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Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

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World Journal of Hepatology 2024年第3期16卷 428-438页

作者： Senamjit Kaur Rodrigo V Motta Bryony Chapman Victoria Wharton Jane D Collier Francesca Saffioti Oxford liver unit Department of Gastroenterology and HepatologyOxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom Oxford liver unit and translational gastroenterology unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine *** safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive *** hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of *** To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver *** A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our united Kingdom tertiary centre between 2018 and 2022 was ***’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,***-Meier survival estimates were generated to stratify time-related outcomes according to the type of *** Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular *** baseline characteristics were similar between the *** antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP *** overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain

关键词： Decompensated liver cirrhosis Indwelling abdominal catheter Rocket drain Palliative care Safety Quality of life

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Risk factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

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World Journal of gastroenterology 2024年第13期30卷 1810-1814页

作者： Yan-Bo Yu Department of gastroenterology Laboratory of Translational GastroenterologyQilu HospitalShandong UniversityJinan 250012Shandong ProvinceChina

In this editorial,we comment on the article by Wang et al published in the recent issue of the World Journal of gastroenterology in *** focused on identifying risk factors for lymph node metastasis(LNM)in superficial esophageal squamous cell carcinoma(SESCC)patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients,thereby helping to guide the selection of an appropriate treatment *** current standard treatment for SESCC is radical esophagectomy with lymph node ***,esophagectomy is associated with considerable morbidity and *** resection(ER)offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory ***,since ER is a localized treatment that does not allow for lymph node dissection,the risk of LNM in SESCC limits the effectiveness of *** LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional *** studies have shown that tumor size,macroscopic type of tumor,degree of differentiation,depth of tumor invasion,and lymphovascular invasion are factors associated with LNM in patients with *** addition,tumor budding is commonly associated with LNM,recurrence,and distant metastasis,but this topic has been less covered in previous *** comprehensively evaluating the above risk factors for LNM,useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.

关键词： Superficial esophageal squamous cell carcinoma Endoscopic resection Lymph node metastasis Risk factors Tumor budding Predictive model

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Navigating the controversy regarding antibiotic prophylaxis in acute variceal bleeding

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World Journal of gastroenterology 2024年第18期30卷 2485-2487页

作者： David Aguirre-Villarreal Ignacio García-Juárez Department of gastroenterology and liver Transplant unit Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical ***,with recent evidence arguing against antibiotic prophylaxis,the role of this... 详细信息

关键词： Cirrhosis Acute variceal bleeding Antibiotic prophylaxis Endoscopic band ligation Spontaneous bacterial peritonitis

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liver transplantation as an alternative for the treatment of perihilar cholangiocarcinoma: A critical review

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 139-145页

作者： Wellington Andraus Francisco Tustumi Alexandre Chagas Santana Rafael Soares Nunes Pinheiro Daniel Reis Waisberg Liliana Ducatti Lopes Rubens Macedo Arantes Vinicius Rocha Santos Rodrigo Bronze de Martino Luiz Augusto Carneiro D’Albuquerque Department of gastroenterology Transplantation UnitUniversidade de São PauloSão PauloBrazil

Background:Perihilar cholangiocarcinoma(phCCC)is a dismal *** is no consensus regard-ing the best treatment for patients with unresectable *** present review aimed to gather the current pieces of evidence for liver transplantation and liver resection as a treatment for phCCC and to build better guidance for clinical *** sources:The search was conducted in PubMed,Embase,Cochrane,and *** related references were searched *** criteria were:reports in English or Portuguese literature that a)patients with confirmed diagnosis of phCCC;b)patients treated with a curative intent;c)patients with the outcomes of liver resection and liver *** reports,reviews,letters,editorials,conference abstracts and papers with full-text unavailability were excluded from the ***:Most of the current literature is based on observational retrospective studies with low grades of *** resection has better long-term outcomes than systemic chemotherapy or palliation ther-apy and liver transplantation is a good alternative for selected patients with unresectable *** candidates for resection or transplantation should be medically fit and free of intrahepatic or extrahep-atic *** a general rule,patients presenting with a tumor having a longitudinal size>3 cm or extending below the cystic duct,lymph node disease,confirmed extrahepatic dissemination;intraoper-atively diagnosed metastatic disease;a history of other malignancies within the last five years,and did not complete chemoradiation regimen and were medically unfit should not be considered for *** of these criteria should be individually *** transplantation or resection should only be considered in highly experienced hepatobiliary centers,and any decision-making must be based on a multidisciplinary ***:phCCC is a complex condition with high *** therapies,including hepatec-tomy and liv

关键词： liver transplantation Cholangiocarcinoma liver neoplasms

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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis translational gastroenterology and liver unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for liver and Digestive Health and Sheila Sherlock liver unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy liver transplant Paediatric

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Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

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World Journal of Hepatology 2024年第4期16卷 650-660页

作者： Dorothy Liu Mark M Youssef Josephine A Grace Marie Sinclair Department of gastroenterology Austin HealthMelbourne 3084VictoriaAustralia Victorian liver Transplant unit Austin HealthMelbourne 3084VictoriaAustralia Department of Medicine University of MelbourneMelbourne 3084VictoriaAustralia

BACKGROUND De novo malignancy is a leading cause of late morbidity and mortality in liver transplant *** immunosuppression has been shown to contribute to post-transplant malignancy(PTM)*** is emerging evidence on the differential carcinogenic risk profile of individual immunosuppressive drugs,independent of the net effect of *** inhibitors such as tacrolimus may promote tumourigenesis,whereas mycophenolic acid(MPA),the active metabolite of mycophenolate mofetil,may limit tumour *** transplantation(LT)is relatively unique among solid organ transplantation in that immunosuppression monotherapy with either tacrolimus or MPA is often achievable,which makes careful consideration of the risk-benefit profile of these immunosuppression agents particularly relevant for this ***,there is limited clinical data on this subject in both LT and other solid organ transplant *** To investigate the relative carcinogenicity of tacrolimus and MPA in solid organ *** A literature search was conducted using MEDLINE and Embase databases using the key terms“solid organ transplantation”,“tacrolimus”,“mycophenolic acid”,and“carcinogenicity”,in order to identify relevant articles published in English between 1st January 2002 to 11th August *** terms,synonyms and explosion of MeSH terms,Boolean operators and truncations were also utilised in the *** lists of retrieved articles were also reviewed to identify any additional *** duplicates,abstracts from 1230 records were screened by a single reviewer,whereby 31 records were reviewed in ***-text articles were assessed for eligibility based on pre-specified inclusion and exclusion *** A total of 6 studies were included in this *** studies were large population registries or cohort studies,which varied in transplant era,type of organ transplanted and immunosuppression protocol us

关键词： Immunosuppression Solid organ transplantation liver transplantation Carcinogenicity Tacrolimus Mycophenolate

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National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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World Journal of gastroenterology 2024年第9期30卷 1018-1042页

作者： Faisal Saud Dar Zaigham Abbas Irfan Ahmed Muhammad Atique Usman Iqbal Aujla Muhammad Azeemuddin Zeba Aziz Abu Bakar Hafeez Bhatti Tariq Ali Bangash Amna Subhan Butt Osama Tariq Butt Abdul Wahab Dogar Javed Iqbal Farooqi Faisal Hanif Jahanzaib Haider Siraj Haider Syed Mujahid Hassan Adnan Abdul Jabbar Aman Nawaz Khan Muhammad Shoaib Khan Muhammad Yasir Khan Amer Latif Nasir Hassan Luck Ahmad Karim Malik Kamran Rashid Sohail Rashid Mohammad Salih Abdullah Saeed Amjad Salamat Ghias-un-Nabi Tayyab Aasim Yusuf Haseeb Haider Zia Ammara Naveed Department of Hepatopancreatic Biliary Surgery&liver Transplant Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Hepatogastroenterology and liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan University of Aberdeen Aberdeen B243FXUnited Kingdom Department of Pathology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of gastroenterology&Hepatology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Radiology Aga Khan UniversityKarachi 74800Pakistan Department of Oncology Hameed Latif HospitalLahore 54000Pakistan Division of Hepatopancreatic Biliary Surgery&liver Transplantation Shifa International HospitalIslamabad 44000Pakistan Department of Hepatopancreatic Biliary Surgery&liver Transplant Shaikh Zayed Hospital and Post Graduate Medical InstituteLahore 54000Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan Department of liver Transplant Pir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Medicine&gastroenterology Lifecare Hospital and Research CentrePeshawar 25000Khyber PakhtunkhwaPakistan Department of Hepatopancreatobiliary&liver Transplant Bahria International HospitalLahore 54000Pakistan Department of Surgery Hepatopancreatobiliary&Liver TransplantDow University of Health SciencesKarachi 74800Pakistan Department of gastroenterology Hepatology&NutritionPir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Oncology Dr.Ziauddin HospitalKarachi 74800Pakistan Department of Radiology Rehman Medical InstitutePeshawar 25000Pakistan Army liver Transplant unit Pak Emirates Military HospitalRawalpindi 46000Pakistan Department of gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan Rashid Nursing Home and Cancer Clinic Rashid Nursing Home and Cancer ClinicRawalpindi 46000Pakistan Department of Gastroentero

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and liver Institute&Research Centre(PKLI&RC)after initial consultations with the *** Pakistan Society for the Study of liver Diseases(PSSLD)and PKLI&RC jointly organised this *** effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these *** coordinated effort can minimise delays and give patients a chance for curative treatment and effective *** diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance *** cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for ***,histopathologic confirmation is not always required before *** ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for *** only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette *** patients with unresectable hCCA can be considered for liver *** chemotherapy should be offered to patients with a high risk of *** use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary *** with acute cholangitis can be drained with endoscopic or percutaneous biliary *** chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

关键词： Hilar cholangiocarcinoma Bismuth-Corlette classification Memorial Sloan Kettering Cancer Centre Staging Preoperative biliary drainage Portal vein embolisation Surgical resection Hepatectomy

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Advancements in Barrett's esophagus detection:The role of artificial intelligence and its implications

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World Journal of gastroenterology 2024年第11期30卷 1494-1496页

作者： Sara Massironi Division of gastroenterology and Center for Autoimmune liver Diseases Department of Medicine and SurgeryFondazione IRCCS San Gerardo dei TintoriUniversity of Milano-BicoccaMonza 20900Italy

Artificial intelligence(AI)is making significant strides in revolutionizing the detection of Barrett's esophagus(BE),a precursor to esophageal *** the research article by Tsai et al,researchers utilized endoscopic images to train an AI model,challenging the traditional distinction between endoscopic and histological *** approach yielded remarkable results,with the AI system achieving an accuracy of 94.37%,sensitivity of 94.29%,and specificity of 94.44%.The study's extensive dataset enhances the AI model's practicality,offering valuable support to endoscopists by minimizing unnecessary ***,questions about the applicability to different endoscopic systems *** study underscores the potential of AI in BE detection while highlighting the need for further research to assess its adaptability to diverse clinical settings.

关键词： Barrett's esophagus Artificial intelligence Endoscopic images Artificial intelligence model Early cancer detection Endoscopy

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liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

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World Journal of Transplantation 2024年第1期14卷 141-153页

作者： Hirak Pahari Amruth Raj Ambreen Sawant Dipak S Ahire Raosaheb Rathod Chetan Rathi Tushar Sankalecha Sachin Palnitkar Vikram Raut Department of liver Transplant and HPB Surgery Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of liver Transplant Anaesthesia Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210India Department of gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of gastroenterology and Hepatology Medicover HospitalsAurangabad 431003India Department of gastroenterology and Hepatology Medicover HospitalsNashik 422009India Department of gastroenterology and Hepatology Medicover HospitalsPune 411026India

BACKGROUND liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established *** cornerstone of this treatment lies in the various criteria formulated by expert consensus and *** variations among the criteria are staggering,and the short-and long-term outcomes are *** To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the *** We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were *** centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was *** Of the 23 centers,35%were high volume center(>500 liver transplants)while 52%were high-volume centers that performed more than 50 transplants/*** 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the *** a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC ***-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied *** alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the *** criteria for successful downstaging v

关键词： Hepatocellular carcinoma liver transplant India Downstaging Survey Milan University of California,San Francisco Portal vein tumor thrombus Expanded criteria

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Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time?

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World Journal of Transplantation 2024年第2期14卷 13-27页

作者： Mai Hashem Mohammed A Medhat Doaa Abdeltawab Nahed A Makhlouf Fellow of Tropical Medicine and gastroenterology Assiut University HospitalAssiut 71515Egypt Department of Tropical Medicine and gastroenterology Faculty of MedicineAssiut UniversityAssiut 71515Egypt Department of Tropical Medicine and gastroenterology Al-Rajhi Liver HospitalAssiut UniversityAssiut 71515Egypt

liver transplantation(LT)provides a life-saving option for cirrhotic patients with complications and hepatocellular *** the increasing number of liver transplants performed each year,the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and *** donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT ***,further strategies can be implemented to increase the pool of potential donors in deceased donor LT,such as reducing the rate of organ *** hepatitis C virus(HCV)seropositive liver grafts is one of the expanded donor organ criteria.A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative ***-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in *** American Society of Transplantation advises against performing transplants from HCV-infected liver donors(D+)into HCV-negative recipient(R-)unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such *** selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is *** and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.

关键词： Donor pool Hepatitis C-viremic organs Non-viremic organs Direct acting antivirals Hepatitis C virus treated liver transplantation

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