No abstract

Highlights • Malnutrition and poor muscle strength are highly prevalent in cirrhotics with hepatorenal syndrome. • Terlipressin infusion increased energy and protein intake in patients with hepatorenal syndrome. • Handgrip strength continued to increase with every day of terlipressin therapy • Medium to long-term terlipressin infusion was safe and efficacious as a bridge to liver transplant.

Background and Aim During COVID‐19 outbreak, restrictions to in‐person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess “failure‐to‐attend” (FTA) rate and satisfaction for two endoscopy‐related compulsory telehealth clinics during the COVID‐19 outbreak. Methods Consecutive patients booked for endoscopy‐related telehealth clinics at a tertiary hospital were prospectively assessed. In‐person clinic control data was assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on 6 Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review. Results 691 patients were booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, p<0.01). The patient 6Q_score was higher for the Advanced Endoscopy clinic (84.6% versus 73.8%, p<0.01), while the doctor 6Q_score was similar between both Advanced and Post Endoscopy clinics (91.1% versus 92.5% respectively, p=0.80). An in‐person follow‐up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%. Conclusions The use of phone consultations in endoscopy‐related clinics during the COVID‐19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in‐person follow‐up consultations and physical examination were low.

No abstract

conceptualized and designed the study. Sujievvan Chandran was responsible for the study supervision. All authors were involved in data extraction. Leonardo Zorron Cheng Tao Pu and Ryma Terbah were involved in the statistical analyses. All authors helped with interpretation of the results and drafting the manuscript. Rhys Vaughan, Marios Efthymiou, and Sujievvan Chandran carried the critical revision of the article for important intellectual content. All authors read and approved the final version of the manuscript.

Introduction Sarcopenia in cirrhosis is associated with poor outcomes. While transjugular intrahepatic portosystemic shunt (TIPS) insertion improves radiological measures of muscle mass, its impact on muscle function, performance and frailty has not been evaluated. Methods Patients with cirrhosis referred for TIPS were prospectively recruited and followed for 6 months. L3 CT scans were used to calculate skeletal muscle and adipose tissue parameters. Handgrip strength, Liver Frailty Index and short physical performance battery were serially monitored. Dietary intake, insulin resistance, insulin-like growth factor (IGF)-1, and immune function using QuantiFERON Monitor (QFM) were measured. Results Twelve patients completed the study with a mean age of 58 ± 9 years and model for end-stage liver disease score of 16 ± 5. At 6 months post-TIPS, skeletal muscle area increased from 139.33 cm2 ± 22.72 to 154.64 ± 27.42 (P = 0.012). Significant increases were observed in the subcutaneous fat area (P = 0.0076) and intermuscular adipose tissue (P = 0.041), but not muscle attenuation or visceral fat. Despite marked changes in muscle mass, no improvements were observed in handgrip strength, frailty, or physical performance. At 6 months post-TIPS, IGF-1 (P = 0.0076) and QFM (P = 0.006) increased compared to baseline. Nutritional intake, hepatic encephalopathy measures, insulin resistance and liver biochemistry were not significantly impacted. Conclusion Muscle mass increased following TIPS insertion as did IGF-1, a known driver of muscle anabolism. The lack of improvement in muscle function was unexpected and may relate to impairment in muscle quality and the effects of hyperammonaemia on muscle contractile function. Improvements in QFM, a marker of immune function, may suggest a reduction in infection susceptibility in this at-risk population and requires further evaluation.

Background/Aim Therapeutic options are limited for patients with hepatorenal syndrome (HRS), diuretic refractory ascites and hepatic hydrothorax who are awaiting liver transplant. We assessed the safety and efficacy of continuous terlipressin infusion (CTI) for treating these conditions in an outpatient setting. Method All patients treated with CTI from May 2013 through March 2018 at our institution were initiated in-hospital on bolus dose terlipressin therapy for 24−72 h prior to commencing CTI for home therapy. Daily home visits for clinical assessment and medication administration were provided. Adverse events, effects of treatment on renal function, model for end-stage liver disease (MELD) score, and paracentesis/thoracentesis requirements were assessed. Results Twenty-three patients were included (HRS = 17; refractory ascites = 4; refractory hepatic hydrothorax = 2). Median (range) duration of outpatient CTI was 50 (1-437) days with a total of 2482 patient days of treatment. Fourteen patients (60.9%) received a liver transplant; of whom 13 (92.9%) were alive at the end of the study period. There were no cardiac or ischemic complications and no serious adverse events reported. In patients with HRS, median serum creatinine significantly decreased from 202.0 μmol/L at baseline to 125.5 μmol/L at day 14 of CTI (P = 0.0003) and remained stable thereafter. Median MELD score decreased from 22.5 to 19.0 at end of CTI (P = 0.008). Median frequency of paracentesis/thoracentesis was 4 per month prior to CTI versus 1.52 during treatment. Conclusion Transplant-eligible and otherwise stable patients can be managed with CTI at home for an extended duration under supervision without adverse consequences.

No abstract