[Treatment with endoscopic endoprosthesis in choledocholithiasis]

The results of the placement of endoscopic endoprosthesis in 51 patients with choledocholithiasis from October 1991 to December 1995 are reviewed. In 13 cases the endoprosthesis was provisionally placed. Surgical or endoscopic treatment was electively completed in all the cases. Thirty-eight patients received the endoprosthesis on a permanent basis. During the follow up (mean 15.2 months) extraction was completed and the prosthesis removed in three cases, one by emigration. Six patients presented recurrent biliary obstruction and underwent surgery or replacement of another prosthesis. In the latter cases, another two underwent surgery due to repeated obstructions. The remaining patients remained asymptomatic until the end of follow up or until death (8 cases) due to unrelated causes. Only three mild episodes of cholangitis were observed as complications related to prosthesis placement. The authors conclude that endoscopic endoprosthesis is an effective provisional treatment to solve acute situations and is a permanent alternative for unextracted choledocholithiasis following sphincterotomy in patients who cannot undergo other techniques and who have a short life expectancy.

[Retrospective multicenter study of the efficacy of interferon alpha in chronic hepatitis C]

BACKGROUND

Until very recently, interferon (INF) in Spain was authorized in chronic hepatitis C (C-HCV) at a dosis of 3 megaunits (mu) for 6 months. Nonetheless, the rate of maintained complete response is lower than that obtained with more prolonged treatments. The first aim of this study was to retrospectively know the effectiveness of alpha INF in patients treated for 6 or 12 months with a dosis of 3 or 5-6 MU. The second was to analyze the characteristics of the patients who achieved a maintained complete response.

PATIENTS AND METHODS

Patients with C-HCV treated in 9 hospitals in Andalucía, Spain who fulfilled the following conditions were retrospectively analyzed: liver biopsy prior to treatment, positive test for anti HCV and a follow up of at least 6 months after alpha INF treatment. A total of 344 patients were studied: 267 treated with alpha INF-2b, 51 with alpha INF-2a and 26 with lymphoblastoid INF. One hundred ninety-five patients were treated for 6 months and 149 for 12 months.

RESULTS

Seventy-seven (22%) of the patients presented maintained complete response, 170 (50%) did not respond and 97 (28%) relapsed. On comparing the three types of interferon used over 6 months, no significant differences were observed. Neither were differences found on comparing the dosis of 3 mu versus 5 or 6 mu. On analyzing the treatments of 6 and 12 months, the following was observed, respectively: maintained complete response 15% vs 32%, relapse 29% vs 30% and non responders 57% vs 38% (p < 0.001). Multivariate analysis demonstrated that the patients who responded the best to INF were those who presented the following characteristics: female sex, age under 40 years last, history of transfusion or IVDA, basal GPT level higher than 145 IU/I, GGT less than 55 IU/I, less evolved histologic lesions and duration of treatment over 12 months.

CONCLUSIONS

Of the different treatments analyzed with alpha interferon in chronic hepatitis C, the best was found to be that with 3 mu during 12 months.

[Portal thrombosis, common bile duct varices and cholestasis]

A case of cholestasis in a young patient with portal cavernomatosis is reported. This clinical picture is very infrequent and appears as a consequence of extrinsic compression on the common bile duct due to which the derivative venous collaterals. There does not appear to be any relationship between the intensity of the morphologic alteration of the biliary tract and the level of portal hypertension and the degree of extrahepatic obstruction. Diagnosis was fundamentally achieved by arteriography and retrograde cholangiography with differential diagnosis with the previously mentioned diseases being required. Chronic cholestasis advises derivative surgery in which difficulties may be found due to the presence of thick collaterals in the hepatic pedicle as occurred in this patient.