Xiuyun Lu, Jia-ying Cao, Yaozu Liu, Jingqin Ma, Jianjun Luo, Yi Dong, Wenping Wang
Giant hepatic cysts may lead to impaired liver function by compressing surrounding tissue, resulting in symptoms such as nausea or portal hypertension. Subharmonic‐aided pressure estimation (SHAPE) offers a noninvasive method for quantitatively estimating pressure and monitoring interstitial fluid pressure. A 55‐year‐old female patient with giant hepatic cysts was admitted to our hospital with elevated protein electrophoretic gamma levels, likely caused by compression of important liver vessels by the cysts. Before surgery, B‐mode ultrasound (BMUS) revealed multiple anechoic cystic lesions with thin, smooth walls in the right lobe. In SHAPE, the curve of the portal vein was lower than that of the hepatic vein, which is absolutely different from a healthy volunteer in our previous SHAPE study. It suggested that the patient may have had portal hypertension. Three days after laparoscopic fenestration and drainage of hepatic cysts, the size of the largest cyst had decreased on BMUS and protein electrophoretic gamma levels had normalized. While the curve of the portal vein remained lower than that of the hepatic vein, the difference between them had decreased compared to presurgery levels. SHAPE shows promise as a tool for noninvasively estimating portal hypertension and improving prognosis assessment in patients.
{"title":"Application of subharmonic‐aided pressure estimation in a patient with giant hepatic cyst: A case report","authors":"Xiuyun Lu, Jia-ying Cao, Yaozu Liu, Jingqin Ma, Jianjun Luo, Yi Dong, Wenping Wang","doi":"10.1002/poh2.80","DOIUrl":"https://doi.org/10.1002/poh2.80","url":null,"abstract":"Giant hepatic cysts may lead to impaired liver function by compressing surrounding tissue, resulting in symptoms such as nausea or portal hypertension. Subharmonic‐aided pressure estimation (SHAPE) offers a noninvasive method for quantitatively estimating pressure and monitoring interstitial fluid pressure. A 55‐year‐old female patient with giant hepatic cysts was admitted to our hospital with elevated protein electrophoretic gamma levels, likely caused by compression of important liver vessels by the cysts. Before surgery, B‐mode ultrasound (BMUS) revealed multiple anechoic cystic lesions with thin, smooth walls in the right lobe. In SHAPE, the curve of the portal vein was lower than that of the hepatic vein, which is absolutely different from a healthy volunteer in our previous SHAPE study. It suggested that the patient may have had portal hypertension. Three days after laparoscopic fenestration and drainage of hepatic cysts, the size of the largest cyst had decreased on BMUS and protein electrophoretic gamma levels had normalized. While the curve of the portal vein remained lower than that of the hepatic vein, the difference between them had decreased compared to presurgery levels. SHAPE shows promise as a tool for noninvasively estimating portal hypertension and improving prognosis assessment in patients.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"7 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post‐hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post‐hepatectomy portal hypertension (PHPH).Data from consecutive patients who underwent curative‐intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new‐onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non‐PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH.Disease‐free survival rates were significantly higher in the non‐PH group (n = 1068) than those in the PHPH group (n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p < 0.001). The 1‐, 3‐, and 5‐year OS rates were 91.0%, 66.4%, and 51.4% in the non‐PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p < 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279–1.704, p < 0.001 and HR 1.601, 95% CI 1.383–1.853, p < 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase > 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH.PHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow‐up surveillance to improve prognosis.
{"title":"Role of post‐hepatectomy portal hypertension in predicting the outcome of hepatocellular carcinoma after curative resection","authors":"Jian Lin, Liangrui Chen, Xiaodong Shi, Fengwei Li, Qian Xu, Hongzhi Liu, Jingfeng Liu, Kui Wang, Feng Shen","doi":"10.1002/poh2.79","DOIUrl":"https://doi.org/10.1002/poh2.79","url":null,"abstract":"Portal venous pressure frequently increases after a major hepatectomy. We aimed to assess the outcomes of patients with hepatocellular carcinoma (HCC) with different post‐hepatectomy portal pressure statuses and the predictive factors correlated with prognosis and post‐hepatectomy portal hypertension (PHPH).Data from consecutive patients who underwent curative‐intent hepatectomy for HCC at the Eastern Hepatobiliary Surgery Hospital and Mengchao Hepatobiliary Hospital of Fujian Medical University between January 2008 and December 2016 were retrospectively analyzed. Patients were followed up until March 1, 2022. PHPH was defined as new‐onset portal hypertension (PH) in patients without preoperative PH within 1 month of hepatectomy. Patients were classified into two groups according to the presence or absence of PHPH: non‐PH and PHPH. The clinicopathological characteristics were compared between the two groups. Univariate and multivariate analyses were used to identify independent risk factors for early and late recurrence of HCC, overall survival (OS), and PHPH.Disease‐free survival rates were significantly higher in the non‐PH group (n = 1068) than those in the PHPH group (n = 423) (62.0%, 39.0%, and 31.0% vs. 46.2%, 24.5%, and 19.3% at 1, 3, and 5 years, respectively; all p < 0.001). The 1‐, 3‐, and 5‐year OS rates were 91.0%, 66.4%, and 51.4% in the non‐PH group and 80.0%, 48.9%, and 32.6% in the PHPH group, respectively (all p < 0.001). Multivariate analysis revealed that PHPH was independently associated with early recurrence of HCC and poor OS (hazard ratio [HR] 1.476, 95% confidence interval [CI] 1.279–1.704, p < 0.001 and HR 1.601, 95% CI 1.383–1.853, p < 0.001, respectively). Furthermore, hepatitis B virus infection, cirrhosis, preoperative alanine aminotransferase > 40 U/L, and major hepatectomy were identified as independent risk factors for PHPH.PHPH was associated with early recurrence of HCC and poor OS but not with late recurrence. Therefore, PHPH may be an attractive target for therapeutic interventions and follow‐up surveillance to improve prognosis.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jerome C. Edelson, Scott Edelson, John G. Quiles, Cyrus V. Edelson, Eric M. Montminy, Christian L. Horn, John P. Magulick, Don C. Rockey
Portal hypertension (PH) is a complication of cirrhosis that leads to hepatic decompensation. Assessing the portal pressure gradient (PPG) provides valuable information for disease assessment, staging, and prognosis. In this study, we aimed to report the utilization of endoscopic ultrasound (EUS)‐guided PPG (EUS‐PPG) measurements in a real‐world setting.This retrospective analysis included patients at a tertiary care center who underwent EUS‐PPG between February 2021 and May 2022. The most common indication was to establish or exclude the diagnosis of cirrhosis, followed by an assessment of surgical risk in the setting of suspected cirrhosis. Extensive demographic and clinical data were collected, and statistical analysis was performed using the Student's t test.Eighteen patients underwent EUS‐PPG. Technical success was achieved in 17 of the 18 patients. No complications were observed. The mean scores of Child‐Pugh, Model for End‐Stage Liver Disease‐Sodium, and Fibrosis‐4 scores were 5.1 ± 0.5, 9.0 ± 3.0, and 3.7 ± 4.5, respectively. Of the 18 patients, two presented with esophageal varices and six with portal hypertensive gastropathy. The mean PPG was 5.8 ± 4.5 mmHg, and five patients exhibited clinically significant PH (CSPH). Of the 18 patients, 15 underwent concurrent EUS‐liver biopsy, which was 100% successful and provided diagnostic histology for all patients. The PPG data led to changes in the clinical management of 17 patients.EUS‐PPG is safe and technically feasible. The Child‐Pugh score did not correlate well with the presence of CSPH; however, PPG measurements resulted in changes in the management of almost all patients. Larger studies correlating EUS‐PPG with other assessments of liver diseases are required.
{"title":"Endoscopic ultrasound‐guided portal pressure gradient identifies patients with previously undiagnosed clinically significant portal hypertension","authors":"Jerome C. Edelson, Scott Edelson, John G. Quiles, Cyrus V. Edelson, Eric M. Montminy, Christian L. Horn, John P. Magulick, Don C. Rockey","doi":"10.1002/poh2.78","DOIUrl":"https://doi.org/10.1002/poh2.78","url":null,"abstract":"Portal hypertension (PH) is a complication of cirrhosis that leads to hepatic decompensation. Assessing the portal pressure gradient (PPG) provides valuable information for disease assessment, staging, and prognosis. In this study, we aimed to report the utilization of endoscopic ultrasound (EUS)‐guided PPG (EUS‐PPG) measurements in a real‐world setting.This retrospective analysis included patients at a tertiary care center who underwent EUS‐PPG between February 2021 and May 2022. The most common indication was to establish or exclude the diagnosis of cirrhosis, followed by an assessment of surgical risk in the setting of suspected cirrhosis. Extensive demographic and clinical data were collected, and statistical analysis was performed using the Student's t test.Eighteen patients underwent EUS‐PPG. Technical success was achieved in 17 of the 18 patients. No complications were observed. The mean scores of Child‐Pugh, Model for End‐Stage Liver Disease‐Sodium, and Fibrosis‐4 scores were 5.1 ± 0.5, 9.0 ± 3.0, and 3.7 ± 4.5, respectively. Of the 18 patients, two presented with esophageal varices and six with portal hypertensive gastropathy. The mean PPG was 5.8 ± 4.5 mmHg, and five patients exhibited clinically significant PH (CSPH). Of the 18 patients, 15 underwent concurrent EUS‐liver biopsy, which was 100% successful and provided diagnostic histology for all patients. The PPG data led to changes in the clinical management of 17 patients.EUS‐PPG is safe and technically feasible. The Child‐Pugh score did not correlate well with the presence of CSPH; however, PPG measurements resulted in changes in the management of almost all patients. Larger studies correlating EUS‐PPG with other assessments of liver diseases are required.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"32 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141120579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianwei Liu, Minmin Sun, Zhiliang Hu, Jie Wang, Caixia Lu, Ya Gao, Cuijuan He, Yeye Wu, Jian Zhai, Yong Xia, Xiaorong Pan, Kui Wang
Few studies have investigated differences in sequential transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and simultaneous RFA‐TACE for the treatment of hepatocellular carcinoma (HCC) using the Milan criteria. This study explored the differences in safety and prognosis between sequential TACE‐RFA and simultaneous RFA‐TACE.This retrospective real‐world study included 109 patients with HCC within the Milan criteria who underwent sequential TACE‐RFA (n = 75) or simultaneous RFA‐TACE (n = 34) at the Eastern Hepatobiliary Surgery Hospital between January 2017 and 2021. Postoperative complications, length of hospital stay, and long‐term prognosis were compared. The median follow‐up duration of these patients was 39.1 months. Overall survival (OS) and time to tumor recurrence (TTR) curves were plotted using the Kaplan−Meier method and were compared using the logarithmic rank test. Independent risk factors for OS and tumor recurrence (TR) were analyzed using the Cox risk regression model.Multivariate analysis showed that tumor diameter >3 cm (hazard ratio [HR]: 2.201, 95% confidence interval [CI]: 1.106–4.378, p = 0.025; HR: 2.236, 95% CI: 1.271–3.934, p = 0.005, respectively) and alpha‐fetoprotein (AFP) > 400 μg/L (HR: 2.362, 95% CI: 1.195–4.668, p = 0.013; HR: 1.798, 95% CI: 1.048–3.086, p = 0.033, respectively) were independent risk factors for OS and TTR, whereas the presence of multiple tumors (HR: 2.352, 95% CI: 1.127–4.907, p = 0.023) was an independent risk factor for TTR. Simultaneous RFA‐TACE did not have an effect on OS or TTR. After propensity score‐matched, comparable results were obtained and RFA‐TACE still had no effect on OS or TTR. No significant differences were observed in grade III/IV complications (2/75 [2.7%] vs. 1/34 [2.9%], p = 1.000) between the two groups. However, the RFA‐TACE group had fewer complications than the TACE‐RFA group (24/34 [70.6%] vs. 66/75 [88.0%], p = 0.026). The RFA‐TACE group had a shorter hospital stay and less total cost during hospitalization compared with the TACE‐RFA group (6.0 vs. 10.0 days, p < 0.001; 30,000 vs. 35,000 CNY, p < 0.001).For HCC within the Milan criteria, there was no significant difference in OS and TTR between RFA‐TACE and TACE‐RFA. However, RFA‐TACE could reduce all‐grade complications and shorten the length of hospital stay compared with TACE‐RFA. Therefore, simultaneous RFA‐TACE may be considered for patients with HCC and good liver function falling within the Milan criteria.
{"title":"Sequential or simultaneous transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma within the Milan criteria: A retrospective real‐world study","authors":"Jianwei Liu, Minmin Sun, Zhiliang Hu, Jie Wang, Caixia Lu, Ya Gao, Cuijuan He, Yeye Wu, Jian Zhai, Yong Xia, Xiaorong Pan, Kui Wang","doi":"10.1002/poh2.73","DOIUrl":"https://doi.org/10.1002/poh2.73","url":null,"abstract":"Few studies have investigated differences in sequential transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and simultaneous RFA‐TACE for the treatment of hepatocellular carcinoma (HCC) using the Milan criteria. This study explored the differences in safety and prognosis between sequential TACE‐RFA and simultaneous RFA‐TACE.This retrospective real‐world study included 109 patients with HCC within the Milan criteria who underwent sequential TACE‐RFA (n = 75) or simultaneous RFA‐TACE (n = 34) at the Eastern Hepatobiliary Surgery Hospital between January 2017 and 2021. Postoperative complications, length of hospital stay, and long‐term prognosis were compared. The median follow‐up duration of these patients was 39.1 months. Overall survival (OS) and time to tumor recurrence (TTR) curves were plotted using the Kaplan−Meier method and were compared using the logarithmic rank test. Independent risk factors for OS and tumor recurrence (TR) were analyzed using the Cox risk regression model.Multivariate analysis showed that tumor diameter >3 cm (hazard ratio [HR]: 2.201, 95% confidence interval [CI]: 1.106–4.378, p = 0.025; HR: 2.236, 95% CI: 1.271–3.934, p = 0.005, respectively) and alpha‐fetoprotein (AFP) > 400 μg/L (HR: 2.362, 95% CI: 1.195–4.668, p = 0.013; HR: 1.798, 95% CI: 1.048–3.086, p = 0.033, respectively) were independent risk factors for OS and TTR, whereas the presence of multiple tumors (HR: 2.352, 95% CI: 1.127–4.907, p = 0.023) was an independent risk factor for TTR. Simultaneous RFA‐TACE did not have an effect on OS or TTR. After propensity score‐matched, comparable results were obtained and RFA‐TACE still had no effect on OS or TTR. No significant differences were observed in grade III/IV complications (2/75 [2.7%] vs. 1/34 [2.9%], p = 1.000) between the two groups. However, the RFA‐TACE group had fewer complications than the TACE‐RFA group (24/34 [70.6%] vs. 66/75 [88.0%], p = 0.026). The RFA‐TACE group had a shorter hospital stay and less total cost during hospitalization compared with the TACE‐RFA group (6.0 vs. 10.0 days, p < 0.001; 30,000 vs. 35,000 CNY, p < 0.001).For HCC within the Milan criteria, there was no significant difference in OS and TTR between RFA‐TACE and TACE‐RFA. However, RFA‐TACE could reduce all‐grade complications and shorten the length of hospital stay compared with TACE‐RFA. Therefore, simultaneous RFA‐TACE may be considered for patients with HCC and good liver function falling within the Milan criteria.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140262713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ming Li, Xiaoming Xu, Yong Liu, Minxin Mao, Yu Geng, Shengxia Yin, Xin Tong, Chao Wu, Jie Li
Hepatitis B virus (HBV) is an enveloped DNA virus belonging to the Hepadnaviridae family. It is a significant contributor to the prevalence of chronic liver disease on a global scale. Mutations in HBV DNA can affect the diagnosis, treatment, and prognosis of patients with chronic hepatitis B. Although numerous studies on HBV DNA mutations have been conducted, few bibliometric studies have been performed to date. This study aimed to analyze changes in scientific output to gain a better understanding of the current research status and identify potential new research directions in the field of HBV DNA mutation.Relevant studies published between 2003 and 2022 were retrieved from the Web of Science Core Collection database. CiteSpace version 6.1.R6 was used to construct network maps to evaluate collaborations among countries, institutions, authors, journals, and keywords.In total, 1508 publications over the past 20 years were obtained, mainly from China, the United States, and Japan. The major research institutions in China included the University of Hong Kong, Fudan University, and Peking University. Lai Ching Lung was the most productive author, whereas Anna Suk‐Fong Lok was the most frequently co‐cited author. The keyword “HBsAg” was the strongest burst keyword in recent years, indicating possible future study trends.This bibliometric analysis intuitively revealed the overall research status of HBV DNA mutations, providing valuable information for researchers, funding agencies, and policymakers to explore the current research status, research hotspots, and new directions for future research.
乙型肝炎病毒（HBV）是一种包膜 DNA 病毒，属于肝病毒科。它是导致全球慢性肝病流行的重要因素。HBV DNA 的突变会影响慢性乙型肝炎患者的诊断、治疗和预后。虽然已经开展了大量有关 HBV DNA 突变的研究，但迄今为止，文献计量学研究还很少。本研究旨在分析科学成果的变化，以更好地了解目前的研究状况，并确定 HBV DNA 变异领域潜在的新研究方向。研究人员从 Web of Science Core Collection 数据库中检索了 2003 年至 2022 年间发表的相关研究。利用CiteSpace 6.1.R6版本构建网络图，评估国家、机构、作者、期刊和关键词之间的合作。中国的主要研究机构包括香港大学、复旦大学和北京大学。黎青龙是高产作者，而骆菁菁则是最常被联合引用的作者。该文献计量分析直观地揭示了HBV DNA突变的整体研究状况，为研究人员、资助机构和政策制定者探索研究现状、研究热点和未来研究的新方向提供了有价值的信息。
{"title":"Global status and trends in hepatitis B virus DNA mutation research from 2003 to 2022: A comprehensive bibliometric view","authors":"Ming Li, Xiaoming Xu, Yong Liu, Minxin Mao, Yu Geng, Shengxia Yin, Xin Tong, Chao Wu, Jie Li","doi":"10.1002/poh2.72","DOIUrl":"https://doi.org/10.1002/poh2.72","url":null,"abstract":"Hepatitis B virus (HBV) is an enveloped DNA virus belonging to the Hepadnaviridae family. It is a significant contributor to the prevalence of chronic liver disease on a global scale. Mutations in HBV DNA can affect the diagnosis, treatment, and prognosis of patients with chronic hepatitis B. Although numerous studies on HBV DNA mutations have been conducted, few bibliometric studies have been performed to date. This study aimed to analyze changes in scientific output to gain a better understanding of the current research status and identify potential new research directions in the field of HBV DNA mutation.Relevant studies published between 2003 and 2022 were retrieved from the Web of Science Core Collection database. CiteSpace version 6.1.R6 was used to construct network maps to evaluate collaborations among countries, institutions, authors, journals, and keywords.In total, 1508 publications over the past 20 years were obtained, mainly from China, the United States, and Japan. The major research institutions in China included the University of Hong Kong, Fudan University, and Peking University. Lai Ching Lung was the most productive author, whereas Anna Suk‐Fong Lok was the most frequently co‐cited author. The keyword “HBsAg” was the strongest burst keyword in recent years, indicating possible future study trends.This bibliometric analysis intuitively revealed the overall research status of HBV DNA mutations, providing valuable information for researchers, funding agencies, and policymakers to explore the current research status, research hotspots, and new directions for future research.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"21 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140267305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. R. A. Lesmana, K. Kalista, S. H. Nababan, Juferdy Kurniawan, C. Jasirwan, Andri Sanityoso Sulaiman, Irsan Hasan, R. Gani
Portal hypertension (PH) poses significant challenges. This paper presents an innovative study on the utilization of endoscopic ultrasound (EUS) for both the diagnosis and management of PH. Conducted at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, this retrospective case series included patients diagnosed with PH through clinical examination, imaging evaluation, and esophagogastroduodenoscopy. Exclusion 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 manometer. The study involved 15 patients, with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari syndrome. Among them, nine patients experienced bleeding due to gastroesophageal varices. Small and large esophageal varices were identified in four and eight patients, respectively. Gastroesophageal varices type 1 were observed in two patients, and type 2 in four patients. Isolated gastric fundal varices type 1 were present in one patient. Based on EUS‐PPG measurements, 14 patients exhibited clinically significant portal hypertension. Seven patients underwent endoscopic band ligation and three underwent EUS‐guided cyanoacrylate injection during the same session as the EUS‐PPG measurement procedure. Notably, no adverse events, such as abdominal pain, perforation, or bleeding were observed during or after the procedure. EUS emerges as a promising and accurate tool for both diagnosis and management.
{"title":"Innovations in endoscopic ultrasound for portal hypertension and its role in managing complications in clinical practice: Lessons learned from a tertiary referral public hospital","authors":"C. R. A. Lesmana, K. Kalista, S. H. Nababan, Juferdy Kurniawan, C. Jasirwan, Andri Sanityoso Sulaiman, Irsan Hasan, R. Gani","doi":"10.1002/poh2.74","DOIUrl":"https://doi.org/10.1002/poh2.74","url":null,"abstract":"Portal hypertension (PH) poses significant challenges. This paper presents an innovative study on the utilization of endoscopic ultrasound (EUS) for both the diagnosis and management of PH. Conducted at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, this retrospective case series included patients diagnosed with PH through clinical examination, imaging evaluation, and esophagogastroduodenoscopy. Exclusion 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 manometer. The study involved 15 patients, with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari syndrome. Among them, nine patients experienced bleeding due to gastroesophageal varices. Small and large esophageal varices were identified in four and eight patients, respectively. Gastroesophageal varices type 1 were observed in two patients, and type 2 in four patients. Isolated gastric fundal varices type 1 were present in one patient. Based on EUS‐PPG measurements, 14 patients exhibited clinically significant portal hypertension. Seven patients underwent endoscopic band ligation and three underwent EUS‐guided cyanoacrylate injection during the same session as the EUS‐PPG measurement procedure. Notably, no adverse events, such as abdominal pain, perforation, or bleeding were observed during or after the procedure. EUS emerges as a promising and accurate tool for both diagnosis and management.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139790616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. R. A. Lesmana, K. Kalista, S. H. Nababan, Juferdy Kurniawan, C. Jasirwan, Andri Sanityoso Sulaiman, Irsan Hasan, R. Gani
Portal hypertension (PH) poses significant challenges. This paper presents an innovative study on the utilization of endoscopic ultrasound (EUS) for both the diagnosis and management of PH. Conducted at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, this retrospective case series included patients diagnosed with PH through clinical examination, imaging evaluation, and esophagogastroduodenoscopy. Exclusion 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 manometer. The study involved 15 patients, with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari syndrome. Among them, nine patients experienced bleeding due to gastroesophageal varices. Small and large esophageal varices were identified in four and eight patients, respectively. Gastroesophageal varices type 1 were observed in two patients, and type 2 in four patients. Isolated gastric fundal varices type 1 were present in one patient. Based on EUS‐PPG measurements, 14 patients exhibited clinically significant portal hypertension. Seven patients underwent endoscopic band ligation and three underwent EUS‐guided cyanoacrylate injection during the same session as the EUS‐PPG measurement procedure. Notably, no adverse events, such as abdominal pain, perforation, or bleeding were observed during or after the procedure. EUS emerges as a promising and accurate tool for both diagnosis and management.
{"title":"Innovations in endoscopic ultrasound for portal hypertension and its role in managing complications in clinical practice: Lessons learned from a tertiary referral public hospital","authors":"C. R. A. Lesmana, K. Kalista, S. H. Nababan, Juferdy Kurniawan, C. Jasirwan, Andri Sanityoso Sulaiman, Irsan Hasan, R. Gani","doi":"10.1002/poh2.74","DOIUrl":"https://doi.org/10.1002/poh2.74","url":null,"abstract":"Portal hypertension (PH) poses significant challenges. This paper presents an innovative study on the utilization of endoscopic ultrasound (EUS) for both the diagnosis and management of PH. Conducted at Dr. Cipto Mangunkusumo National General Hospital in Jakarta, this retrospective case series included patients diagnosed with PH through clinical examination, imaging evaluation, and esophagogastroduodenoscopy. Exclusion 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 manometer. The study involved 15 patients, with 14 having liver cirrhosis and 1 diagnosed with Budd–Chiari syndrome. Among them, nine patients experienced bleeding due to gastroesophageal varices. Small and large esophageal varices were identified in four and eight patients, respectively. Gastroesophageal varices type 1 were observed in two patients, and type 2 in four patients. Isolated gastric fundal varices type 1 were present in one patient. Based on EUS‐PPG measurements, 14 patients exhibited clinically significant portal hypertension. Seven patients underwent endoscopic band ligation and three underwent EUS‐guided cyanoacrylate injection during the same session as the EUS‐PPG measurement procedure. Notably, no adverse events, such as abdominal pain, perforation, or bleeding were observed during or after the procedure. EUS emerges as a promising and accurate tool for both diagnosis and management.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"1 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139850549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brian I. Carr, F. Rui, V. Ince, Sezai Yilmaz, Xinya Zhao, Yuemin Feng, Jie Li
There are many studies on the incidence of hepatitis B virus (HBV)‐associated hepatocellular carcinoma (HCC), but very little is known about the HCC features in different populations. The study aimed to compare characteristics in two cohorts of patients with HBV‐associated hepatocellular carcinoma from Turkey and China.Data on patients with HBV‐associated HCC diagnosed by imaging or liver biopsy were retrospectively collected from Shandong Provincial Hospital (n = 578) and Inonu University Hospital (n = 359) between January 2002 and December 2020, and the liver function and HCC characteristics were compared. Continuous variables were compared using Student's t‐test or Mann–Whitney U test and categorical variables were compared using the χ² test or Fisher's exact test.The patients in the Turkish cohort had significantly worse Child‐Pugh scores (Child‐Pugh A: 38.3% vs. 87.9%; Child‐Pugh B: 40.3% vs. 11.1%; Child‐Pugh C: 21.4% vs. 1.0%; p < 0.001) and significantly higher levels of aspartate aminotransferase (66.5 [38.0−126.0] vs. 36.0 [27.0−50.0] IU/L; p < 0.001), alanine aminotransferase (47.5 [30.0−87.3] vs. 33.0 [24.0−45.0] IU/L; p < 0.001), total bilirubin (20.8 [13.7−39.3] vs. 17.9 [13.8−24.0] mg/dL; p < 0.001), and lower albumin levels (32.0 [26.0−39.0] vs. 40.0 [36.1−43.8] g/L; p < 0.001) than patients in Chinese cohort. The tumor characteristics showed the Barcelona Clinic Liver Cancer (BCLC) score (BCLC 1: 5.1% vs. 71.8%; BCLC 2: 48.7% vs. 24.4%; BCLC 3: 24.4% vs. 3.8%; BCLC 4: 21.8% vs. 0; all p < 0.001), maximum tumor diameter (5.0 [3.0−9.0] vs. 3.5 [2.5−6.0] cm; p < 0.001), alpha‐fetoprotein values (27.7 vs. 13.2 ng/mL; p < 0.001), and percentage of patients with portal vein tumor thrombus (33% vs. 6.1%; p < 0.001) were all significantly worse in the Turkish cohort compared with Chinese cohort.HBV‐associated HCC from the Turkish cohort had worse liver function and more aggressive clinical characteristics than patients from the Chinese cohort.
关于乙型肝炎病毒（HBV）相关肝细胞癌（HCC）发病率的研究很多，但对不同人群的 HCC 特征却知之甚少。该研究旨在比较土耳其和中国两组HBV相关肝细胞癌患者的特征。研究人员回顾性收集了2002年1月至2020年12月期间山东省医院（578人）和伊诺努大学医院（359人）通过影像学或肝活检确诊的HBV相关HCC患者的数据，并比较了患者的肝功能和HCC特征。连续变量的比较采用Student's t检验或Mann-Whitney U检验，分类变量的比较采用χ²检验或Fisher's精确检验。土耳其队列中的患者的Child-Pugh评分明显较差（Child-Pugh A：38.3% vs. 87.9%；Child-Pugh B：40.3% vs. 11.1%；Child-Pugh C：21.4% vs. 1.0%；P < 0.001），天冬氨酸氨基转移酶水平明显较高（66.0-126.5[38.0-126.5]）。5 [38.0-126.0] vs. 36.0 [27.0-50.0] IU/L；p < 0.001）、丙氨酸氨基转移酶（47.5 [30.0-87.3] vs. 33.0 [24.0-45.0] IU/L；p < 0.001）、总胆红素（20.8 [13.7-39.3] vs. 17.9 [13.8-24.0] mg/dL; p < 0.001），白蛋白水平（32.0 [26.0-39.0] vs. 40.0 [36.1-43.8] g/L；p < 0.001）低于中国队列中的患者。肿瘤特征显示，巴塞罗那临床肝癌（BCLC）评分（BCLC 1：5.1% vs. 71.8%；BCLC 2：48.7% vs. 24.4%；BCLC 3：24.4% vs. 3.8%；BCLC 4：21.8% vs. 0；所有P < 0.001。0; all p < 0.001）、最大肿瘤直径（5.0 [3.0-9.0] vs. 3.5 [2.5-6.0] cm; p < 0.001）、甲胎蛋白值（27.7 vs. 13.2 ng/mL; p < 0.与中国队列相比，土耳其队列的 HBV 相关 HCC 患者肝功能更差，临床特征更具侵袭性。
{"title":"Comparison of patients with hepatitis B virus‐associated hepatocellular carcinoma: Data from two hospitals from Turkey and China","authors":"Brian I. Carr, F. Rui, V. Ince, Sezai Yilmaz, Xinya Zhao, Yuemin Feng, Jie Li","doi":"10.1002/poh2.60","DOIUrl":"https://doi.org/10.1002/poh2.60","url":null,"abstract":"There are many studies on the incidence of hepatitis B virus (HBV)‐associated hepatocellular carcinoma (HCC), but very little is known about the HCC features in different populations. The study aimed to compare characteristics in two cohorts of patients with HBV‐associated hepatocellular carcinoma from Turkey and China.Data on patients with HBV‐associated HCC diagnosed by imaging or liver biopsy were retrospectively collected from Shandong Provincial Hospital (n = 578) and Inonu University Hospital (n = 359) between January 2002 and December 2020, and the liver function and HCC characteristics were compared. Continuous variables were compared using Student's t‐test or Mann–Whitney U test and categorical variables were compared using the χ² test or Fisher's exact test.The patients in the Turkish cohort had significantly worse Child‐Pugh scores (Child‐Pugh A: 38.3% vs. 87.9%; Child‐Pugh B: 40.3% vs. 11.1%; Child‐Pugh C: 21.4% vs. 1.0%; p < 0.001) and significantly higher levels of aspartate aminotransferase (66.5 [38.0−126.0] vs. 36.0 [27.0−50.0] IU/L; p < 0.001), alanine aminotransferase (47.5 [30.0−87.3] vs. 33.0 [24.0−45.0] IU/L; p < 0.001), total bilirubin (20.8 [13.7−39.3] vs. 17.9 [13.8−24.0] mg/dL; p < 0.001), and lower albumin levels (32.0 [26.0−39.0] vs. 40.0 [36.1−43.8] g/L; p < 0.001) than patients in Chinese cohort. The tumor characteristics showed the Barcelona Clinic Liver Cancer (BCLC) score (BCLC 1: 5.1% vs. 71.8%; BCLC 2: 48.7% vs. 24.4%; BCLC 3: 24.4% vs. 3.8%; BCLC 4: 21.8% vs. 0; all p < 0.001), maximum tumor diameter (5.0 [3.0−9.0] vs. 3.5 [2.5−6.0] cm; p < 0.001), alpha‐fetoprotein values (27.7 vs. 13.2 ng/mL; p < 0.001), and percentage of patients with portal vein tumor thrombus (33% vs. 6.1%; p < 0.001) were all significantly worse in the Turkish cohort compared with Chinese cohort.HBV‐associated HCC from the Turkish cohort had worse liver function and more aggressive clinical characteristics than patients from the Chinese cohort.","PeriodicalId":361247,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"32 1‐2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138966915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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