Khalil Ur Rehman

Background/Objectives: Laparoscopic cholecystectomy (LC) is the current gold standard in patients with acute cholecystitis. Percutaneous cholecystostomy (PC) remains an option for those who are not surgical candidates but is associated with adverse effects. We studied technical success and patient satisfaction for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) after initially receiving a PC drain. Methods: A multi-center study was conducted at 4 institutions involving patients who initially received a PC. These patients were given the option to transition to receive EUS-GBD. A 5-point Likert scale was used to assess patient satisfaction comparing PC vs. EUS-GBD. Demographic data, including age, sex, reason for PC, complications, and patient satisfaction scores, were collected. Result: All seven patients who underwent percutaneous cholecystostomy rated their experience as 1 (very dissatisfied), whereas the same patients rated EUS-guided gallbladder drainage with a mean satisfaction score of 4.7 (very satisfied). Conclusions: EUS-GBD is effective and offers higher satisfaction scores in patients who are not surgical candidates.

Background: Hepatitis C virus (HCV) remains a major cause of preventable liver-related mortality in the United States despite highly effective direct-acting antivirals (DAAs). Contemporary assessment of mortality trends and disparities is essential for elimination efforts. Methods: Using CDC WONDER multiple cause-of-death data (1999–2023), we identified HCV-related deaths using ICD-10 codes for acute and chronic HCV (B17.1, B18.2) and calculated age-adjusted mortality rates (AAMRs) per 100,000 (2000 US standard). Rates were stratified by sex, race/ethnicity, census region, and 2013 NCHS urban–rural classification. Joinpoint regression quantified temporal inflection points and annual percent changes (APCs). Results: Overall HCV-related AAMR increased from 1.8 (1999) to a peak of 5.0 (2014), then declined to 2.3 (2023), with a marked post-2014 decrease (APC −8.2%). Mortality was consistently higher in males than females (2023 rate ratio 2.57). In 2023, American Indian/Alaska Native individuals had the highest mortality (AAMR 8.7; rate ratio 3.48 vs. non-Hispanic White), followed by non-Hispanic Black individuals (AAMR 6.2; rate ratio 2.48). Mortality remained highest in the West and was higher in non-metropolitan than metropolitan counties (AAMR 2.8 vs. 2.3; rate ratio 1.22), with a slower post-2014 decline in non-metropolitan areas. Conclusions: Our findings indicate that while the DAA era has been associated with a substantial reduction in HCV-related mortality at the national level, this progress has not been uniform across all populations. Persistent excess mortality among Native American and non-Hispanic Black individuals may reflect inequities in the HCV care cascade, including screening, confirmatory testing, linkage to specialty care, insurance-related restrictions, and the high cost of antiviral therapy. These results highlight the need for policies and public health strategies that improve equitable and affordable access to curative HCV treatment.

Background/Aim: Hepatitis D virus (HDV) infection is the most severe form of viral hepatitis but is under-recognized. We evaluated HDV screening frequency and clinical characteristics of HDV-positive patients in our liver center in the United States. Method: Patients with chronic hepatitis B (CHB) evaluated between January 2021 and December 2023 were included. For those tested anti-HDV(+), HDV RNA was performed and clinical data were recorded. Results: Among 1,337 (M=716, F=621) CHB patients, 93.3% were foreign-born. The cohort included 74.9% Asians, 12.3% Blacks, 9.1% Whites and 1.3% Hispanics. HDV screening significantly increased after 2011 reflecting an increase in HDV awareness. Patients aged 18-40 years had the highest screening rate of 58%. Overall, 13 (1.95%) were tested HDV positive and 11 were repeatedly HDV RNA(+). PWID was noted in 5 of 11. Despite low HBV DNA levels, all had ≥stage 2 fibrosis, and 7 had advanced stage 3-4 disease. After a median follow-up of 8.75 years, 8 (73%) developed hepatic decompensation and 4 had hepatocellular carcinoma. Conclusion: HDV screening reached 51.3% among our predominantly foreign-born CHB patients. The high prevalence of advanced fibrosis at diagnosis underscores the importance of HDV screening. Early diagnosis and effective therapy are urgently needed for this challenging disease.

The concurrent seropositivity of HBsAg and anti-HBs has been described among patients with chronic hepatitis B (CHB), but its prevalence is variable. HBV S-gene mutations can affect the antigenicity of HBsAg. Patients with mutations in the ‘α’ determinant region of the S gene can develop severe HBV reactivation under immunosuppression. In this study at a tertiary liver center in the United States, we evaluated the frequency and virological characteristics of the HBsAg mutations among CHB patients with the presence of both HBsAg and anti-HBs. In this cohort, 45 (2.1%) of 2178 patients were identified to have a coexistence of HBsAg and anti-HBs, and 24 had available sera for the genome analysis of the Pre-S1, Pre-S2, and S regions. The frequency of mutations in the S gene was significantly higher among those older than 50 years (mean 8.5 vs. 5.4 mutations per subject, p = 0.03). Twelve patients (50%) had mutations in the ‘α‘ determinant region of the S gene. Mutations at amino acid position 126 were most common in eight subjects. Three had a mutation at position 133. Only one patient had a mutation at position 145—the classic vaccine-escape mutation. Despite the universal HBV vaccination program, the vaccine-escape mutant is rare in our cohort of predominantly Asian patients.