17^th World Congress on Gastroenterology -Therapeutics & Hepatology July 17-18, 2023 Zurich, Switzerland

Biography:

I have been working in the department of hepatology since 2019. During this short time I have seen patients with various liver pathologies, and patients with idiopathic portal hypertension, remains a separate cohort of patients, outwardly indistinguishable from healthy people, but having colossal changes inside. This patient has been seen in our hospital for a long time, and I myself witnessed his CT picture during that time. After splenectomy we decided to publish this case.

Abstract:

Idiopathic portal hypertension (IPH) is a rare disease characterized by clinical portal hypertension in the absence of a recognizable cause and has a good prognosis, but some cases require liver transplantation. We report the case of a 32-year-old male patient diagnosed with IPH 10 years ago. Clinical signs were splenomegaly, leucothrombocytopenia, and esophageal varices. The histology of the liver biopsy showed portal fibrosis with no evidence of incomplete septal cirrhosis. Due to recurrent episodes of bleeding from esophageal varices, despite band-ligations and performed TIPS procedure, cadaveric liver transplantation was performed 6 years ago. Following liver transplantation, the esophageal varices disappeared but splenomegaly and low blood cells leucothrombocytopenia persisted. The immunosuppression composed of prednisolon, tacrolimus. After 3 years increase in portal vein diameter, which reached over 4 in 2022 with the reccurence of esophageal varices, in December there was a thrombosis of the portal vein, complicated by ascites and bleeding. Anticoagulant therapy for 3 months was unsuccessful. In April 2023, the patient underwent splenectomy. Histopathologically, the liver had obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal cirrhosis. Liver transplantation may be a curative therapy for patients with advanced disease of IPH but the long-term follow-up after transplantation and we need more information on the benefits of one-stage splenectomy during transplantation.

Biography:

Prof. Madacsy was born and raised as 3rd generation in a doctor’s family in Southern Hungary. He pursued his international academic career in GI starting from the University of Szeged, pushing from isotopic procedures towards gastroenterology in Copenhagen, Denmark and after that, invasive endoscopic procedures. Quickly climbing the ladder, he soon became Head of the Internal Medicine Ward with 200 beds in one of Hungary’s biggest county hospitals. His creative mindset and unparalleled thirst for new procedures and experimental medical technologies drove him towards building his own premium, private facility in the last decade, where as CEO and medical director he regularly invests in the best technologies available in the market. He became an associate professor and an unavoidable expert in Europe in ERCP, EUS, invasive endoscopy and magnetic capsule endoscopy. Now he is mainly working on his new visions regarding Artificial Intelligence and robotics for modern medical science.

Abstract:

Introduction: Magnetically controlled capsule endoscopy with robotic guidance is a new non-invasive endoscopic method to evalute the upper Gi tract. Our aim was to compare the Ankon magnetically controlled capsule endoscopy system (MCCE) and traditional gastroscopy in the evaluation of gastric disorders in outpatients who underwent both examinations on the same day. Methods: Between August 2018 and October 2022, consecutive outpatients were enrolled to study who underwent MCCE and was referred to traditional gastroscopy and biopsies due to the found pathologies on capsule endoscopy. UBT test was done just before MCCE. Results: Overall 62 outpatients (36 male, 26 female, 45 years old in average) underwent gastroscopy and MCCE on the same day in our Endoscopy Unit. MCCE revealed no pathologies in 11 patients. By MCCE, focal lesions were found in overall 15 patients (1 gastric polyp, 5 erosions, 3 ulcer, 6 foveolar hyperplasia) and gastritis were described in overall 50 patients (39 distal gastritis, 10 pangastritis, 1 other gastritis). By gastroscopy, focal lesions were found in 8 cases (1 polyp, 4 erosions, 3 ulcers, 3 foveolar hyperplasia) and gastritis were found in 61 patients (51 lower, 9 pangastritis, 1 other gastritis). Gastroscopy was negative in 2 patients. Regarding focal lesions, the gastric polyp, 3 foveolar hyperplasias and 3 gastric ulcers were visualised by both endoscopy techniques, from the 2 out of the 4 gastric erosions were visualised both techniques. Conclusions: MCCE is an effective and safe diagnostic method to evaluate upper GI mucosal lesions, and it is a usefull non-invasive diagnostic method to evaluate gastric mucosa and it can be the future screening tool to decrease morbidity and mortality of upper GI disorders.

Biography:

Dr. Yury Marakhouski. approved as Professor of Clinical Medicine in 2005 year by the Higher Certification Commission of the Council of Ministers of the Republic of Belarus.  He is head of the Department Gastroenterology and Nutrition of the Byelorussian Medical Academy of Postgraduate Education. He has published more than 30 papers in reputed journals and serving as a member of the editorial board of several reputed journals (predominantly in Russia and Belarus). His Current Position is Head of Department of Gastroenterology and Nutrition, Byelorussian Medical Academy Postgraduate Education (BelMAPE).He is principal investigator on numerous clinical (18) and preclinical (6) studies and has been involved in the study of many medication including mesalazine, amino acids, anti-TNF.

Abstract:

Liver steatosis is a highly common pathology in the population, in many countries. It is significant practical importance in such situation, to identify individuals with the steatosis possible presence.

Aims. To identify bioimpedancemetries indicators that increase the degree of confidence in the presence liver steatosis and fibrosis in practically healthy individuals and those with hepatomegaly.

Methods. All study participants in this prospective study were Caucasian. 20 practically healthy persons with chronological age (Chr-age) = mean 40.4 (95% CI=30.8-49.9), median 39 (Q25/75=28-51). M/F = 6/20 (30.0%/70.0%), and 31 patients with hepatomegaly referred for transient elastography (FibroTouch in iLivtouch FT 100). Steatosis(S) and Fibrosis (F) was measured in each patient according to the manufacturer's recommendations. Steatosis and fibrosis staging sections recommended by the manufacturer were used. Additionally, each participant underwent bioimpedancemetry (BIM) (tetrapolar, multifrequency and vector analysis) with the determination of body mass composition. Proper parameter reference values are calculated based on previous studies by centile tables of sex and age variability of traits according to health centers for 2010-2012. (n=819808, age 5-85) and each patient assessment according to the manufacturer's recommendations as due and in actual. The methabolic age (Met-age) was determined with BIM, based on 40 parameters. Feature of the used BIM method is the calculation of the due indicator for the differentiation between Met-age and Chr-age(Age-diff). All subjects are randomly selected without examination and immediately tested by transient elastography and BIM.  Statistical analyzes performed with chi-square and t-test (p <0.05).

Results.

Practically healthy persons. S- median = 276,0 dB/m (Q25/75=250,0-324,0); F - median = 6,1kPa (Q25/75=5,7-6,4). As follows from the presented data, there is not fibrosis(F=0) in group, but there is moderate steatosis (S=2). Analysis of individual values: only 6 people (30% at 95% CI = 11.9 - 54.3) did not have steatosis and Controlled attenuation parameter in decibels per meter (CAP) equal to or less than 244 dB/m. Severe steatosis was found in 9 people (45% at 95% CI = 23.1 - 68.5), the CAP index was more than 296 dB/m. Age-diff on 2 years was found in the subgroup with severe steatosis(S=3) in 88,9% (8 of 9)(95%CI= 51,8 – 99,7) and in 1 of 11 individuals with mild steatosis (S0+S1): 9,1% at 95%CI= 0,2 – 41,3. Single Binary Sample Diagnostic Test (for Age Diff): sensitivity- 86% (95%CI= 49 – 97); specificity-83% (95%CI= 44 – 97); Likelihood ratio for positive test  = 5,14 (95% C.I. = 1,34 – 87,52); for negative test  = 0,17% (95% C.I. = 0,05 – 0,71).

Persons with hepatomegaly. S- median = 313,5 dB/m (Q25/75=260,0-352,0); F - median = 8,8 kPa (Q25/75=7,0-12,9). As follows from the presented data, there is fibrosis (from F1 to F2-3) in group, and there is severe steatosis (S=3). Analysis of individual values: only 5 people (15,6% at 95% CI = 5,3 - 32.8) did not have steatosis, CAP equal to or less than 244 dB/m). Severe steatosis was found in 18 people (56,3% at 95% CI = 37.7 – 73,6), the CAP index was more than 296 dB/m. In 11 persons (35,5% (95%CI =19,2-54,6) indicated fibrosis F3-4 (more than 12 kPa), from its 3 persons have cirrhosis (F4, more than 18 kPa).  Cut-off value of 6.0 in the Age-diff in order to establish the threat of fibrosis in individuals with hepatomegaly. Exposed to risk factor: 46.15% (calculated). Odds Ratio (cases/controls) = 19.80 ([reciprocal = 0.05), Fisher's exact confidence intervals: 95%:  1.67 - 944.21. Sensitivity = 81.25% (95% C.I. = 56.99 - 93.41%). Specificity = 80.00% (95% C.I. = 54.81% - 92.95%). Likelihood ratio:  for positive test  = 4.06 (95% C.I. = 1.44 - 11.48); for negative test  = 0.23 (95% C.I. = 0.08 - 0.67).

Conclusion

Presented the possibility using a new Non-Invasive Technology that Increases Confidence in Suspicion of Liver Steatosis and Fibrosis. More alder metabolic ages can predict the presence of steatosis in practically healthy individuals and steatosis with fibrosis in individuals with hepatomegaly and it has been shown for the first time.