Ruling in and ruling out with elastography in compensated advanced chronic liver disease

The recent letter by Jansen et al1 presenting an algorithm to rule out clinically significant portal hypertension (CSPH) by combining shear-wave elastography of liver (L-SWE) and spleen (S-SWE) is an important contribution to the increasing knowledge regarding non-invasive assessment of patients with compensated advanced chronic liver disease (cACLD). Baveno VI recommendations focused on transient elastography as a tool to rule in CSPH in patients with the authors cACLD of viral etiology,2 3 but there is no doubt that other related elastography techniques should work similarly. Also, recent UK guidelines on variceal bleeding introduced elastography for variceal screening and diagnosis.4 In their study, the authors concluded that combining L-SWE
Source: Gut - Category: Gastroenterology Authors: Tags: PostScript Source Type: research

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An 80-year-old female patient with a history of hypertension presented to our hospital with tarry stool for 3 days. Physical examination revealed a palpable mass in the upper abdomen. Laboratory studies showed a hemoglobin level of 6.5  g/dL.
Source: Digestive and Liver Disease - Category: Gastroenterology Authors: Tags: Image of the Month Source Type: research
ConclusionRYGB is a feasible option in selected patients with morbid obesity and cirrhosis. These patients ideally should be managed in centers having experience in bariatric surgery and hepatology.
Source: Obesity Surgery - Category: Surgery Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0040-1715451Thrombocytopenia is one of the most common hematologic complications in cirrhosis. Despite limited data linking platelet count and bleeding risk in patients with cirrhosis, the use of platelets transfusions for invasive procedures has been a common practice. Recently, thrombopoietin (TPO) receptor agonists have been approved for use in patients with chronic liver disease (CLD) undergoing invasive procedures. The aim of this study was to review current literature on bleeding risk in patients with cirrhosis and the use of platelet transfusions and TPO receptor agonists in the co...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Review Article Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0040-1714202There is increasing evidence that portal hypertension plays a major role in bleeding risk during orthotopic liver transplantation (OLT). We investigated the association between preoperative blood levels of von Willebrand factor (VWF) and soluble CD163 (sCD163), which are established markers of portal hypertension, and blood loss and transfusion requirements during OLT. We measured levels of VWF and sCD163 in preoperative serum samples of 168 adult patients undergoing a primary OLT between 1998 and 2012. Preoperative levels of VWF and sCD163 correlated with the model of end-sta...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Review Article Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0040-1714205Historically, liver disease has been associated with a bleeding tendency. Global hemostatic assays have demonstrated that hemostasis is overall rebalanced, in both acute liver failure and chronic liver disease. It is now recognized that many bleeding events in chronic liver disease are mediated by portal hypertension rather than an underlying hemostatic defect. This is acknowledged in recent guidelines, which recommend against coagulation testing prior to low risk procedures in this patient group, with avoidance also of attempts at correction of prolonged coagulation times. Ov...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Review Article Source Type: research
This study aimed to determine the diagnostic value of T1 and T2 mapping and extracellular volume fraction (ECV) for the non-invasive assessment of portal hypertension.MethodsIn this prospective study, 50 participants (33 patients with indication for trans-jugular intrahepatic portosystemic shunt (TIPS) and 17 healthy volunteers) underwent MRI. The derivation and validation cohorts included 40 and 10 participants, respectively. T1 and T2 relaxation times and ECV of the liver and the spleen were assessed using quantitative mapping techniques. Direct hepatic venous pressure gradient (HVPG) and portal pressure measurements wer...
Source: European Radiology - Category: Radiology Source Type: research
Thrombocytopenia is a consequence of portal hypertension and is the most common hematological manifestation of chronic liver disease (CLD) (ie, cirrhosis). Data indicates the rates of CLD are increasing and, as a result, so will the incidence of this complication. Although bleeding risks are only relevant when elective procedures are performed, this is a frequent concern as these procedures are commonly part of the spectrum of care for patients with cirrhosis. As such, thrombocytopenia remains a pertinent issue. Fortunately, we now have effective and accurate treatment modalities to raise platelet counts before scheduled p...
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: CLINICAL REVIEWS Source Type: research
Refractory variceal bleeding and early re-bleeding are associated with high mortality in patients with chronic liver disease (CLD) complicated by portal hypertension. A fully-covered self-expanding metal stent (SEMS) (SX-ELLA Danis stent; ELLA-CS, Hradec Kralove, Czech Republic) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was to evaluate the efficacy and safety of this SEMS for control of refractory variceal bleeding in local clinical practice.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Poster abstracts Source Type: research
Gastric varices (GV) and Portal Hypertensive Gastropathy (PHG) are well recognized complications of portal hypertension and carry a risk of gastrointestinal bleeding. Percutaneous endoscopic gastrostomy (PEG) tubes are a valuable tool for long term nutrition, among other indications, and are often indicated in patients with liver disease and portal hypertension. However, the safety and outcomes of PEG tube placement in patients with pre-existing PHG and GV is not well established in current literature.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Poster abstracts Source Type: research
Conclusion: TIPS appears to have a high mid-term patency rate, especially if monitored and revised. Its high clinical success rate, along with a minimally invasive approach, suggests that in this setting TIPS should not be regarded only as a bridge to liver transplantation.
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
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