IPEG 2024 Round Table Discussion from East Asia - Dr. Eri Ueda (Abe)

So first presenter is Doctor Ellie Weda Abe. She will present the casenob Viaria Treasure. Thank you all. I'm talking about our greatest case of beauty, a treasure. This case is a girl with barely a treasure. She was referred to a hospital at 41 days of age with a complaint of grayish stools starting at day 12. A diagnosis was made, and laparoscopic caci was performed 46 days of age, which was 34 days after the onset of symptoms. This is a short video. This action was performed mainly by bipolar instead of cadre. Transaction of the filo spirili laminant is the rebel of the hepatic capsule, and all the anastomotic sutures are just as usual. It took 2 months to be jaundice free after Lap cassa, which is longer than usual, but once it was free, she had a good cause without any ronitis or other problems and without any increase in bubine levels. However, the looting brought sampling showed. Anemia about one year after lab kite and GIF diagnosed the esophageal balysis. Then endoscopic treatment was plan, but before that she had tearly stools and further nemir developed. So liver transplantation was performed as a result of portal hypertension, but still beerbin levels were within the normal range. Here's the picture from liver transplantation in another hospital, which is nicely done. This is a message. Photo hypertension can develop even in the absence of jaundice, so we need the conservation of hemoglobin check and GIF even in jaundice-free. We are happy to discuss those points. Thanks again. Thanks, Ellie. Now, once again, welcome to the, the, our discussion for the, you know, the commentators. Yeah, thank you, uh, uh, Doctor, Doctor, you do, uh, Eric, Eric, yeah, yes, uh, I just wonder if there are any injury. Uh, to the, uh, portal vein during the CASA procedure, uh, can you, uh, tell us what is the reason? Actually this is my case, so I can answer, but, uh, during the operation for the, uh, initial lab casa, there is no, you know, the injury for the portal vein or anything, you know, just the usual, and then, uh. Actually, dissection and anastomos, everything is, you know, just as usual, then post-operative state that is also. Uneventful. So, uh, actually, I didn't expect to like this. So, uh, does the patient, uh, did the patient had a hyper potential of the uh portal vein before the before the procedure do you still have some. It's just as usual actually. There is no specific. So can we, can we get a poll for this presentation. So the message is that portal hypertension can develop even without the jaundice, so. Yeah, thanks. This is the routine DIF checkup after exercise for BDI treasure. Wow, that's great. Even normal bedroom. So 76% of the audience. Is doing the Gastrointestinal fiber as a routine check. Actually, this, you know, the, the liver transplantation was done in the hospital of Doctor Isimal's center, so Letzia, do you have any comments about this case? Uh, I have a question. Yeah. Um, Um, what, what period, so maybe you, you had another, uh, children with, uh, such complication before. I, I don't know. Uh, so what period, uh, do you think is crucial to, um, To check after such surgery, so how long it takes. To develop I think, I, I think it's depending on the nations, but, uh, so basically, the routine checkup at least once in 6 months. But basically, just checking the ultrasounds as well as the blood sample test. Not for the GI fibers, but from this experience of this case, maybe we have to, you know, prepare for the Uh, GI fibers in Every in several years. Do you have any comments? Hello, uh, she was referred to my hospital and underwent liver transplantation by transplant team and, uh, Um, so I checked her medical record. She's doing well, and, uh, she stayed only 5 days in ICU and, uh, she started oral intake postoperative day 7, and all drains were removed, uh, postoperative day 14. So that means, uh, there's no problem. She's very, uh, good. No, no uneventful cause. She's very good. Yeah. Thank you so much. Any comments? So do you perform sonography to check the flow of the port and vein after the Kasa operation? Yeah, actually, we didn't, but we have to think about it. Thank you. So, I think, uh, I. Um, I think, uh, it depends on the expertise of the local pediatricians because, um, We don't do the, the panendoscopes ourselves. So pediatrician will, will routinely check the bloods and the, and the ultrasound looking for splenomegaly. Uh, like, we didn't, we don't routinely check for the portal vein pressure, which, which maybe we should. And it's always difficult to say when we should perform the endoscope, whether it's prophylactically in uh fixed intervals. Or only when the symptoms occur. So, for now, we don't, we do, we do not do routine, uh, panel scope, uh, to look for varices. Um, I think it's only when the symptoms occur. So it's quite difficult to, to, to, to see this early or prevent it. Um, I think it's only when the symptoms arrive, unless you do the panoscope every 6 months or 12 months. Thank you. Thank you. So, uh, you know, there is a, a question from the chat. What is a GIF? So, GIF is a GI gastrointestinal fiber. Sorry about that. And you know, Eddie, do you have final comments? Something about this case? Actually, this case was just recently done, so we would make further analysis, especially if a skull out, if there are some key factors that other hypertension can be developed even with the jaundice and ronitiss. Thank you. Thanks Ellie. So we can move on to the next presentation. Doctor Sam, we have a very, very goal. Do we have a consensus of the about the timing of, uh, pan endoscope among our panelists? You just do, do somebody do them routinely or only when the symptoms occur? Any comments? We don't do that routinely, so. What about in Korea? Uh, can I answer this, these questions? I'm coming in from Korea, Dos Hospital Children's, uh, in, uh, it's different by case by case and center by center and also in Korea. In our center, uh, we, we do not routinely check the endoscopic examination for only, we, but we, uh, sly check the hepatic Uh, virus scan or uh biotrasonographically with uh erography. So we uh evaluated and published some cutoff line of uh uh F4 fibrosis 4/10, 9.4 kilopascal uh by virus scan, we checked, uh, chart surveillance by endoscopic, uh. Once in a year or once in 2 years. So that is uh that depend the duration or term is depend on, is, uh, depend on theenterologist. So we check, uh, the endoscopic by the uh development of a progression of fibrosis of liver. That's a nice option. I had a question for, for the panel. Do you guys correlate pathology, you know, during first CASA to see where you guys go, if, you know, and follow the fiber scan before you pull the trigger and a redo. Yeah, during the operation, we always check the, uh, the diameter of the, the bile duct. OK. And you kind of correlate with fiber scan. We, we do fiber scans here as a follow-up, but not, uh, not a routine, you know, not routinely, yeah, actually not routinely, yeah, yeah. But we have to think about it.