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Innovations in endoscopic ultrasound for portal hypertension and its role in managing complications in clinical practice:Lessons learned from a tertiary referral public hospital

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Portal Hypertension & Cirrhosis 2024年第1期3卷 31-35页

作者： Cosmas R.A.Lesmana Kemal F.Kalista Saut H.H.Nababan Juferdy Kurniawan Chyntia O.M.Jasirwan Andri S.Sulaiman Irsan Hasan rino a.gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalMedical Faculty Universitas IndonesiaJakartaIndonesia Digestive Disease&GI Oncology Center Medistra HospitalJakartaIndonesia Gastrointestinal Cancer Center MRCCC Siloam Semanggi HospitalJakartaIndonesia

Portal hypertension(PH)poses significant *** paper presents an innovative study on the utilization of endoscopic ultrasound(EUS)for both the diagnosis and management of *** at *** Mangunkusumo National General Hospital in Jakarta,this retrospective case series included patients diagnosed with PH through clinical examination,imaging evaluation,and *** criteria comprised a history of reduced blood consumption within the last 5 days,hepatocellular carcinoma,massive ascites,or elevated international normalized ratio(>1.4).EUS-guided portal pressure gradient(PPG)measurements were performed using an innovative standard *** study involved 15 patients,with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari *** them,nine patients experienced bleeding due to gastroesophageal *** and large esophageal varices were identified in four and eight patients,*** varices type 1 were observed in two patients,and type 2 in four *** gastric fundal varices type 1 were present in one *** on EUS-PPG measurements,14 patients exhibited clinically significant portal *** patients underwent endoscopic band ligation and three underwent EUS-guided cyanoacrylate injection during the same session as the EUS-PPG measurement ***,no adverse events,such as abdominal pain,perforation,or bleeding were observed during or after the *** emerges as a promising and accurate tool for both diagnosis and management.

关键词： cyanoacrylate injection endoscopic ultrasound liver cirrhosis portal hypertension portal pressure gradient

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Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment:A case series

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Portal Hypertension & Cirrhosis 2022年第1期1卷 76-81页

作者： Cosmas Rinaldi A.Lesmana Saut H.Nababan Kemal F.Kalista Juferdy Kurniawan Chyntia O.M.Jasirwan Andri S.Sulaiman Irsan Hasan rino a.gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalJakartaIndonesia Digestive Disease and GI Oncology Center Medistra HospitalJakartaIndonesia

Aim:The presence of esophageal collateral veins(ECV)has been reported to be associated with the recurrence of esophageal varices(EV)and bleeding in liver cirrhotic(LC)*** study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound(EUS)in liver cirrhotic patients with ***:During 6 months period,a prospective study is conducted,where we identified LC patients who were admitted for esophagogastroduodenoscopy(EGD)screening at the Department of Internal Medicine,*** Mangunkusumo National General Hospital,*** was examined using *** were excluded if they had(1)liver malignancy,(2)history of ligation or glue injection,or(3)portal or splenic vein *** collected demographic data,medical history,data pertaining to use of nonselective beta blocker(NSBB),and laboratory,imaging,and endoscopy *** was performed using a gastroscope(EG29‐i10,3.2 mm Pentax Medical)while EUS was performed using a linear array echoendoscope(EG‐3870UTK,3.8 mm,Pentax Medical)before band ligation or glue ***:There were 20 LC patients included in this study,where 15(75%)of patients were classified with Child-Pugh(CP)‐A and five(25%)of patients with CP‐*** most common aetiologies were hepatitis B in seven(35%)patients and hepatitis C in nine(45%)*** EV with peri‐or para‐esophageal veins(PEEV or PAEV)were detected in 65%of *** of the LC patients with no EV showed the presence of *** or PAEV were detected in grades 1-3 ***:EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.

关键词： endoscopic ultrasound esophageal collateral vein gastroesophageal varices liver cirrhosis portal hypertension

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An international Delphi consensus statement on metabolic dysfunction-associated fatty liver disease and risk of chronic kidney disease

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 386-403,I0014-I0016页

作者： Dan-Qin Sun Giovanni Targher Christopher D.Byrne David C.Wheeler Vincent Wai-Sun Wong Jian-Gao Fan Herbert Tilg Wei-Jie Yuan Christoph Wanner Xin Gao Michelle T.Long Mehmet Kanbay Mindie H.Nguyen Sankar D.Navaneethan Yusuf Yilmaz Yuli Huang rino a.gani Pierluigi Marzuillo Jérôme Boursier Huijie Zhang Chan-Young Jung Jin Chai Luca Valenti George Papatheodoridis Giovanni Musso Yu-Jun Wong Mohamed El-Kassas Nahum Méndez-Sánchez Silvia Sookoian Michael Pavlides Ajay Duseja Adriaan G.Holleboom Junping Shi Wah-Kheong Chan Yasser Fouad Junwei Yang Sombat Treeprasertsuk Helena Cortez-Pinto Masahide Hamaguchi Manuel Romero-Gomez Mamun Al Mahtab Ponsiano Ocama Atsushi Nakajima Chunsun Dai Mohammed Eslam Lai Wei Jacob George Ming-Hua Zheng Department of Nephrology Jiangnan University Medical CenterWuxiChina Affiliated Wuxi Clinical College of Nantong University WuxiChina Section of Endocrinology Diabetes and MetabolismDepartment of MedicineAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly Southampton National Institute for Health and Care Research Biomedical Research Centre University Hospital Southamptonand Southampton General HospitalUniversity of SouthamptonSouthamptonUK Department of Renal Medicine University College LondonLondonUK Department of Medicine and Therapeutics Chinese University of Hong KongHong KongChina Center for Fatty Liver Department of GastroenterologyXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina Department of Internal Medicine I GastroenterologyEndocrinology&MetabolismMedical University InnsbruckInnsbruckAustria Department of Nephrology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina Division of Nephrology Department of MedicineWürzburg University ClinicWürzburgGermany Department of Endocrinology and Metabolism Zhongshan HospitalFudan UniversityShanghaiChina Section of Gastroenterology Boston Medical CenterBoston University School of MedicineBostonMAUSA Division of Nephrology Department of Medicine(M.K.)Koc University School of MedicineIstanbulTurkey Division of Gastroenterology and Hepatology Department of MedicineStanford University Medical CenterPalo AltoCAUSA Department of Epidemiology and Population Health Stanford University Medical CenterPalo AltoCAUSA Section of Nephrology and Institute of Clinical and Translational Research Baylor College of Medicineand Michael E.DeBakey VA Medical CenterHoustonTXUSA Department of Gastroenterology School of MedicineMarmara UniversityIstanbulTurkey Department of Gastroenterology School of MedicineRecep Tayyip Erdoğan UniversityRizeTurkey Department of Cardiology Shunde HospitalSouthern Medical UniversityFoshanChina Division of Hepat

Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly *** 2020,the more inclusive term metabolic dysfunction-associated fatty liver disease(MAFLD)was proposed to replace the term non-alcoholic fatty liver disease(NAFLD).The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without ***,to date,there is no appropriate guidance on CKD in individuals with ***,there has been little attention paid to the link between MAFLD and CKD in the Nephrology *** and Results:Using a Delphi-based approach,a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and ***:This Delphi-based consensus statement provided guidance on the epidemiology,mechanisms,management and treatment of MAFLD and CKD,as well as the relationship between the severity of MAFLD and risk of CKD,which establish a framework for the early prevention and management of these two common and interconnected diseases.

关键词： Metabolic dysfunction-associated fatty liver disease(MAFLD) non-alcoholic fatty liver disease(NAFLD) chronic kidney disease(CKD) consensus

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Therapeutic interventional endoscopic ultrasound in pancreatobiliary disorders:Does it really replace the surgical/percutaneous approach?

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 537-547页

作者： Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha rino Alvani gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalMedical Faculty Universitas IndonesiaJakarta 10430Indonesia Digestive Disease and GI Oncology Center Medistra HospitalJakarta 12950Indonesia

Pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology,as they would sometimes require multi-approach interventional ***,therapeutic interventional endoscopic ultrasound(EUS)has emerged as a potential alternative to surgical or percutaneous ***,considering the high cost of EUS,lack of facility and expertise,most gastroenterologists still often refer cases to undergo surgical interventions without contemplating the possibility of utilizing EUS ***-guided biliary drainage has become one of the best choices for establishing access to biliary system,given the clear visualization of pancreas,gallbladder,and common bile *** there are still only a few studies which directly compare EUSguided and surgical approaches for biliary drainage,current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and reintervention rates,with similarly high technical and clinical success rates compared to percutaneous and surgical approaches,especially in patients with history of failed endoscopic retrograde cholangiopancreatography *** success rates with shorter length of hospital stay between endoscopic and surgical approaches have also been exhibited for pancreatic pseudocysts and walled-off *** findings about the progress of EUS approach in gastroenterostomy/jejunostomy also indicated a promising potential of EUS,as a less invasive approach,for managing gastric outlet obstruction.

关键词： Pancreato-biliary Endoscopic ultrasound Percutaneous approach Surgical approach Biliary drainage Pancreatic fluid collection

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Association of core promoter mutations of hepatitis B virus and viral load is different in HBeAg(+) and HBeAg(-) patients

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World Journal of Gastroenterology 2011年第6期17卷 708-716页

作者： Andi Utama Marlinang Diarta Siburian Sigit Purwantomo Mariana Destila Bayu Intan Tri Shinta Kurniasih Susan Tai rino Alvani gani Laurentius Adrianus Lesmana All Sulaiman Wenny Astuti Achwan Soewignjo Soemohardjo Arnelis Nasrul Zubir Julius Syafruddin AR Lelosutan Benyamin Lukito Tantoro Harmono Molecular Epidemiology Division Mochtar Riady Institute for Nanotechnology Universitas Pelita Harapan Lippo Karawaci Tangerang 15810 Indonesia Hepatology Division Department of Intemal Medicine Faculty of Medicine University of Indonesia Jakarta 10430 Indonesia Department of Internal Medicine Mataram General Hospital Mataram 83127 Indonesia Gastroentero-Hepatology Division Department of Internal Medicine Dr. M. Jamil Hospital Padang 25127 Indonesia Gastroentero-Hepatology Division Department of Intemal Medicine Dr. Gatot Soebroto Hospital Jakarta 10410 Indonesia Department of Internal Medicine Siloam Hospital Lippo Village Tangerang 15810 Indonesia Department of Internal Medicine Dr. Moewardi Hospital Surakarta 57126 Indonesia

AIM:To identify the prevalence of hepatitis B e antigen (HBeAg) and to assess the association of hepatitis B virus (HBV) core promoter mutations and viral load in Indonesian ***:Sixty-four patients with chronic hepatitis,65 with liver cirrhosis and 50 with hepatocellular carcinoma were included in this *** and hepatitis B e antibody (HBeAb) tests were performed using enzyme-linked immunosorbent assay and the mutations were analyzed by *** load was measured by real-time polymerase chain ***:Of 179 patients,108 (60.3%) were HBeAg(-) and 86 (79.6%) of these HBeAg(-) patients had been *** A1896 mutation was not found in HBeAg(+) patients,however,this mutation was detected in 70.7% of HBeAg(-) *** mutation was frequently found when HBeAg was not expressed (87.7%),compared to that found in HBeAg seroconverted patients (65.1%).The A1899 mutation was also more prevalent in HBeAg(-) than in HBeAg(+) patients (P=0.004).The T1762/A1764 mutation was frequently found in both HBeAg(+) and HBeAg(-) patients,however,the prevalence of this mutation did not significantly differ among the two groups (P=0.054).In HBeAg(+) patients,the T1762/A1764 mutation was correlated with lower HBV DNA (P < 0.001).The A1899 mutation did not correlate with HBV DNA (P=0.609).In HBeAg(-) patients,the T1762/A1764 mutation alone was not correlated with HBV DNA (P=0.095),however,the presence of either the T1762/A1764 or A1896 mutations was associated with increased HBV DNA (P < 0.001).CONCLUSION:The percentage of HBeAg(-) patients is high in Indonesia,and most of the HBeAg(-) patients had been *** A1896 mutation was most likely the major cause of HBeAg *** T1762/A1764 mutation alone was associated with lower viral loads in HBeAg(+) patients,but not in HBeAg(-) patients.

关键词：乙型肝炎病毒 HBeAg 突变检测核心启动子患者载量酶联免疫吸附试验协会

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Hepatitis B virus subgenotypes and basal core promoter mutations in Indonesia

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World Journal of Gastroenterology 2009年第32期15卷 4028-4036页

作者： Andi Utama Sigit Purwantomo Marlinang Diarta Siburian Rama Dhenni rino Alvani gani Irsan Hasan Andri Sanityoso Upik Anderiani Miskad Fardah Akil Irawan Yusuf Wenny Astuti Achwan Soewignjo Soemohardjo Syafruddin AR Lelosutan Ruswhandi Martamala Benyamin Lukito Unggul Budihusodo Laurentius Adrianus Lesmana Ali Sulaiman Susan Tai Molecular Epidemiology Division Mochtar Riady Institute for NanotechnologyLippo KarawaciTangerangBanten 15810Indonesia Hepatology Division Department of Internal MedicineFaculty of MedicineUniversity of IndonesiaJakarta 10430Indonesia Center of Gastroentero-Hepatology Department of Internal MedicineFaculty of MedicineHasanuddin UniversityMakassar 90245Indonesia Department of Internal Medicine Mataram General HospitalMataram 83127Indonesia Gastroentero-Hepatology Division Department of Internal MedicineGatot Soebroto HospitalJakarta 10410Indonesia Department of Internal Medicine Siloam Hospital Lippo KarawaciTangerang Banten 15810Indonesia

AIM:To identify the distribution of hepatitis B virus (HBV) subgenotype and basal core promoter (BCP) mutations among patients with HBV-associated liver disease in ***: Patients with chronic hepatitis (CH, n=61), liver cirrhosis (LC, n=62), and hepatocellular carcinoma (HCC,n=48) were included in this study. HBV subgenotype was identified based on S or preS gene sequence, and mutations in the HBx gene including the overlapping BCP region were examined by direct ***: HBV genotype B (subgenotypes B2, B3, B4, B5 and B7) the major genotype in the samples, accounted for 75.4%, 71.0% and 75.0% of CH, LC and HCC patients, respectively, while the genotype C (subgenotypes C1, C2 and C3) was detected in 24.6%, 29.0%, and 25.0% of CH, LC, and HCC patients, respectively. Subgenotypes B3 (84.9%) and C1 (82.2%) were the main subgenotype in HBV genotype B and C, respectively. Serotype adw2 (84.9%) and adrq+ (89.4%) were the most prevalent in HBV genotype B and C, respectively. Double mutation (A1762T/G1764A) in the BCP was significantly higher in LC (59.7%) and HCC (54.2%) than in CH (19.7%), suggesting that this mutation was associated with severity of liver disease. The T1753V was also higher in LC (46.8%), but lower in HCC (22.9%) and CH (18.0%), suggesting that this mutation may be an indicator of ***: HBV genotype B/B3 and C/C1 are the major genotypes in Indonesia. Mutations in BCP, such as A1762T/G1764A and T1753V, might have an association with manifestations of liver disease.

关键词：印度尼西亚病毒亚型乙型肝炎启动子突变

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