Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

AIM To evaluate the reversibility of minimal hepatic encephalopathy(MHE) following liver transplantation(LT) in Egyptian cirrhotic patients. METHODS This prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty ageand sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A(TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score(PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTS Before LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls(P < 0.001). There was a statistically significant improvement in test values in the patient group after LT; however, their values were still significantly worse than those of the controls(P < 0.001). The PHES detected MHE in 16 patients(80%) before LT with a median value of -7 ± 3.5. The median PHES value was significantly improved following LT, reaching-4.5 ± 5(P < 0.001), and the number of patients with MHE decreased to 11(55%). The pre-transplant model for end-stage liver disease(MELD) score ≥ 15 was significantly related to the presence of post-transplant MHE(P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score < 15.CONCLUSION Reversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score < 15.

N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices. METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I(n-butyl-2-cyanoacrylate; Histoacryl), Group II(iso-amyl-2-cyanoacrylate; Amcrylate) and Group III(mixture of 72% chromated glycerin; Scleremo with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo. RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference,(P < 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference,(P > 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments. CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.