BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events ...BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.展开更多
Hepatitis C virus(HCV)infection has a worldwide incidence of 1.1%.In Italy,60%of people who inject drugs(PWIDs)and are receiving assistance for substance use disorder are infected with HCV.However,this subset of patie...Hepatitis C virus(HCV)infection has a worldwide incidence of 1.1%.In Italy,60%of people who inject drugs(PWIDs)and are receiving assistance for substance use disorder are infected with HCV.However,this subset of patients has extremely limited access to care due to multiple factors,including alcohol abuse,psychological comorbidities,and homeless status.AIM To describe the impact of our HCV-dedicated service for substance use disorder(SSUD)service on PWIDs receiving anti-HCV therapy.METHODS A dedicated,multidisciplinary team was set up at the SSUD of Trento in October 2020 to provide antiviral treatment to HCV RiboNucleic Acid-positive patients with an active or previous history of substance abuse.The treatment was followed by a health education program.Patients were treated with Direct-Acting Antivirals(DAAs).Data were retrospectively analyzed to assess the efficacy of our dedicated program in terms of therapy completion,HCV eradication,and compliance(primary endpoint).The rate of HCV reinfection and DAA-related toxicity were also assessed(secondary endpoints).RESULTS A total of 40 patients were enrolled in the study:28(70.0%)were treated with Sofosbuvir/Velpatasvir,while 12(30.0%)received Glecaprevir/Pibrentasvir.At the time of inclusion in the study,36 patients were receiving opioid agonist maintenance therapy,whilst another 4 had just finished the treatment.37.5%had a history of alcoholism and 42.5%received concomitant psychiatric treatment.All 40 patients(100.0%)completed the therapy cycle and 92.5%of patients adhered to the program.All patients tested negative for viral load at the end of the treatment.There were no significant drug interactions with common psychiatric treatments and no side effects were observed.The sustained virological response was achieved in 92.5%of cases with good tolerability,although two patients discontinued treatment temporarily.After HCV eradication,one patient died from an overdose,another from complications of cirrhosis,and one reinfection occurred.CONCLUSION Very high adherence to therapy and good tolerability was observed in our series of HCV patients treated at the SSUD,regardless of the substance abuse condition.Further validation in a larger population is required.展开更多
文摘BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.
文摘Hepatitis C virus(HCV)infection has a worldwide incidence of 1.1%.In Italy,60%of people who inject drugs(PWIDs)and are receiving assistance for substance use disorder are infected with HCV.However,this subset of patients has extremely limited access to care due to multiple factors,including alcohol abuse,psychological comorbidities,and homeless status.AIM To describe the impact of our HCV-dedicated service for substance use disorder(SSUD)service on PWIDs receiving anti-HCV therapy.METHODS A dedicated,multidisciplinary team was set up at the SSUD of Trento in October 2020 to provide antiviral treatment to HCV RiboNucleic Acid-positive patients with an active or previous history of substance abuse.The treatment was followed by a health education program.Patients were treated with Direct-Acting Antivirals(DAAs).Data were retrospectively analyzed to assess the efficacy of our dedicated program in terms of therapy completion,HCV eradication,and compliance(primary endpoint).The rate of HCV reinfection and DAA-related toxicity were also assessed(secondary endpoints).RESULTS A total of 40 patients were enrolled in the study:28(70.0%)were treated with Sofosbuvir/Velpatasvir,while 12(30.0%)received Glecaprevir/Pibrentasvir.At the time of inclusion in the study,36 patients were receiving opioid agonist maintenance therapy,whilst another 4 had just finished the treatment.37.5%had a history of alcoholism and 42.5%received concomitant psychiatric treatment.All 40 patients(100.0%)completed the therapy cycle and 92.5%of patients adhered to the program.All patients tested negative for viral load at the end of the treatment.There were no significant drug interactions with common psychiatric treatments and no side effects were observed.The sustained virological response was achieved in 92.5%of cases with good tolerability,although two patients discontinued treatment temporarily.After HCV eradication,one patient died from an overdose,another from complications of cirrhosis,and one reinfection occurred.CONCLUSION Very high adherence to therapy and good tolerability was observed in our series of HCV patients treated at the SSUD,regardless of the substance abuse condition.Further validation in a larger population is required.
