Ledipasvir‐sofosbuvir, a once‐a‐day, oral combination pill, was approved in 2014 for the treatment of chronic hepatitis C infection. Initial trials did not comment on nephrotoxicity; however, recent data suggest a risk of acute kidney injury (AKI) with the use of the medication. We assessed the rates of AKI in patients undergoing ledipasvir‐sofosbuvir in a large, urban tertiary care center. This single‐center retrospective observation study included all patients undergoing therapy from October 1, 2014, to October 1, 2015. Rates of AKI, defined by more than a 0.3 mg/dL increase in serum creatinine level, were calculated. Patients were followed 12 weeks after therapy to assess for sustained viral response as well as to assess for improvement of AKI after completion of therapy, defined by less than 0.2 mg/dL above baseline serum creatinine. In total, 197 patients were included in the final analysis who had completed ledipasvir‐sofosbuvir therapy and completed laboratory values. Among the patients treated, 38 (19%) had AKI during therapy. An additional 4 (2%) had AKI at the end of therapy. Of the 38 patients who experienced AKI, 20 (53%) had improvement in serum creatinine to less than 0.2 mg/dL above their baseline. When comparing for chronic kidney disease (CKD) stage, those with CKD I or II experienced AKI 17% of the time compared with 47% of the time in CKD III or worse (P = 0.005). Conclusion: AKI was seen in nearly one‐fifth of our patients, and patients with CKD stage III or worse are at increased risk. Although ledipasvir‐sofosbuvir is generally safe in the general population, close monitoring of renal function is recommended.

We present a 42-year-old woman who developed colo-colonic intussusception of the transverse colon near the hepatic flexure within a few hours after a routine colonoscopy. After conservative management with pain medication and hydration, her symptoms completely resolved within 24 hours. Colonic intussusception after a colonoscopy is rare, and the present case describes the most conservative approach leading to a complete resolution of symptoms.

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184 Background: Diabetes mellitus (DM) has been linked to an increase in the incidence of hepatocellular carcinoma (HCC). However, these studies have yielded controversial findings. This study evaluates the association between DM and risk of HCC in a meta-analysis. Methods: Two investigators independently conducted a search of studies on the association between DM and HCC from January 1970 through August 2010 on Medline. Identified articles were manually reviewed for additional references. Only full articles that provided risk estimates for the association were selected. The most adjusted risk estimates were abstracted and synthesized using the random-effects model. A stratified analysis by study design and study region has also been done. All studies were evaluated for publication bias before analysis. Results: A total of 35 studies, 20 case-control and 15cohort studies, were eligible for analysis. The overall summary risk ratio for HCC in DM was 1.60 (95% CI 1.49, 1.70; p<0.001). Among the case-control and cohort studies, the pooled risk estimate was 1.33 (95% CI 1.21, 1.46; p<0.001) and 2.24 (2.05, 2.44; p<0.001) respectively. By geographic location, the association remained significant among the European (15) and U.S. (10) based studies with risk ratios of 2.7 (95% CI 2.37, 3.05; p<0.001) and 1.58 (95% CI 1.45, 1.7) respectively. However, among the Japanese (10) based studies there was a nonsignificant 3% reduction in the risk of HCC (RR 0.97; 95% CI 0.71, 1.24; p>0.05). There was no evidence of publication bias among the studies included. Conclusions: The evidence in support of DM as an independent risk factor for HCC remains unclear. Though not significant, the finding among the Japanese based populations raises concerns over the potential role of environmental and/or genetic factors in the observed association. Further studies with great attention to potential confounders are warranted to definitively define the association between DM and HCC. No significant financial relationships to disclose.

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