Aim and background:To determine the factors that affect outcome in hospitalized patients of hepatic encephalopathy (HE). Materials and methods:This was a cross-sectional observational study aimed at correlating the presenting patient profile with outcome in patients of chronic liver disease (CLD) HE; with 131 participants over 18 months. The primary outcome was mortality, and the secondary outcome was duration of hospital stay in surviving patients. Results:Hypoglycemia, hypoxia, abnormal total leukocyte count (TLC), %Neutrophils, S. Sodium, S. Chloride, S. Urea, S. Creatinine and aspartate transaminase (AST) levels, MELD-Na score, and the number of precipitating factors were associated with higher mortality (at p ≤0.05). A prognostic index was calculated from seven parameters to predict mortality (area under curve AUC = 80.2%, sensitivity = 84.1%, specificity = 72.4% at cut-off 42). The mean duration of hospital stay was 4.3 (±4.5) days in patients who expired and 9.0 (±9.6) days in patients who recovered (p ≤ 0.05). Approximately 81.8 and 90.9% of deaths occurred within the first 3 and 10 days of admission, respectively. Conclusion:The study identified readily available lab parameters that can be used to detect patients at high risk of mortality during hospitalization for HE. A prognostic score calculable from these parameters has also been proposed. Most of the deaths were found to occur during the initial days of hospital stay. Clinical significance:The presentation and prognostic factors were different from those reported in Western literature. The identification of prognostic factors, and a high-risk early hospitalization period will help in the early detection and aggressive management of at-risk patients. How to cite this article:Singh H, Singh K, Kumar V, et al. Patient Characteristics at Admission Affecting Short-term Outcome in Hepatic Encephalopathy: A Cross-sectional Study. Euroasian J Hepato-Gastroenterol 2025;15(1):68-71.
Introduction:With the advancement in surgical techniques, the mortality after pancreaticoduodenectomy (PD) has significantly decreased, but the morbidity remains the same. The occurrence of postoperative pancreatic fistula (POPF) directly affects morbidity, and many pancreatic reconstruction techniques have been developed to decrease the rates of clinically relevant postoperative pancreatic fistula (CR-POPF). Materials and methods:Our modified Heidelberg (Buchler's) technique differs from the original in the aspect that continuous sutures rather than intermittent sutures are used in all layers of the anastomosis. The outcomes of this technique were analyzed, and factors associated with POPF and CR-POPF were determined. A retrospective analysis was performed on data from 78 patients for whom the modified Heidelberg technique was used to perform pancreatojejunostomy (PJ) after PD at our institute between 2017 and 2023. In subgroup analysis, the incidence of POPF was compared between the initial phase when other PJ techniques were still practiced at our institute and the period after the technique was standardized. Results:The incidence of CR-POPF was 6.4%, and the overall incidence of POPF was 33.3%. Postpancreatectomy hemorrhage occurred in 7.6% of the patients, and the 30-day mortality rate was 5.1%. Following standardization, the incidence of CR-POPF was significantly reduced to 4%. Prior biliary stenting and soft pancreas were risk factors for the development of POPF (p < 0.05). Conclusion:The outcomes of PD tended to improve with the use of a single pancreatic anastomosis technique. Our modification of the Heidelberg technique of PJ is easy to perform and produces outcomes equivalent to the original Heidelberg technique. Our analysis showed that prior biliary stenting, soft pancreas, and intraoperative pancreatic duct stent placement increased the incidence of POPF, and CR-POPF was significantly associated with morbidity. How to cite this article:Chalamalasetti K, Sankareswaran S, Raju P, et al. Modified Heidelberg (Buchler's) Technique of Pancreaticojejunostomy after Pancreaticoduodenectomy and Its Implications on Postoperative Pancreatic Fistula. Euroasian J Hepato-Gastroenterol 2025;15(1):100-106.
Acute liver failure due to widespread carcinomatous infiltration of the liver by breast cancer carries a grave prognosis. The disease course is fulminant and deranged hepatic functions and poor performance status make chemotherapy difficult. Our patient was a 46-year-old lady with breast cancer who presented with acute liver failure and hepatic encephalopathy secondary to extensive liver metastases and who was successfully treated with chemotherapy (Nab-paclitaxel) and (immunotherapy) Trastuzumab. There is no such report of concomitant use of nab-paclitaxel and trastuzumab in acute liver failure in world literature. Usually, these patients are administered palliative care only, however, such nihilistic approaches prevent us from salvaging such patients. It is possible to salvage a proportion of this high-risk group of patients with immediate institution of suitable systemic therapy and appropriate supportive care. We present the report of such a case. How to cite this article:Gupta A. Acute Liver Failure and Hepatic Encephalopathy Secondary to Extensive Liver Metastases from Breast Cancer Successfully Treated Using Dose Modified Weekly Nab-paclitaxel and Trastuzumab. Euroasian J Hepato-Gastroenterol 2025;15(1):83-86.
Background and aim:Inflammatory biomarkers are commonly utilized and remain a topic of ongoing discussion regarding their role in predicting outcomes in advanced hepatocellular carcinoma (HCC). The overall survival (OS) of patients with advanced HCC who received first-line systemic therapy at a tertiary care hospital in Pakistan was examined in this study in relation to the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at baseline and 1 month after treatment. Materials and methods:The study tracked 107 patients with advanced HCC from 2017 to 2024 who received atezolizumab/bevacizumab, lenvatinib, and sorafenib as therapy. Pretreatment and posttreatment (1 month) NLR and PLR values were analyzed. The most appropriate NLR and PLR cutoff thresholds were determined using receiver operating characteristic (ROC) analysis. Kaplan-Meier survival curves and log-rank tests were used to determine OS. Results:Nine months was the median OS, with a 95% confidence interval (CI) ranging from 5 to 13.7 months. Patients with a pretreatment NLR below 2.72 had a median survival of 13 months (95% CI: 9-32 months), whereas those with an NLR of 2.72 or higher had a median survival of 5 months (95% CI: 4-11). Similarly, patients with a pretreatment PLR under 102.86 achieved a median survival of 13 months (95% CI: 9-32), while those with a PLR equal to or above 102.86 experienced a median survival of 5 months (95% CI: 4-14). Treatment-related side effects, including deranged liver function tests, led to dose adjustments in 83.9% of patients and significantly influenced survival outcomes. Conclusions:Higher pretreatment NLR and PLR were related with lower survival outcomes in advanced HCC patients undergoing first-line systemic treatment. Although not statistically significant, these biomarkers show potential as predictive tools when integrated with established systems like Albumin-Bilirubin grading and Child-Pugh classification. Additional studies are required to validate their significance, particularly in the context of emerging therapies. Clinical significance:The NLR and PLR, combined with established tools, offer a cost-effective approach to refine patient selection and improve outcomes in advanced HCC, particularly in resource-limited settings. How to cite this article:Naviwala MSS, Tariq M, Saleem W, et al. Assessing the Predictive Value of NLR and PLRs in Advanced Hepatocellular Carcinoma Patients Receiving First-line Systemic Therapy: Observations from a Tertiary Care Hospital in Pakistan. Euroasian J Hepato-Gastroenterol 2025;15(1):107-112.
Background:Achalasia, a rare motility disorder characterized by impaired lower esophageal sphincter relaxation, significantly impacts patients' quality of life. Pneumatic dilatation (PD) is a cost-effective and minimally invasive treatment, yet long-term prospective data from resource-limited settings remain scarce. This study aimed to evaluate the efficacy of PD in improving health-related quality of life (HRQoL) and patient satisfaction among achalasia patients in a peripheral Pakistani hospital. Materials and methods:A single-center, quasi-experimental study was conducted at Madina Teaching Hospital, Faisalabad, from 2017 to 2021. Eighty patients (mean age: 37.03 ± 10.49 years) diagnosed via high-resolution manometry or barium swallow were enrolled. Pneumatic dilatation was performed under fluoroscopic and endoscopic guidance using 35 and 40 mm balloons. Outcomes were assessed at baseline, 6 months, and 24 months using the Eckardt score and Short Form-8 Health Survey Questionnaire. Statistical analyses included repeated measures analysis of variance, Kaplan-Meier survival analysis, and Spearman's correlation. Results:Pneumatic dilatation resulted in a 75.1% reduction in Eckardt scores at 24 months (p < 0.001), with sustained symptom relief. Health-related quality of life scores improved significantly, from 18.05 ± 1.39 at baseline to 37.00 ± 1.08 at 24 months (p < 0.001). A strong negative correlation was observed between Eckardt scores and HRQoL (r = -0.40, p < 0.001). Minor complications occurred in 12.5% of patients, with no major adverse events. Symptom recurrence was observed in 8.75% of cases, successfully managed with repeat PD. Subgroup analyses revealed no significant differences in outcomes based on gender or age. Conclusion:Pneumatic dilatation is a safe, effective, and sustainable intervention for achalasia in resource-limited settings. It provides durable symptom relief, significantly improves HRQoL, and achieves high patient satisfaction over 24 months, with minimal complications. These findings highlight PD's viability as a first-line treatment in regions with limited access to advanced therapeutic options. How to cite this article:Hanif S, Rasool S, Shafqat U, et al. Improvement in Health-related Quality of Life and Patient Satisfaction after Pneumatic Dilatation in Achalasia Patients. Euroasian J Hepato-Gastroenterol 2025;15(1):54-57.
Introduction:Colorectal cancer (CRC) is the third most common malignancy and a major cause of cancer-related mortality worldwide. The optimal anastomosis technique after surgical resection remains controversial, as each method presents distinct advantages and drawbacks. In particular, antiperistaltic and isoperistaltic side-to-side anastomosis (SSA) are associated with varying benefits and postoperative outcomes. This study highlights the benefits of isoperistaltic SSA and compares its outcomes with existing literature on antiperistaltic techniques. Methods:A retrospective cohort study was conducted at King Hamad University Hospital, Bahrain, from February 2019 to September 2023, involving 24 patients undergoing laparoscopic or open right hemicolectomy with isoperistaltic SSA. Data collected included demographics, operative characteristics, and postoperative outcomes. Results:The cohort had a mean age of 56.17 years with 58.3% of the cohort being male. The average operative time was 207.5 minutes, with minimal blood loss and low transfusion rates. Early complications included nausea and vomiting in 20.83% of patients; no anastomotic leakage or stenosis was observed. The mean hospital stay was 6.33 days, and only one readmission occurred. Long-term complications included hernias (16.67%) and transient diarrhea, with no cases of chronic diarrhea or bowel obstruction. Conclusion:Our findings indicate that isoperistaltic anastomosis was associated with lower complication rates compared to outcomes for antiperistaltic anastomosis reported in the literature. Notably, reinforced hand-sewn sutures appeared to further improve surgical results and reduce leakage. These observations suggest that reinforcement methods may have a greater impact on outcomes than anastomosis orientation itself. However, larger, controlled studies are necessary to confirm these findings. How to cite this study:Algahiny AT, Elnagar MBG, Elmitwalli OSMMS, et al. Isoperistaltic Side-to-side Anastomosis in Colorectal Surgery: Outcomes and Comparative Insights from Bahrain. Euroasian J Hepato-Gastroenterol 2025;15(1):44-49.
Aim and background:Signet ring cell carcinoma (SRCC) is a rare variant of adenocarcinoma, typically presenting as gastric carcinoma and infrequently in the breast. Metastasis from breast cancer to the colorectum is notably rare. This case report documents a unique presentation of primary breast invasive lobular SRCC with colorectal metastasis and highlights the diagnostic challenges of such cases. Case description:A 52-year-old woman with a history of type II diabetes mellitus presented with obstipation, abdominal pain, and significant weight loss. Initial evaluations suggested colorectal malignancy. However, further diagnostic procedures, including colonoscopy, computed tomography scans, positron emission tomography computed tomography scan, breast imaging, and histopathological examinations revealed a more complex scenario. The identified rectal mass was a metastatic manifestation of primary breast cancer, specifically an invasive lobular carcinoma with a signet ring cell variant. The rarity of SRCC metastasizing from the breast to the colorectum adds complexity to the diagnostic process. Despite the typical negative expression for CK7 and CK20 in breast SRCC, this case exhibited a positive E-cadherin immunoreactivity. Hormone receptor analysis played a crucial role in distinguishing the primary site of the malignancy. Conclusion:This case contributes valuable insights into the rare occurrence of breast SRCC metastasizing to the colorectum. It highlights the importance of considering metastasis in differential diagnoses and advocates for multidisciplinary management in complex oncological cases. Clinical significance:Despite the aggressive nature and complex treatment requirements of such cases, the importance of a tailored approach in managing metastatic breast cancer is highlighted. The need for further research to better understand and manage this rare malignancy subtype is evident. How to cite this article:Saeed MF, Nemrish K, Alrefaie K, et al. Breast to Bowel: Unraveling the Metastatic Enigma of Signet Ring Cell Carcinoma. Euroasian J Hepato-Gastroenterol 2025;15(1):87-90.
Background:The standard treatment for bleeding esophageal varices typically combines pharmacotherapy with endoscopic variceal ligation (EVL). As a general practice, vasoactive drugs are administered for 3-5 days, following banding to reduce the risk of rebleeding. However, the necessity of continuing these vasoactive drugs after definitive therapy remains uncertain, with no conclusive results available. This study aims to compare the efficacy of octreotide against a placebo after EVL in variceal bleeding. Materials and methods:This study was a prospective, double-blinded, randomized controlled trial conducted at a tertiary care institute in India. A total of 270 patients were recruited. All patients underwent EVL for variceal bleeding and were subsequently randomized into two groups. Patients in group A did not receive any drug, while patients in group B received octreotide for 3 days. They were monitored for 5 days to assess instances of very early rebleeding. Results:The baseline characteristics of patients in both groups were comparable. There was no significant difference observed between the two groups regarding very early rebleeding (within 5 days). One patient in each group (2/270) had very early rebleeding (p = 1.00). Although the cost-effectiveness of discontinuing octreotide immediately after EVL was not quantified, it was noted that the use of octreotide for 3 days resulted in increased demands on manpower, materials, finances, and prolonged hospital stays. Conclusion:Octreotide does not reduce the rates of very early rebleeding after EVL. Therefore, it can be safely discontinued after EVL, which could lead to shorter hospital stays and is more cost-effective. How to cite this article:Kiran P, Nagarajan RK, Theakarajan R, et al. Comparison of Octreotide with Placebo after Successful EVL to Prevent Rebleeding: A Randomized Controlled Trial. Euroasian J Hepato-Gastroenterol 2025;15(1):63-67.
Background:Ewing's sarcomas (ES) are exceedingly malignant undifferentiated small round cell tumors of the neuroectodermal origin. It primarily occurs in the skeletal tissue; however, it has also been documented in extraskeletal tissues, including the small intestine, esophagus, vagina, pancreas, ovaries, rectovaginal septum, prostate, and kidneys.Extraskeletal Ewing sarcoma (EES) constitutes approximately 15-20% of neoplasms within the ES family, which includes both Ewing sarcoma/peripheral neuroectodermal tumors (ES/PNET) and EES. Extraskeletal ES are frequently observed in the paraspinal region, limbs and retro peritoneum. Encountering primary gastric ES is exceptionally rare. Methods and result:We, herby, present here an extremely rare case of primary gastric ES in a 17-year-old male who had presented to us with features of gastric outlet obstruction. Contrast-enhanced abdominal computed tomography revealed an asymmetrical circumferential thickening of about 5 cm in the antropyloric region of the stomach and the first part of the duodenum, with multiple enlarged perigastric lymph nodes. Endoscopic biopsy revealed a tumor composed of cells arranged in nests, cords and sheets. An extensive immunohistochemistry panel examination found tumor cells to be strongly positive for vimentin, NKX2.2, FLI1, CD99 and CK.The patient received 9 weeks of neoadjuvant chemotherapy based on IE-VAC regimen. The patient underwent elective classical pancreaticoduodenectomy (Whipple's procedure). The postoperative course of the patient unfolded without any complications. The patient was subsequently discharged in a state of good health 12 days post-procedure. Thereafter, he underwent four cycles of adjuvant chemotherapy. Discussion:A review of the elucidated cases of primary gastric Ewing's sarcoma depicts its aggressive nature with frequent regional and distant metastasis, and mostly manifesting through non-specific clinical features, thereby, evading early diagnostic efforts. A comprehensive multimodal therapeutic strategy, with chemotherapy, radiotherapy, and surgical intervention is typically employed.We, thus, report this case to help with disease identification and acceptance for the clinicians. How to cite this article:Pawar SS, Priya S, Kumar M, et al. Ewing's Sarcoma of Stomach Masquerading as Gastric Cancer: A Case Report and Literature Review. Euroasian J Hepato-Gastroenterol 2025;15(1):1-9.
Background:The correlation between small intestinal bacterial overgrowth (SIBO) and nonalcoholic fatty liver disease (NAFLD) has gained heightened acknowledgment, especially in the late phases of liver disease. Despite this, studies focusing on the prevalence and specific characteristics of SIBO within the steatotic liver disease patient population in Pakistan remain sparse. This research seeks to investigate the prevalence and characteristics of SIBO in patients with fatty liver disease in a tertiary healthcare facility in Karachi. Materials and methods:Conducted from July 2023 to March 2024 at Ziauddin Medical University Hospital's Clifton Campus, this prospective cross-sectional study included 65 adults aged 18-80 diagnosed with NAFLD via FibroScan®. The evaluation of small bowel microbial overgrowth was established by a glucose hydrogen breath test (GHBT), where a rise in hydrogen concentration of ≥20 ppm from the initial measurement within two hours signifies a good outcome. Participant demographics, comorbid conditions, and clinical symptoms were documented. Results:Of the 65 individuals, 46 were male, with an average age of 44.88 ± 12.30 years, a mean index of body mass of 26.45 ± 6.45 kg/m², and an average waist measurement of 95.20 ± 15.17 cm. Lean NAFLD was observed in 40% of the participants. Frequent comorbidities included diabetes (40%), hypertension (38%), and dyslipidemia (38%). Small intestinal bacterial overgrowth was identified in 37% of the subjects, 28% of whom were asymptomatic. Symptoms prevalent in SIBO-positive individuals were bloating (41%), belching (26%), and abdominal pain (28%). Liver stiffness indicated that 23% had F2 fibrosis, 28% had F3, and 49% had F4. Controlled attenuation parameter (CAP) scores showed S1 steatosis in 37% of patients, S2 in 29%, and S3 in 34%. The presence of SIBO correlated with increasing fibrosis and steatosis levels. Small intestinal bacterial overgrowth (SIBO) positivity was more prevalent in the high Child-Pugh class and more severe liver dysfunction. With post-treatment giving Lactobacillus reuteri and rifaximin for two weeks, only 4% remained SIBO-positive. Significant associations of SIBO were also noted with dyslipidemia, hyperuricemia, and irritable bowel syndrome. Conclusion:This research highlights a significant incidence of SIBO in NAFLD individuals, particularly those with severe liver damage and comorbidities. It stresses the importance of regular screening for SIBO in such patients, suggesting that timely detection and intervention could enhance patient outcomes. How to cite this article:Naizr S, Abbas Z, Gazder DP, et al. Incidence and Characterization of SIBO in NAFLD Patients, Euroasian J Hepato-Gastroenterol 2025;15(1):38-43.
Aim and background:Acute pancreatitis (AP) is an inflammatory condition of the pancreas with varying severity, traditionally managed by delaying oral feeding to prevent enzyme stimulation. However, prolonged fasting may worsen patient outcomes by increasing catabolism and the risk of bacterial translocation. This study aims to compare the effects of immediate oral feeding (IOF) within 24 hours of hospital admission vs conventional oral feeding (COF) after 48 to 72 hours in patients with mild to moderately AP, hypothesizing that IOF will reduce length of hospital stay (LOHS) without increasing complications. Methods:An open labeled, stratified, randomized controlled trial (RCT) involving adult patients with mild to moderate AP, conducted at Government Medical College and Hospital, Chandigarh, India, with 100 adult participants, over a duration of 18 months and registered in the Clinical Trial Registry of India (CTRI/2023/02/049370) on February 1, 2023. Patients were randomized into two treatment groups: IOF (intervention group) and COF (control group). In the IOF group, the diet was started within 24 hours of admission, and in the COF, the diet was started in a stepwise manner after 48-72 hours. Decisions regarding the progression of the diet and the timing of hospital discharge were made by the medical team independently, without involvement from the study team members. The primary outcome was to observe the LOHS, while the secondary outcome was to observe recurrence of abdominal pain and diet intolerance and to analyze the laboratory parameters between the two groups. Results:We randomized 100 patients: 51 to the IOF and 49 to the COF groups. The LOHS was significantly shorter in the IOF group, with a mean of 4.5 ± 6.9 days, compared to 7.5 ± 5.5 days in the COF group (p < 0.01). Diet intolerance and recurrence of pain after refeeding developed in 15 patients (29.4%) in the IOF group and 11 patients (22.4%) in the COF group, with no significant difference between the groups. Additionally, there was no statistically significant difference in the presence of complications between the two groups. Conclusion:Administration of an immediate oral low-fat solid diet to patients with mild to moderately severe AP appears safe, feasible, and may reduce the LOHS, with comparable results to COF regarding diet intolerance, recurrence of pain, and complications. Further research is needed to compare low- and normal-fat diets for optimal outcomes. Clinical significance:This study shows that IOF in mild to moderately severe AP can safely reduce hospital stays without increasing complications. It highlights the potential of early nutritional intervention to enhance recovery and streamline care. How to cite this article:Sandeep VS, Dahra A, Singh P, et al. Comparison of Immediate Oral Feeding vs Conventional Oral Feeding in Patients with Mild to Moderately Severe Acute Pancreatitis: A Randomized Controlled Trial from a Tertiary Care Center in North India. Euroasian J Hepato-Gastroenterol 2025;15(1):10-17.
Background:Decompensated liver disease is a debilitating condition often accompanied by significant micro- and macronutrient deficiencies, which can worsen prognosis and complicate treatment, particularly in potential liver transplant candidates. Objective:We aimed to identify nutritional deficiencies in patients with decompensated chronic liver disease (CLD), who are potential recipients for liver transplantation. Materials and methods:This cross-sectional, single-center prospective study included consecutive patients. Blood tests were performed to measure levels of key micronutrients, including vitamin D3, zinc, calcium, magnesium, phosphorus, iron, folic acid, and vitamin B12. Nutrient deficiencies were compared in patients with a model for end-stage liver disease (MELD) score ≥15 or less, and Child-Pugh class of B and C. Results:The cohort comprised a total of 116 patients, 79 (68.1%) males and 37 (31.9%) females. Sixty-nine patients (59.5%) were classified as Child-Pugh class B and 47 patients (40.5%) as Child-Pugh class C, and 71 (61.2%) patients had an MELD score of ≥15. The primary etiologies of CLD were hepatitis C [49 (42.2%)], non-alcoholic fatty liver disease [30 (25.9%)], alcoholic liver disease [20 (17.2%)], hepatitis B [11 (9.5%)], and autoimmune liver disease [6 (5.2%)]. The study identified higher frequencies of deficiencies in zinc (89.7%), vitamin D3 (deficient 62.1%, insufficient 23.3%), calcium (18.1%), folate (15.5%), magnesium (14.7%), iron (13.8%), phosphorus (10.3%), and vitamin B12 (5.2%) across the entire cohort. Vitamin D and magnesium deficiencies became more frequent in Child-Pugh class C compared to B (p = 0.001 and p = 0.006) and MELD score ≥15 (p = 0.001 and p ≤ 0.001). Conclusion:The high prevalence of deficiencies of crucial micronutrients, such as vitamin D3, zinc, magnesium, and iron highlighted the necessity of comprehensive assessments of nutrition and targeted intervention in patients with decompensated CLD. Effective management of micronutrient levels could potentially reduce complications, improve patient health, and enhance outcomes in these potential liver transplant candidates. How to cite this article:Kumar M, Abbas Z, Gazder DP, et al. Deficiencies of Micronutrients in Potential Liver Transplant Candidates: A Cross-sectional Study. Euroasian J Hepato-Gastroenterol 2025;15(1):24-28.
Background:Enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) have shown promising results. In all previous studies on ERAS following PD; the earliest oral feeding (liquids only) was started on the first postoperative day; our objective was to start oral (liquid and soft) feed at 6 hours of surgery and assess its effect on postoperative outcome. Materials and methods:All 26 patients (Group-I) undergoing PD from November 2021 to June 2022 were prospectively enrolled and subjected to early oral feeding (EOF), i.e., oral feed at 6 hours. They were compared with a retrospective cohort (Group-II) of 40 patients who received conventional oral feeding (COF) i.e., by feeding jejunostomy on day 1. Results:Age, intraoperative blood loss, and operative time were comparable. Time to start oral liquid (0 vs 1.5 ± 1.2 days, p = 0.00), soft diet (0 vs 3.8 ± 1.9 days, p = 0.00) and solid diet (3.1 ± 0.5 vs 7.2 ± 2.9 days, p = 0.00) was significantly shorter in EOF group. Nasogastric (NG) tube removal was earlier (1.6 ± 1.5 vs 3.9 ± 1.7 days, p 0.00) and required reinsertion less frequently in the EOF group. First stool passage time (3.7 ± 0.9 vs 5.9 ± 1.8 days, p 0.00) and stoppage of intravenous fluids (3.4 ± 0.8 vs 5.2 ± 1.8 days, p 0.00) were significantly earlier in EOF group. The length of postoperative hospital stay was less (5.9 ± 2.6 vs 8.8 ± 4.1 days, p 0.007) in the EOF group. There was no significant difference in postoperative complications, 90-day mortality, and readmission rates between the two groups. Conclusion:Early oral feeding after PD is feasible, safe, and reduces hospital stay. How to cite this article:Sharma A, Mahla VK, Nagar A, et al. Early vs Conventional Oral Feeding after Pancreaticoduodenectomy: A Prospective Observational Study. Euroasian J Hepato-Gastroenterol 2025;15(1):29-33.
Background:Hypertriglyceridemia-associated pancreatitis (HTG-AP) is a notable cause of acute pancreatitis (AP) due to high triglyceride (TG) levels. It is associated with more complications than non-hypertriglyceridemia-associated acute pancreatitis (non-HTG AP). Current treatments include supportive care, insulin infusion, and plasmapheresis. Improved guidelines and protocols are needed due to the complex nature and rarity of the condition. The current study was conducted because of the paucity of data available for HTG-AP from India. Materials and methods:The study retrospectively analyzed data of adult HTG-AP patients hospitalized at a tertiary care facility in Eastern India from August 2021 to August 2024. Acute pancreatitis was classified per modified Atlanta criteria, with HTG-AP defined as AP associated with a serum TG > 1000 mg/dL. The primary outcome was a > 50% decline in TG level from the baseline. Secondary outcomes included complete cessation of insulin therapy once the TG level < 500 mg/dL, adverse events, and in-hospital mortality. Results:Twenty-four patients had HTG-AP (median age: 38.5 years; 87.5% male), accounting for 5.7% of all AP admissions. Diabetes and alcohol use were each present in 62.5% of cases. About 62.5% of patients had moderately severe to severe AP, which was significantly higher than non-HTG-AP cases. Necrotizing pancreatitis was observed in 45.8% of patients. Insulin therapy reduced TG levels by more than 50% in 45.83%, 87.5%, and 91.67% of the patients at 24, 48, and 72 hours, respectively. Insulin therapy could be stopped in 25%, 62.5%, and 83.3% of the patients at 24, 48, and 72 hours, respectively. Only one patient had symptomatic hypoglycemia, which was managed with a dextrose bolus. In-hospital mortality was seen in 12.5% of the cases. Conclusion:About 5.7% of the Indian patients admitted with AP had HTG-AP, with about two-thirds having non-mild AP. Insulin infusion was the primary treatment for lowering serum TG levels in most patients with HTG-AP, with a fourth to a fifth of the patients achieving control of their TG levels. How to cite this article:Giri S, Singh RK, Jena SK, et al. Incidence and Outcome of HTG-AP at a Tertiary Care Center in Eastern India: A Retrospective Analysis. Euroasian J Hepato-Gastroenterol 2025;15(1):50-53.
Background and objective:This cross-sectional study aimed to determine the frequency of distal biliary strictures in biliary pancreatitis, their relation with clinical and biochemical characteristics, and possible associations as a precipitating factor. Materials and methods:A total of 51 patients with biliary pancreatitis were assessed for distal common bile duct (CBD) strictures and stones. Demographic data, biochemical parameters, and imaging findings were analyzed. Comparative analyses were conducted to evaluate differences between patients with and without strictures or stones. Results:The mean age of the cohort was 54.0 ± 16.72 years, with females comprising 58.8% of the population. Distal CBD strictures were detected in 54.9% of patients, more frequently in females (64.3%) compared with males (35.7%). Patients without strictures accounted for 45.1%, with an almost equal gender distribution (52.2% females and 47.8% males). The CBD stones were identified in 70.6% of cases, with a marginally higher frequency among females (52.8%). Comparative analyses between patients with and without strictures showed no statistically significant differences in amylase (p = 0.616), lipase (p = 0.531), total bilirubin (p = 0.674), alanine aminotransferase (p = 0.589), aspartate aminotransferase (p = 0.621), gamma-glutamyl transferase (p = 0.483), or alkaline phosphatase (p = 0.398). Similarly, no significant differences were observed between patients with and without CBD stones in amylase (p = 0.420), lipase (p = 0.471), total bilirubin (p = 0.545), or inflammatory markers such as C-reactive protein (p = 0.313). Among patients with strictures, 53.6% had concurrent CBD stones, compared with 91.3% of those without strictures (p = 0.005). Conclusion:Distal CBD strictures were present in over half of the patients with acute biliary pancreatitis (ABP). The presence of CBD stones was less common in these patients. Strictures were more common in females. There is a possibility that the presence of stricture may itself lead to complete obstruction even without stone when plugged with sludge or microlithiasis, ending up in the building of back pressure and pancreatitis. How to cite this article:Kumar M, Abbas Z, Gazder DP, et al. Is there any Association of Distal Biliary Strictures with Acute Pancreatitis? Euroasian J Hepato-Gastroenterol 2025;15(1):34-37.
Prostate cancer is a significant cause of morbidity and death among men. While prostate cancer often metastasizes to common sites such as bone and liver, there have been rare cases of metastasis along the gastrointestinal tract. In this case report, we present an 85-year-old man who initially presented with altered mental status and later developed abdominal pain and tenderness leading to the discovery of duodenal ulceration. The biopsy of the ulcer was consistent with metastatic spread from the prostate. Involvement of the duodenum complicated both diagnosis and therapeutic management. This case highlights the possibility of unusual spread of prostatic metastases and further underscores the importance of early detection to guide treatment outcomes. How to cite this article:Sangam S, Tole C, Mekonen Y, et al. Metastasis of Prostate Cancer to Duodenum: An Unusual Presentation. Euroasian J Hepato-Gastroenterol 2025;15(1):91-93.
Aim and background:The prognosis of advanced pancreatic cancer is also found to be associated with the host's nutritional status. The prognostic nutritional index (PNI) is an emerging marker that uses serum albumin and lymphocyte count, found to be a potent prognostic measure in many malignancies. However, its efficacy in predicting clinical outcomes in pancreatic cancer is not well explored in low- and middle-income countries (LMICs), like Pakistan. Objective:To evaluate the association between PNI and clinical outcomes in patients with advanced pancreatic cancer treated at a tertiary care hospital in Pakistan between 2019 and 2023. Materials and methods:A retrospective study was conducted using patient's record who were diagnosed with locally advanced or metastatic pancreatic cancer from Aga Khan University Hospital (AKUH). Prognostic nutritional index was calculated at diagnosis and at 12 months or last follow-up. The primary outcome was to assess the association between PNI and progression-free survival (PFS). The secondary outcome was to assess the association between PNI and type of chemotherapy drug, weight, age, stage, smoking, and alcohol intake, family history, and albumin levels at different intervals. Results:Among the included 47 patients, the association between PNI and survival was 19 months (6.44 months). Multivariable analysis showed albumin at 12 months was correlated with PNI. While the multivariable analysis of factors affecting survival revealed following significant factors, eastern cooperative oncology group (ECOG) performance, weight changes, frequency of nutritional assessment done and response evaluation. Conclusion:The PNI association with PFS further concretes the importance of this tool in clinical practices. This can lead to early identification of malnourished patients who can be treated with prompt nutritional interventions to treat pancreatic cancer-related cachexia. This is more important in context of LMIC like Pakistan where such worse outcomes add more burden on an already weak health infrastructure. However, more prospective studies with larger samples are needed to explore this associations and factors affecting PNI in more detail. Clinical significance:This study highlights the importance of nutritional assessment by utilizing PNI in patients with advanced pancreatic cancer. How to cite this article:Ahmed F, Amjad A, Saleem W, et al. Impact of Clinical Outcomes and Prognostic Nutritional Index in Patients with Advanced Pancreatic Cancer Treated at a Tertiary Care Hospital in Pakistan. Euroasian J Hepato-Gastroenterol 2025;15(1):94-99.
Alpha-fetoprotein (AFP), a major oncofetal protein, plays a pivotal role in cancer biology, extending beyond its initial identification in fetal development. Alpha-fetoprotein has multifaceted physiological functions mediated by its' complex structure interacting with specific receptors and ligands. The involvement of AFP in carcinogenesis encompasses a broad spectrum of pathophysiological mechanisms, including cell proliferation, apoptosis, metastasis, and immune modulation. Alpha-fetoprotein contributes to the pathological landscape of several cancers, especially hepatocellular carcinoma and germ cell tumors, through an intricate network of signaling pathways. Recent studies highlight the expanding clinical applications of AFP, suggesting its potential to improve the diagnosis and treatment of cancer as well as monitoring genetic diseases, such as neural tube defects and Down syndrome. This comprehensive overview of AFP aims to elucidate the complex biological interactions and clinical implications in cancer management. How to cite this article:Ucdal M, Yazarkan Y, Sonmez G, et al. Alpha-fetoprotein: A Multifaceted Player in Cancer Biology. Euroasian J Hepato-Gastroenterol 2025;15(1):72-82.
Objectives:This study was conducted to assess the therapeutic benefit of using rifaximin in combination with lactulose vs lactulose alone in the management of overt hepatic encephalopathy (OHE) within a tertiary care setting. Methods:A randomized controlled trial was conducted with 132 adult patients diagnosed with decompensated liver cirrhosis and presenting with OHE of West Haven Criteria grade II or higher. Participants were randomly allocated to receive either combination therapy (CT), comprising rifaximin and lactulose, or lactulose monotherapy (LM). Clinical outcomes were monitored over a 10-day period or until symptom resolution. The key outcome measure was symptom resolution in OHE, defined by reduction in grade and resolution of neurocognitive deficits. Results:Clinical improvement was achieved in 80.3% (n = 53) of patients receiving CT compared with 56.1% (n = 37) in the LM (p = 0.005). Response rates were significantly higher among males (82.5 vs 57.9%, p = 0.0329) and in patients aged 41-50 (85.7 vs 28.6%, p = 0.0308), 51-60 (78.1 vs 54.3%, p = 0.0401), and over 61 years (83.3 vs 54.5%, p = 0.0340) in the CT group compared with the LM group. Conclusion:The addition of rifaximin to standard lactulose therapy significantly improved clinical outcomes in patients with OHE, particularly among male patients and those in older age-groups, reinforcing its role as a preferred treatment strategy for OHE. How to cite this article:Alazazzi H, Algahiny AT, Sharif Z, et al. Evaluating Clinical Outcomes of Adjunct Rifaximin Therapy in Patients with Overt Hepatic Encephalopathy: A Prospective Randomized Study. Euroasian J Hepato-Gastroenterol 2025;15(1):58-62.
Objectives:The purpose of our study was to compare single-layer and double-layer anastomosis in terms of anastomotic leak, length of hospital stay, and duration required to perform anastomosis. The primary objectives were to compare the duration required to perform single- and double-layered intestinal anastomosis, to compare the duration of hospital stay in single- vs double-layered bowel anastomosis, and to study postoperative complications in single- and double-layered intestinal anastomosis. Secondary objectives were to study the relationship between preoperative albumin (Alb) and hemoglobin (Hb) levels and the risk of developing anastomotic leak. Materials and methods:This was a prospective comparative study conducted in the department of general and minimally invasive surgery. The study was conducted on patients presenting to Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Soura who underwent anastomosis of the bowel from 2020 to 2022. Patients of either sex, in the age range of 20-75 years with various conditions like ileostomy, colostomy, strangulated hernias, intestinal malignancies, and adhesion/band obstruction of the bowel etc., requiring intestinal anastomosis were included in the study. Children <20 years of age and elderly >75 years of age, patients with biliary and esophageal anastomosis were excluded. Baseline blood investigations were done in all patients. Single-layer anastomosis was done in patients of group A, and double-layer anastomosis was done in group B patients. During surgery, the time duration required to perform single-layer and double-layer anastomosis was noted. In the postoperative period, all patients were observed for the development of anastomotic leak, and all the patients were followed till discharge from the hospital. Results:Anastomotic leak developed in three patients in group A (6.8%) and four patients in group B (9.1%). The mean duration of hospital stay was 6.6 and 7.21 days in group A (single-layer) and group B (double-layer), respectively. The mean duration to perform anastomosis in group A (single-layer) and group B (double-layer) was 17.68 and 27.22 minutes, respectively. The mean Hb of patients who developed a leak was 9.35, and those who did not develop a leak was 10.73. The mean Alb level in patients who developed a leak was 2.48, and in patients who did not develop a leak was 3.12. Conclusion:Based on the results obtained in the present study, the following conclusions were drawn: (1) The duration required to perform a single-layer anastomosis was significantly less when compared to double-layer anastomosis. (2) There was no significant difference in anastomotic leak between the two groups. (3) There was no significant difference in the duration of hospital stay between the two groups. (4) Low preoperative Alb levels increase the risk of developing anastomotic leak. (5) There was no significant relationship between preoperative Hb level and the chance of developing anastomotic leak. How to cite this article:Bashir S, Ahrar N, Khurshid MS, et al. Single-layer vs Double-layer Intestinal Anastomosis: A Prospective Comparative Study. Euroasian J Hepato-Gastroenterol 2025;15(1):18-23.
