Background Ascites is a common, painful, and serious complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. Objective This study aims to evaluate the feasibility of a smartphone app in facilitating outpatient ascites management. Methods In this feasibility study, patients with cirrhotic ascites requiring active management were identified in both inpatient and outpatient settings. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a smartphone app and then via the internet to an electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change of ≥5 lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were the percentage of enrolled days during which weight data were successfully transmitted to an EMR and the percentage of weight alerts that prompted responses by the provider. Results In this study, 25 patients were enrolled: 12 (48%) were male, and the mean age was 58 (SD 13; range 35-81) years. A total of 18 (72%) inpatients were enrolled. Weight data were successfully transmitted to an EMR during 71.2% (697/979) of the study enrollment days, with technology issues reported on 16.5% (162/979) of the days. Of a total of 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) were by weight gain. Providers responded in some fashion to 66 (84%) of the weight alerts and intervened in response to 45 (57%) of the alerts, for example, by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose, or requesting a laboratory workup. Providers responded equally to weight increase and decrease alerts (P=.87). The staff called patients a mean of 3.7 (SD 3.5) times per patient, and the number of phone calls correlated with technology issues (r=0.60; P=.002). A total of 60% (15/25) of the patients chose to extend their participation beyond 30 days. A total of 17 patient readmissions occurred during the study period, with only 4 (24%) related to ascites. Conclusions We demonstrated the feasibility of a smartphone app to facilitate the management of ascites and reported excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among patients with cirrhosis.

Objectives: Preoperative biliary stenting is required for patients with obstructive jaundice from pancreatic adenocarcinoma who are receiving neoadjuvant chemotherapy. While in most patients this approach results in durable biliary drainage, some patients develop cholangitis during neoadjuvant treatment. Further, several studies have shown that preoperative cholangitis in patients with hepatobiliary malignancies can result in substantially unfavorable outcomes. The aim of this study was to evaluate the impact of preoperative cholangitis in patients who underwent pancreaticoduodenectomy after completing neoadjuvant chemotherapy. Methods: Participants: all adult patients (n ¼ 449) diagnosed with pancreatic adenocarcinoma from January 1st, 2013 to March 31st, 2018 who pursued treatment at the Massachusetts General Hospital were screened. Of these 449 patients, 97 met final inclusion criteria of receiving neoadjuvant chemotherapy with intent to pursue curative surgery. Data were collected via retrospective chart review including baseline characteristics, survival, episodes of preoperative cholangitis, and surgical complications. Results: In patients completing successful pancreaticoduodenectomy surgery, preoperative cholangitis is associated with increased mortality (HR 2.67, 95% CI:1.16e6.13). This finding is independent of postoperative outcomes or tumor recurrence rate. The presence of cholangitis did not impact completion of neoadjuvant chemotherapy (92% vs 85%, p ¼ 0.5) or ability to proceed to surgery (76% vs 75%, p ¼ 1.0). Preoperative cholangitis was not associated with postoperative morbidity (42.1% vs 45.1%, p ¼ 1.0). Conclusions: One episode of cholangitis during neoadjuvant chemotherapy is associated with increased mortality following successful pancreaticoduodenectomy, independent of immediate postoperative outcomes or tumor recurrence. Preoperative cholangitis does not affect ability to pursue neoadjuvant chemotherapy or complete successful surgery. Patients who develop cholangitis during the neoadjuvant chemotherapy treatment phase may reflect a distinct phenotype of patients with PDAC with a complex and more challenging clinical course.

BACKGROUND Ascites is a common, painful, and dangerous complication of cirrhosis. Body weight is a reliable proxy for ascites volume; therefore, daily weight monitoring is recommended to optimize ascites management. OBJECTIVE This study evaluates the feasibility of a Smartphone application in facilitating outpatient ascites management. METHODS In this feasibility study, cirrhotic patients with ascites requiring active management were identified in both the inpatient or outpatient setting. Patients were provided with a Bluetooth-connected scale, which transmitted weight data to a Smartphone application, and then via the internet to the electronic medical record (EMR). Weights were monitored every weekday. In the event of a weight change ≥ 5lbs in 1 week, patients were called and administered a short symptom questionnaire, and providers received an email alert. The primary outcomes of this study were percentage of enrolled days during which weight data was successfully transmitted to the EMR, and the percentage of weight alerts which prompted a response by the provider. RESULTS Twenty-five patients were enrolled: 12 (48%) were male and mean age was 58 years (range 35-81 years). Eighteen (72%) were enrolled as inpatients. Cirrhosis etiology was alcohol-related in 44%, non-alcoholic steatohepatitis in 36%, and viral in 12%. Weight data was successfully transmitted to the EMR during 71% of study enrollment days, with technology issues reported on 17% of days. Of a total 79 weight change alerts fired, 41 (52%) were triggered by weight loss and 38 (48%) by weight gain. Providers responded in some fashion to 84% of weight alerts, and intervened in response to 57% of alerts, for example by contacting the patient, scheduling clinic or paracentesis appointments, modifying the diuretic dose or requesting laboratory workup. Fifteen (60%) patients chose to extend their participation beyond 30 days. Seventeen readmissions occurred during the study period, with only 4 related to ascites. CONCLUSIONS We demonstrate the feasibility of a Smartphone application in facilitating the management of ascites. We report excellent rates of patient and provider engagement. This innovation could enable early therapeutic intervention, decreasing the burden of morbidity and mortality among cirrhotic patients. CLINICALTRIAL NA