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- Role of alpha-1 antitrypsin genotypes in the progression of adult liver diseasePublication . Pereira, Vítor Magno; Gaspar, R; Simões, C; Maia, L.; Costa, C; Carvão, J; Oliveira, G; Serrão, G; Jesus, V; Sucena, M.C; Santos, C; Gomes, J; Lages, J; Abreu S, I; Freitas, S; Carvalhana, S; Mandorfer, M; Cortez-Pinto, H; Macedo, C; Trauner, M; Liberal, R; Jasmins, L.
- Demystifying endoscopic retrograde cholangiopancreatography (ERCP)Publication . Magno Pereira, Vítor; Moutinho-Ribeiro, Pedro; Macedo, GuilhermeBackground: For many years, ERCP was avoided in pregnancy given the concerns regarding the adverse effects that, with special focus on radiation, could occur in the developing fetus. However, the postponement or rejection of ERCP in pregnant women, may lead to a higher risk for mother and fetus, especially when the indication is unequivocal, namely cholangitis, biliary pancreatitis and symptomatic choledocholithiasis. Summary and key messages: This review aims to summarize the scarce literature on the subject in order to plan ERCP in pregnancy with the highest safety. The use of techniques that reduce radiation and increase the protection of pregnant women allow radiation levels far below the safety limits. We also discuss the various alternatives of ERCP without radiation. EUS can eliminate the need for ERCP with doubtful choledocholithiasis and plan the best approach in those with previous evidence. The possibility of performing “ERCP” with a linear echoendoscope uniquely under ultrasound control has been described. Conversely, the two-step strategy (initial sphincterotomy with stent placement without fluoroscopy and after delivery, ERCP with lithiasis extraction) proved to be safe obviating fluoroscopy. In conclusion, ERCP can be performed in pregnancy safely and effectively with minimal radiation or even no-radiation at all.
- A Case of Unexplained Cutaneous Lesions, Cholestatic Hepatitis, and Noncirrhotic Portal Hypertension in a Female PatientPublication . Carvão, Joana; Pereira, Vítor Magno; Jasmins, LuísQuestion: A 57-year old woman with a previous history of contrast-related anaphylaxis was referred to the gastroenterology department with worsening liver function tests. She developed recurrent abdominal pain, diarrhea, significant weight loss, pruriginous generalized skin rash, and increased abdominal volume over 1 year. Physical examination revealed generalized small reddish monomorphic macules on the trunk and thighs (Figure A), hepatosplenomegaly, peripheral lymphadenopathy, and ascites. Blood tests showed normocytic normochromic anemia (hemoglobin 9.4 g/dL), monocytosis (1.3 103/mL), thrombocytopenia (97 103/mL), slight international normalized ratio prolongation, and a marked elevation of cholestasis parameters without jaundice (aspartate aminotransferase, 60 U/L; alanine aminotransferase, 56 U/L; gamma-glutamyl transferase, 324 U/L; and alkaline phosphatase, 1277 U/L). Abdominal Doppler ultrasound examination and a computed tomography scan revealed homogeneous hepatosplenomegaly (without signs of chronic liver disease), signs of portal hypertension without thrombosis of the splenoportal axis, moderate ascites, and intra-abdominal, axillary, and inguinal lymphadenopathies. Upper endoscopy showedesophageal varices and portal hypertensive gastropathy.Laboratory studies for chronic hepatopathy, infectious agents, and angiotensin-converting enzyme were negative. Bone marrow biopsy revealed granulomatous myelitis, and both lymphadenopathy and skin biopsies showed increased mononuclear cells.
- Risk Predictive Values of ACG Classification in a Cohort of Colon Ischemia: Redefining the Definition of Mild diseasePublication . Pereira, Vítor Magno; Simões, Carolina; Silva, Marco; Carvão, Joana; Oliveira, AntónioIntroduction: Although most cases of colon ischemia (CI) are mild and self-limiting, when severe it implies high mortality rates. We aimed to evaluate the risk predictive value of the classi!cation proposed by American College of Gastroenterology (ACG) guidelines (2015), created to provide a management algorithm.