioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions.Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.

Barriers for resuming endoscopy service in the context of COVID-19 pandemic:A multicenter survey from Egypt

BACKGROUND The current coronavirus disease 2019(COVID-19)pandemic has affected routine endoscopy service across the gastroenterology community.This led to the suspension of service provision for elective cases.AIM To assess the potential barriers for resuming the endoscopy service in Egypt.METHODS A national online survey,four domains,was disseminated over a period of 4 wk in August 2020.The primary outcome of the survey was to determine the impact of the COVID-19 pandemic on the endoscopy service and barriers to the full resumption of a disabled center(s).RESULTS A hundred and thirteen Egyptian endoscopy centers participated in the survey.The waiting list was increased by≥50% in 44.9% of areas with clusters of COVID-19 cases(n=49)and in 35.5% of areas with sporadic cases(n=62).Thirty nine(34.8%)centers suffered from staff shortage,which was considered a barrier against service resumption by 86.4% of centers in per-protocol analysis.In multivariate analysis,the burden of cases in the unit locality,staff shortage/recovery and the availability of separate designated rooms for COVID-19 cases could markedly affect the resumption of endoscopy practice(P=0.029,<0.001 and 0.02,respectively)and Odd’s ratio(0.15,1.8 and 0.16,respectively).CONCLUSION The COVID-19 pandemic has led to restrictions in endoscopic volumes.The staff shortage/recovery and the availability of COVID-19 designed rooms are the most important barriers against recovery.Increasing working hours and dividing endoscopy staff into teams may help to overcome the current situation.

Metabolic aspects of hepatitis C virus

Many metabolic factors are associated with chronic hepatitis C virus(HCV)infection and can influence the course of the illness and impact the progression of liver and non-liver-related diseases through complex interactions.Several of these factors impact the course of chronic HCV(CHC)and result in the conceptual translation of CHC from a localized to systemic disease.Besides the traditional liver manifestations associated with CHC infection,such as cirrhosis and hepatocellular carcinoma,various extrahepatic disorders are associated with HCV infection,including atherosclerosis,glucose and lipid metabolic disturbances,alterations in the iron metabolic pathways,and lymphoproliferative diseases.The coexistence of metabolic disorders and CHC is known to influence the chronicity and virulence of HCV and accelerates the progression to liver fibrosis and hepatocellular carcinoma.Insulin resistance is one of the key factors that have a tremendous metabolic impact on CHC.Therefore,there is a great need to properly evaluate patients with CHC infection and correct the modifiable metabolic risk factors.Furthermore,patients with HCV who achieved a sustained virological response showed an overall improvement in glucose metabolism,but the exact evidence still requires further studies with long-term follow-up.This review delineates the most recent evidence on the main metabolic factors associated with CHC and the possible influence of chronic HCV infection on metabolic features.