Vivek Saraswat - Academia.edu (original) (raw)

Papers by Vivek Saraswat

Journal of Hepatology, 2017

Background and Aims: Sofosbuvir, a renally cleared, NS5B polymerase inhibitor, is the backbone to... more Background and Aims: Sofosbuvir, a renally cleared, NS5B polymerase inhibitor, is the backbone to 4 out of the 6 currently FDA-approved regimens for treatment of chronic hepatitis C (CHC) in the US. Its efficacy, tolerability, pan-genotypic activity, low rate of resistanceassociated variants, and minimal drug interactions has made sofosbuvir a cornerstone in CHC therapy. Given its renal clearance, sofosbuvir is not approved for use in severe renal impairment. Information on efficacy of daily, full-dose use of this particular drug in patients with end-stage renal disease (ESRD) on dialysis or with GFR < 30 mL/min is scant. We present completed data of the largest-to-date clinical experience on the cure rates of all-oral, ribavirin-free regimens containing daily, full-dose sofosbuvir in patients with ESRD. Methods: Data of CHC-infected patients with ESRD from three hepatology centers was collected. All patients included had CHC and ESRD on dialysis or GFR < 30 mL/min. All received and completed the full duration of an all-oral, ribavirin-free regimen containing sofosbuvir (sofosbuvir + simeprevir; sofosbuvir + ledipasvir; sofosbuvir + daclatasvir, or sofosbuvir + velaptasvir) for 12 or 24 weeks. Sofosbuvir was administered daily at full-dose (i.e. 400 mg). Results: Forty-one patients with CHC and ESRD were included in the analysis. Most were on dialysis (n = 38, 93%). Twenty (49%) were cirrhotic. Twenty seven (66%) were African American, 27 (66%) were genotype 1A, one was genotype 2, and one was genotype 3. Thirty two were treatment naïve (78%). All (100%) have completed treatment; thirty were on sofosbuvir + simeprevir (23 on 12 wks; 7 on 24 wks); 9 were on sofosbuvir + ledipasvir (12 wks), and two on sofosbuvir + daclatasvir (12 wks). All patients reached 12-week post treatment follow up period. All 41 patients (100%) had undetectable virus at 12 weeks, therefore are cured. Conclusions: As seen in the general population of CHC patients, regimens that contain sofosbuvir are also highly efficacious in CHC patients with ESRD. The cure rates of ribavirin-free, sofosbuvir-based regimens are remarkably higher than older regimens used in this special population, and comparable to other non-sofosbuvir containing regimens recently studied as well as to those commercially available for the treatment of ESRD CHC subjects. The use of sofosbuvir by experienced clinicians can be an option to treat CHC in ESRD patients.

Journal of Clinical and Experimental Hepatology

Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupre... more Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published

2023 International Conference on Simulation of Semiconductor Processes and Devices (SISPAD)

Journal of clinical and experimental hepatology, Mar 1, 2012

Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consen... more Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consensus has been reached on the best way for treating these patients. Gastric variceal obturation (GVO) with the tissue adhesive, N-2-butyl-cyanoacrylate (NBC), is considered the treatment of first-choice for this condition in most parts of the world. The liquid monomer polymerizes into a solid cast, obturating the vessel within 10-20 s of coming in contact with ionic solutions such as blood. Gastric variceal obturation achieves hemostasis in over 90% of patients with active bleeding, eradicates GV in over 80% of these patients, and re-bleeding occurs in 3-30%. These results are comparable with those of transjugular intrahepatic portosystemic shunting (TIPS; over 90% hemostasis in acute bleeding with re-bleeding in 15-30%). Though, there has been no direct comparison with GVO, balloon-occluded retrograde transvenous obliteration of GV (BRTO) achieves near 100% obliteration with recurrence in 0-10% and is superior to TIPS for hemostasis in active bleeding when used in combination with transcatheter sclerotherapy. Several complications have been described for GVO including thromboembolic complications which occur in 0.5-4.3% and may be devastating in some. Many of the complications and the variability in results of GVO can be attributed to variations in injection technique. The use of a standardized injection technique has been reported to achieve 100% hemostasis and obliteration with 6.9% re-bleeding and no embolic complications. Gastric variceal obturation with NBC continues to be the first-choice therapy for GV bleeding outside Japan. Adherence to a standard injection technique will maximize hemostasis and eradication of GV while minimizing complications of therapy.

Gastrointestinal Endoscopy, Feb 1, 1999

Background: Colorectal varices and congestive rectopathy or colopathy have been erratically repor... more Background: Colorectal varices and congestive rectopathy or colopathy have been erratically reported in patients with portal hypertension. The clinical importance of these entities has not been described. We assessed the changes in the venous system of the rectum by endoscopy and rectal endosonography (EUS). We also assessed the role of factors such as etiology of portal hypertension, grade of esophageal varices, sclerotherapy, and liver disease severity on the occurrence of these vascular changes. Methods: We studied changes in the venous system of the rectum using endoscopy and EUS in 60 patients with portal hypertension (cirrhotic 41, noncirrhotic 19). Ten patients with irritable bowel syndrome and 6 patients with hemorrhoids served as controls. Rectal varices were classified as tortuous, nodular, and tumorous. Corresponding appearances on rectal EUS were classified as single or discrete multiple, multiple, and innumerable submucosal veins, respectively. Evidence of congestive rectopathy was also recorded. Results: Prevalence of rectal varices was 43.3% on endoscopy (73% tortuous, 19% nodular, and 8% tumorous) and 75% on EUS (p < 0.0005). The latter showed corresponding appearances of submucosal veins in 25 of 26 patients and detected submucosal veins not identified at endoscopy in 19 other patients. Congestive rectopathy was found in 38.3% of patients. Multiple small dilated vessels in the submucosa were seen in 23.3% patients on rectal EUS. The development of these vascular changes was significantly influenced by sclerotherapy, but not by higher grade of esophageal varices, the etiology of portal hypertension, or severity of liver disease. Conclusions: Changes in the rectal venous system are common, with rectal EUS being superior to endoscopy in detecting early, as well as florid, changes.

Journal of Gastroenterology and Hepatology, Jul 1, 2008

Background and Aim: Cerebral edema is a major complication in patients with fulminant hepatic fa... more Background and Aim: Cerebral edema is a major complication in patients with fulminant hepatic failure (FHF). The aim of this study was to evaluate the metabolite alterations and cerebral edema in patients with FHF using in vivo proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging, and to look for its reversibility in survivors.Methods: Ten FHF patients along with 10 controls were studied. Five of the 10 patients who recovered had a repeat imaging after three weeks. N‐acetylaspartate, choline (Cho), glutamine (Gln), glutamine/glutamate (Glx), and myoinositol ratios were calculated with respect to creatine (Cr). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated in different brain regions.Results: Patients exhibited significantly increased Gln/Cr and Glx/Cr, and reduced Cho/Cr ratios, compared to controls. In the follow‐up study, all metabolite ratios were normalized except Glx/Cr. Significantly decreased Cho/Cr were observed in deceased patients compared to controls. In patients, significantly decreased MD and FA values were observed in most topographical locations of the brain compared to controls. MD and FA values showed insignificant increase in the follow‐up study compared to their first study.Conclusions: We conclude that the Cho/Cr ratio appears to be an in vivo marker of prognosis in FHF. Decreased MD values suggest predominant cytotoxic edema may be present. Persistence of imaging and MRS abnormalities at three weeks' clinical recovery suggests that metabolic recovery may take longer than clinical recovery in FHF patients.

Journal of clinical and experimental hepatology, Jul 1, 2018

Methods: HepG2 cells were incubated with FFAs-1000 M (oleic acid: palmitic acid/2:1) for 20 h. Re... more Methods: HepG2 cells were incubated with FFAs-1000 M (oleic acid: palmitic acid/2:1) for 20 h. Results: PII-10 M inhibited FFAs-induced lipid accumulation, loss of mitochondrial membrane potential (m), ATP depletion and production of reactive oxygen species (ROS). The gain in m and ATP production is indicative of increase in expression of Cytochrome C-mRNA and protein. Increase in the expression of MnSOD, catalase and higher levels of tGSH and GSH:GSSG ratio explained the ROS salvaging of PII. SIL showed parallel activities in some targets. Conclusions: The findings suggest that PII effectively attenuated FFAs-induced lipotoxicity. The activation of mitochondrial ATP generation, reduction in ROS and increase in antioxidant enzymes explain the underlying mechanisms of action. Reverse Pharmacology path may be expedited by these findings for a potential drug candidate for NAFLD.

Liver International, Mar 23, 2022

Transition from compensated to decompensated stage, represents a vital point in the natural histo... more Transition from compensated to decompensated stage, represents a vital point in the natural history of cirrhosis and is known to influence the quality of life and longevity. There have been multiple attempts to identify an accurate noninvasive marker for predicting the development of decompensation. In the recent study, Schneider et al. developed an Early Prediction of Decompensation (EPOD) score, including noninvasive tests like platelet count, albumin and bilirubin, to predict 3year probability of decompensation.1 It is indeed a herculean effort by the authors to validate their findings in a large sample size of 19 305 patients. However, there are some concerns regarding the current study, which require mention. Decompensation in cirrhosis is related to fibrosis and portal hypertension but causative factors for cirrhosis may also determine different activation intensity of the decompensating mechanisms. The rate of decompensation significantly differs across different aetiologies, with recent data pointing that cirrhosis because of alcoholrelated liver disease and nonalcoholic steatohepatitis progress more rapidly than other aetiologies.2 In addition, removal or treatment of primary aetiological factor, substantially reduces the risk of hepatic decompensation.2,3 One of the major information lacking in both the derivation and validation cohort for EPOD score was aetiology of liver cirrhosis. We understand that being a retrospective cohort study, information pertaining to treatment of aetiology and compliance with treatment could not be estimated. As highlighted by the authors, portal hypertension is a proven predictor of decompensation.4 On that basis, compensated cirrhosis is divided into two stages, based on the absence or presence of clinically significant portal hypertension (CSPH). Patients with CSPH are at increased risk of decompensation. Authors have tried to incorporate platelet count as a surrogate for CSPH while deriving EPOD score. However, previous studies have reported inferior performance of platelet count in predicting CSPH when compared with the presence of oesophageal varices.5 Since information on variceal status was not available, it is uncertain whether patients were comparable regarding the likelihood of having CSPH and, therefore, of decompensation. In summary, the availability of a simple noninvasive tool to predict decompensation in patients with cirrhosis is still an unmet need. Future multicentre collaborative studies, with large sample sizes for each major aetiology, considering the impact of portal hypertension are needed to develop a robust prognostic model that would be useful in both clinical and research settings.

Journal of Gastroenterology and Hepatology, Nov 1, 1997

We report a case of Caroli&amp;amp;amp;#39;s disease associated with diverticulae and cho... more We report a case of Caroli&amp;amp;amp;#39;s disease associated with diverticulae and choledochocele of the common bile duct, a wide pancreaticobiliary angle and non-cirrhotic portal hypertension. This patient presented with recurrent episodes of cholangitis. To our knowledge, such a range of findings in the same patient has not been previously reported in the English language literature.

Transactions of The Royal Society of Tropical Medicine and Hygiene, Jul 1, 2000

Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 94, Issue 4, Pages 404... more Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 94, Issue 4, Pages 404, July 2000, Authors:Renu Agarwal; A. Ayyagari; VB Yadav; KN Prasad; VA Saraswat. ...

Journal of Digestive Endoscopy, Apr 1, 2017

Background: We evaluated short-and long-term results of endoscopic drainage (a minimally invasive... more Background: We evaluated short-and long-term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy-seven patients (56 males), median age 36 years (range, 15-73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8-68), large (volume 582 mL [range, 80-2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty-nine patients were followed up (median 28 months, range 2-156; other eight lost to follow-up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001-0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03-135.95). Conclusion: Endoscopic drainage is safe and effective for PPC.

PubMed, Feb 5, 2000

Although sclerosing cholangitis is well recognized to occur in patients with idiopathic inflammat... more Although sclerosing cholangitis is well recognized to occur in patients with idiopathic inflammatory bowel disease, pancreatitis as a complication of ulcerative colitis is uncommon. We describe a patient who had idiopathic ulcerative colitis, primary sclerosing cholangitis and calcific pancreatitis with endocrine pancreatic deficiency, a rare combination.

PubMed, Jan 31, 2002

Introduction: Gastric Helicobacter pylori infection is believed to be associated with a higher ri... more Introduction: Gastric Helicobacter pylori infection is believed to be associated with a higher risk of hepatic encephalopathy among patients with cirrhosis of liver. However, the role of this infection in causation of subclinical hepatic encephalopathy has not been studied in detail. Methods: Patients with cirrhosis of liver but no hepatic encephalopathy underwent venous blood ammonia measurement, psychometric tests (number connection tests [NCT] and figure connection tests [FCT]), and gastric biopsies for presence of H. pylori infection. The results of blood ammonia and psychometric tests in the H. pylori-positive and -negative study subjects were compared. Results: Of 58 patients with liver cirrhosis studied, 31 had evidence of gastric H. pylori infection. Venous blood ammonia levels were comparable in patients with (median 29 mmol/L; range 18-47) and without (34 [15-48] mmol/L; p=ns) H. pylori infection. The time taken to complete NCT trail A (median 37 s [range 25-69] versus 36.5 [26-62]), NCT trail B (64 s [48-91] versus 63.5 [42-88]), FCT trail A (59 s [31-115] versus 58 [38-590]) and FCT trail B (76 s [55-187] versus 82 [36-125]) were similar in those with and those without H. pylori infection. For each of the four tests, the proportion of subjects with abnormal test results was similar among H. pylori-positive and -negative subjects. Conclusion: Presence of H. pylori infection among patients with cirrhosis of liver but no overt hepatic encephalopathy is not associated with increase in blood ammonia concentration or deterioration in psychomotor function.

Indian Journal of Gastroenterology, Jan 14, 2021

Diagnostic yield of an automated molecular test, Gene Xpert Mycobacterium tuberculosis /rifampici... more Diagnostic yield of an automated molecular test, Gene Xpert Mycobacterium tuberculosis /rifampicin (MTB/RIF), was evaluated in this study to simultaneously detect the MTB gene and resistance to rifampicin (RIF) on cytology samples acquired via endoscopic ultrasound (EUS)–guided fine-needle aspiration (FNAC) in suspected tubercular lymphadenitis. Microscopy, cytology, Gene Xpert MTB/RIF assay data on Acid-fast bacillus (AFB), and traditional culture of lymph nodes were retrospectively analyzed. Thirty-one patients (median age 33.5 years, inter-quartile range [IQR] 21–66, 18, 58% female) presented with fever (28, 90%), dysphagia (2, 7%), and recurrent subacute intestinal obstruction (1, 3%). Gene Xpert showed higher sensitivity (30, 97%) compared to the other tests: cytology (23, 77%; odds ratio [OR] 8.8, 95% confidence interval [CI] 1.0–76.9; p = 0.05), AFB smears (12, 39%; OR 50, 95% CI 5.9–420.4; p = 0.00001), and conventional culture (4, 13%; OR 188.5, 95% CI 19.7–1796.3; p = 0.0000). We conclude that Gene Xpert MTB/RIF test on EUS-guided FNAC samples is very useful to diagnose tubercular lymphadenitis.

PubMed, Jul 26, 2005

A report of post-ERCP Pseudomonas aeruginosa infection outbreak. ... There are no files associate... more A report of post-ERCP Pseudomonas aeruginosa infection outbreak. ... There are no files associated with this item. ... Items in Index Medicus for South-East Asia are protected by copyright, with all rights reserved, unless otherwise indicated. ... Index Medicus for South-East Asia Region ...

Journal of Gastroenterology and Hepatology, Feb 1, 1989

Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppu... more Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1-10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall-bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile-duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall-bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3-26 months (mean follow-up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.

PubMed, Dec 20, 2005

Background: Factor V Leiden (FVL) and prothrombin gene (G20210A) mutations are known to be associ... more Background: Factor V Leiden (FVL) and prothrombin gene (G20210A) mutations are known to be associated with venous thromboembolism. Several studies have shown an association of these mutations with hepatic venous outflow tract obstruction (HVOTO). We studied the prevalence of these mutations among patients with HVOTO in northern India in comparison with healthy population. Methods: Genomic DNA from patients with HVOTO and healthy controls was analyzed for the presence of FVL and prothrombin gene G20210A mutations, using PCR and restriction-fragment length polymorphism. Results: Fifty-nine patients with HVOTO (age 5-69 years, median 27; 39 male) and 49 unrelated healthy controls from the same geographic region were studied. Of the 59 patients, 19 had a block in the hepatic vein, 7 in inferior vena cava, and 33 had mixed block. Presentation was with acute thrombosis in 9 patients and with long-standing obstruction in 50 patients. Among 49 controls, heterozygous and homozygous FVL mutations were observed in 2 and 0 subjects, respectively, with an allele frequency of 2% (2 of 98). In comparison, among 59 patients with HVOTO, four had heterozygous and none had homozygous FVL mutation, with an allele frequency of 3.4% (p=ns versus controls). The G20210A prothrombin gene mutation was not found in any of the patients or controls. Conclusion: FVL and prothrombin G20210A mutations appear to have no role in the pathogenesis of HVOTO in our patients with Budd-Chiari syndrome, consisting largely of those with long-standing obstruction of the inferior vena cava.

Hepatology International, Feb 21, 2019

Background and aims In clinical studies, sofosbuvir-velpatasvir has demonstrated high cure rates ... more Background and aims In clinical studies, sofosbuvir-velpatasvir has demonstrated high cure rates and favorable tolerability in patients chronically infected with chronic hepatitis C virus (HCV) of any genotype. We evaluated the effectiveness and safety of sofosbuvir-velpatasvir administered with minimal medical monitoring to patients in India. Methods At 16 sites in India, 129 adult patients with chronic HCV infection of any genotype initiated 12 weeks of once-daily sofosbuvir-velpatasvir (400-100 mg). Patients with compensated cirrhosis or prior treatment experience could be included in the study. Study drug was dispensed monthly, but there were no on-treatment study assessments. The primary efficacy endpoint was rate of sustained virologic response (HCV RNA < 15 IU/mL) 12 weeks after treatment (SVR12), which was compared to a pre-specified performance goal of 85%. Results The majority of patients had HCV genotype 3 infection (70%), followed by HCV genotype 1 (22%). The SVR12 rate was 93% (120/129; 95% CI, 87% to 97%) (p = 0.009 compared with the 85% performance goal). Of the nine patients who did not achieve SVR12, 1 experienced virologic failure, 2 relapsed after treatment, 1 withdrew consent after treatment, and 5 were lost to follow-up (1 during and 4 after treatment). Sofosbuvir-velpatasvir was well-tolerated, and no patients discontinued treatment because of an adverse event. The most frequently reported adverse events were headache (3% of patients), upper abdominal pain (2%), and pyrexia (2%). Conclusions In this study conducted at multiple sites in India, sofosbuvir-velpatasvir administered without genotype restriction or on-treatment safety assessments was well-tolerated and highly effective.

PubMed, Dec 1, 2003

Minimal hepatic encephalopathy (mHE) consists of cognitive deficits found on neuropsychological a... more Minimal hepatic encephalopathy (mHE) consists of cognitive deficits found on neuropsychological and/or neurophysiologic methods in patients with liver disease, present most commonly in cirrhosis. Patients suffering from mHE may have psychomotor slowing and cognitive deficits affecting their ability to perform many activities of daily life, especially driving and other activities requiring subtle cognitive abilities. It has been now been shown that patients with mHE improve after treatment with agents like lactulose and other therapeutic interventions. Neuropsychological and neurophysiologic tests have been widely used and have shown the greatest promise for the detection of mHE. Commonly used psychometric tests include trailmaking tests (number and figure connection tests) and Wechsler Adult Intelligence Scale (WAIS) for verbal and performance skills. Among the various neuropsychological or psychometric tests, trailmaking tests and block design and digit symbol tests from WAIS-performance battery appear to be adequate for diagnosis of mHE. Standardized tests including NCT A and B, line tracing, serial dotting test and digits-symbol test (PSE syndrome test) validated in German patients need validation in other populations. Both exogenous evoked potentials and endogenous event-related potentials have been used extensively in diagnosing mHE. However, the event-related P300 wave is the most consistent wave and can be considered the electrophysiological counterpart of the psychometric tests as both involve active use of the cognitive faculties. Other new tests like the critical flicker frequency have shown some promise but further studies are required to substantiate initial results. In conclusion, a combination of at least two psychometric (trailmaking tests [NCT or FCT], block design and digit symbol test) and neurophysiological tests (P300 auditory evoked potential or electroencephalography with mean dominant frequency) appears to be optimal in detecting mHE.

Gastrointestinal Endoscopy, 1993

Rectal endoscopic ultrasonography was performed using an ultrasound fiberscope in 20 patients wit... more Rectal endoscopic ultrasonography was performed using an ultrasound fiberscope in 20 patients with cirrhotic portal hypertension (6 alcoholic patients, 4 patients with hepatitis B surface antigen positive, and 10 cryptogenic patients) and in 10 patients with irritable bowel syndrome as controls. Rectal varices were diagnosed endoscopically when either tortuous or saccular distended veins were seen beneath the mucosa. At rectal endoscopic ultrasonography rectal varices were seen as rounded or oval echo-free structures in the submucosa. Rectal endoscopic ultrasonography also showed perirectal veins outside the rectal wall. Rectal varices were detected by endoscopy in 9 patients and by rectal endoscopic ultrasonography in 17 patients. Rectal endoscopic ultrasonography also detected submucosal veins in 3 of 10 controls. The number and size of submucosal veins seen on rectal endoscopic ultrasonography in patients with portal hypertension were greater than in controls (p &amp;amp;amp;lt; 0.01 for both number and size). The size of perirectal veins was greater in patients than in controls (p &amp;amp;amp;lt; 0.05), although their number was no different (p = NS). A perforating vein communicating between a submucosal and perirectal vein was seen in only one patient. Rectal wall thickness was not different in patients and controls (p = NS). Rectal endoscopic ultrasonography was superior to endoscopy in detecting the presence (85% versus 45%, p &amp;amp;amp;lt; 0.01), and number (p &amp;amp;amp;lt; 0.01) of rectal varices. Our study suggests that rectal endoscopic ultrasonography is useful in detecting changes in rectal and perirectal vasculature in patients with cirrhotic portal hypertension.