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Can liver stiffness measurement accurately predict disease progression and clinical outcome in patients with metabolic dysfunction-associated steatotic liver disease and bridging fibrosis or cirrhosis?

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Hepatobiliary Surgery and Nutrition 2023年第6期12卷 912-915页

作者： Diederick J.van Doorn Adriaan G.Holleboom R.Bart Takkenberg Joanne Verheij marten a.lantinga Department of Gastroenterology and Hepatology Amsterdam UMCUniversity of AmsterdamAmsterdam Gastroenterology Endocrinology MetabolismAmsterdamThe Netherlands Department of Vascular Medicine Internal MedicineAmsterdam UMCUniversity of AmsterdamAmsterdam Gastroenterology Endocrinology MetabolismAmsterdamThe Netherlands Department of Hepatopancreatobiliary Pathology Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands

Diederick *** Doorn1,Adriaan ***2,*** Takkenberg1,Joanne Verheij3,marten ***11Department of Gastroenterology and Hepatology,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;2Department of Vascular Medicine,Internal Medicine,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;3Department of Hepatopanc Metabolic dysfunction-associated steatotic liver disease(MASLD)-until recently termed non-alcoholic fatty liver disease(NAFLD)-is a rising cause of chronic liver disease with an estimated global prevalence of 30%(1).

关键词： Cirrhosis liver stiffness steatotic liver disease

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Prevention of overuse: A view on upper gastrointestinal endoscopy

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World Journal of Gastroenterology 2019年第2期25卷 178-189页

作者： Judith J de Jong marten a.lantinga Joost PH Drenth Department of Gastroenterology Radboud University Medical Center

Many upper gastrointestinal(GI) endoscopies worldwide are performed for inappropriate indications. This overuse of healthcare negatively affects healthcare quality and puts pressure on endoscopy services. Dyspepsia is one of the most common inappropriate indications for upper GI endoscopy as diagnostic yield is low. Reasons for untimely referral are: unfamiliarity with dyspepsia guidelines,uncertainty about etiology of symptoms, and therapy failure. Unfiltered openaccess referrals feed upper GI endoscopy overuse. This review highlights strategies applied to diminish use of upper GI endoscopies for dyspepsia. First,we describe the impact of active guideline implementation. We found improved guideline adherence, but resistance was encountered in the process. Secondly, we show several forms of clinical assessment. While algorithm use reduced upper GI endoscopy volume, effects of referral assessment of individual patients were minor. A third strategy proposed Helicobacter pylori test and treat for all dyspeptic patients. Many upper GI endoscopies can be avoided using this strategy, but outcomes may be prevalence dependent. Lastly, empirical treatment with Proton pump inhibitors achieved symptom relief for dyspepsia and avoided upper GI endoscopies in about two thirds of patients. Changing referral behavior is complex as contributing factors are manifold. A collaboration of multiple strategies is most likely to succeed.

关键词： Endoscopy Dyspepsia Medical Overuse Guidelines Proton Pump Inhibitors Helicobacter pylori

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Evaluation of hepatic cystic lesions

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World Journal of Gastroenterology 2013年第23期19卷 3543-3554页

作者： marten a.lantinga Tom JG Gevers Joost PH Drenth Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Centre6500 HB Nijmegen The Netherlands

Hepatic cysts are increasingly found as a mere coincidence on abdominal imaging techniques, such as ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). These cysts often present a diagnostic challenge. Therefore, we performed a review of the recent literature and developed an evidence-based diagnostic algorithm to guide clinicians in characterising these lesions. Simple cysts are the most common cystic liver disease, and diagnosis is based on typical USG characteristics. Serodiagnostic tests and microbubble contrast-enhanced ultrasound (CEUS) are invaluable in differentiating complicated cysts, echinococcosis and cystadenoma/cystadenocarcinoma when USG, CT and MRI show ambiguous findings. Therefore, serodiagnostic tests and CEUS reduce the need for invasive procedures. Polycystic liver disease (PLD) is arbitrarily defined as the presence of > 20 liver cysts and can present as two distinct genetic disorders: autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (PCLD). Although genetic testing for ADPKD and PCLD is possible, it is rarely performed because it does not affect the therapeutic management of PLD. USG screening of the liver and both kidneys combined with extensive family history taking are the cornerstone of diagnostic decision making in PLD. In conclusion, an amalgamation of these recent advances results in a diagnostic algorithm that facilitates evidence-based clinical decision making.

关键词： Coincidental hepatic cystic lesions Cystic liver disease Complicated cyst Polycystic liver disease Diagnostic algorithm

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