The edition · Gastroenterology & Hepatology
Acetic acid chromoendoscopy found more suspicious areas in Barrett's, but no more neoplasia
A Dutch community trial tests a cheap surveillance add-on and finds it wanting, dual checkpoint therapy is tried in the HCC patients trials usually exclude, and heart muscle mass predicts outcomes in children with cirrhosis.
The edition in brief
The ACID-trial (BMJ, 21 October), a stepped-wedge cluster randomised trial in 18 Dutch community hospitals with 2267 patients under Barrett's surveillance, found acetic acid chromoendoscopy did not raise the neoplasia detection rate (7.4% vs 7.1%; OR 0.97). It doubled the number of suspicious areas found (14.0% vs 6.4%) without more neoplasia in targeted biopsies. SIERRA (Journal of Hepatology, 6 October), a single-arm phase 3b study, gave tremelimumab plus durvalumab to 111 people with unresectable hepatocellular carcinoma and poor prognostic features: Child-Pugh B7 or B8, performance status 2, or main portal vein thrombosis. Grade 3 or 4 treatment-related adverse events occurred in about 20% within six months, and objective response was 14%, lowest in Child-Pugh B. In 226 children with cirrhosis listed for transplant (Journal of Hepatology, 12 October), a quarter had left ventricular hypertrophy, and left ventricular mass index predicted waitlist decompensation, post-transplant complications and death, adding to PELD/MELD. The pearl covers the first steps in suspected variceal bleeding.
Dual checkpoint therapy in poor-prognosis liver cancer: tolerable, with modest responses
Dual checkpoint therapy is tolerable in poor-prognosis liver cancer, but responses in Child-Pugh B are infrequent.
Left ventricular mass predicted outcomes in children with cirrhosis awaiting transplant
In children with cirrhosis awaiting transplant, raised left ventricular mass flags higher risk; record it on the echo.
Suspected variceal bleed: vasoactive drug and antibiotic before the scope
In cirrhosis with GI bleeding, give a vasoactive drug and antibiotics early and transfuse restrictively.
Acetic acid chromoendoscopy did not improve neoplasia detection in Barrett's surveillance
In routine Barrett's surveillance, acetic acid did not find more neoplasia; keep to careful inspection and protocol biopsies.
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