Case Series Review of the Safety and Effcacy of Endoscopic Ultrasound-Guided Splenic Mass Core Biopsy

Sammy Saab,Youssef Challita,David Holloman,Kelli Hathaway,Michel Kahaleh,Jose Nieto 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

Relationship between Telomere Maintenance and Liver Disease

Abbey Barnard,Ashley Moch,Sammy Saab 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.1

Previous studies have established a correlation between increasing chronological age and risk of cirrhosis. This pattern raised interest in the role of telomeres and the telomerase complex in the pathogenesis of liver fibrosis and cirrhosis. This review aims to summarize and analyze the current understanding of telomere regulation in hepatocytes and lymphocytes and how this ultimately relates to the development of liver fibrosis. Notably, in chronic viral hepatitis, telomere shortening in hepatocytes and lymphocytes occurs in such a way that may promote further viral replication while also leading to liver damage. However, while telomere shortening occurs in both hepatocytes and lymphocytes and ultimately results in cellular death, the mechanisms of telomere loss appear to be initiated by independent processes. The understanding of telomere maintenance on a hepatic and immune system level in both viral and non-viral etiologies of cirrhosis may open doors to novel therapeutic strategies.

Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions

( Duminda Suraweera ),( Vinay Sundaram ),( Sammy Saab ) 대한간학회 2016 Gut and Liver Vol.10 No.4

Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. (Gut Liver 2016;10:509-519)

Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

Edward Wolfgang Lee,Lourdes Alanis,조성기,Sammy Saab 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.4

Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

Extrahepatic Manifestations of Primary Biliary Cholangitis

( Sara L Chalifoux ),( Peter G Konyn ),( Gina Choi ),( Sammy Saab ) 대한간학회 2017 Gut and Liver Vol.11 No.6

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by progressive destruction of the intrahepatic bile ducts, leading to cholestasis. PBC is known to have both hepatic and extrahepatic manifestations. Extrahepatic manifestations are seen in up to 73% of patients with PBC, with the most common being Sjogren’s syndrome, thyroid dysfunction and systemic sclerosis. It is thought that patients with PBC are at increased risk of developing these extrahepatic manifestations, almost all of which are autoimmune, because patients with autoimmune disease are at higher risk of developing another autoimmune condition. Due to the high prevalence of extrahepatic diseases in patients with PBC, it is important to complete a thorough medical history at the time of diagnosis. Prompt recognition of extrahepatic disease can lead to improved patient outcomes and quality of life. The following review summarizes the most common extrahepatic conditions associated with PBC. (Gut Liver 2017;11:771-780)

Effectiveness of Hepatitis C Virus (HCV) Screening Laws in United States [US]: Evidence from Paid Claims Data from 2010 to 2016

( Darshan Mehta ),( Jeffrey Mccombs ),( Yuri Sanchez Gonzalez ),( Steven Marx ),( Sammy Saab ),( Yongkyun Won ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The World Health Organization [WHO] has set a goal of having 90% of the world’s population screened for chronic hepatitis C (HCV) infection by 2030. Starting from 2014 in the United States (US) 5 states (NY, CA, CT, MA, CO) implemented new HCV screening policies. This study assesses the effectiveness of these screening laws and projects states’ progress toward the WHO target. Methods: Claims data for 2010-2016 from Optum Clinformatics ® Data Mart, a de-identified claims database from the US were analyzed. HCV screening was identified by paid claims for CPT codes 86803, 86804, or G0742. Logistic regression models of the likelihood of a patient being screened were estimated, controlling for patient demographic and clinical characteristics. Three time periods [2010; 2011-13 and 2014-16] were used to measure the effect on screening of the availability of the newer curative agents. Variables identifying states with screening policies were entered as interaction terms with the post-2014 time period to test if new screening policies enhanced screening rates, independent of the availability effect of the newer agents. Further, the proportion of the population screened in each state was extrapolated to 2050 using each state’s 2014-16 screening rates applied to an assumed baseline diagnosis rate of 50%. Results: Relative to the annual screening rate in 2010, annual screening rates were increased by 19.9% post 2014. In the states that passed screening laws, the annual post 2014 screening rates were increased by an additional 6.4%. Among the states that passed screening laws, MA and CT increased annual screening rates but policies in NY, CA and CO had no significant effect. Other factors that increased the likelihood of a patient being screened were female gender, Medicare enrollment and presence of comorbidities like chronic kidney disease, mixed cryoglobulinemia, fatigue and coinfection with HIV and/ or HBV. Projections of screening rates suggest that NY and 4 other states without screening laws were on track to reach the WHO target by 2030 with 8 additional states attaining WHO target by 2040. 29 states would not attain this target by 2050. Conclusions: The availability of curative therapies has increased the likelihood of screening for HCV. While current efforts to increase annual HCV screening have had positive impact, over 90% of states in the US are still not on track to reach WHO target by 2030.