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Interventional Procedures in Hepatobiliary Diseases, An Issue of Clinics in Liver Disease, E-Book

Interventional Procedures in Hepatobiliary Diseases, An Issue of Clinics in Liver Disease, E-Book

Andres Cardenas

(2015)

Additional Information

Abstract

The field of hepatobiliary diseases has advanced enormously in the past 3 decades. The incorporation of new diagnostic and therapeutic interventions in clinical hepatology as well as liver transplantation has exponentially grown and specialty fields have emerged within the liver disease arena. Interventional procedures play a critical role in the management of patients with hepatobiliary diseases as they offer diagnostic and definite treatment options for an array of conditions. Interventions include those that directly measure portal pressure, perform transjugular liver biopsy and place transjugular intrahepatic portsosystemic shunts as therapy for complications of portal hypertension. Other commonly performed intervention is digestive and hepatobiliary endoscopy which offers not only diagnostic but also therapeutic choices in various areas such as portal hypertension and hepatobiliary disease. Endoscopy plays a fundamental role in the management of patients with almost all types of liver disease. Additionally, both the fields of hepatology and endoscopy have become very specialized and thus a thorough knowledge of the indications, findings, therapeutic possibilities and complications that arise from endoscopic interventions is a must for the practicing clinician. The rising incidence of liver cancer has also placed radiofrequency ablation and chemoembolization of liver lesions at the forefront of interventional therapies for hepatocellular carcinoma. Finally the management of acute liver failure has certainly evolved with new therapeutic options such as liver assist devices that can help manage these patients in the intensive care unit. This issue of Clinics in Liver Disease devoted to Interventional Hepatology is a timely and unique one. The Guest Editors have assembled an outstanding group of experts in several fields that can provide practitioners with state of the art and evidence based articles that help manage patients with hepatobiliary disease.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Interventional Proceduresin Hepatobiliary Diseases i
Copyright\r ii
Contributors iii
Contents vii
Clinics In Liver Disease xi
Preface\r xiii
Transjugular Liver Biopsy 767
Key points 767
Introduction: nature of the problem 768
Indications/Contraindications 768
Technique/Procedure 768
Preparation 768
Necessary Material 770
Position 770
Approach 771
Technique/Procedure (Detail Steps) 771
Complications and management 774
Sample quality and clinical implications (if procedure is used for diagnostic purposes) 774
Sample Quality 774
Clinical Implications 776
Current controversies/future considerations 776
Summary 776
References 777
Measurement of Portal Pressure 779
Key points 779
Introduction 779
Hepatic venous pressure gradient 780
Rationale 780
The Procedure 781
Complications 781
Contraindications 781
Associated Procedures 781
Reporting 781
Follow-up 781
Applications of HVPG measurement 783
Diagnosis of Portal Hypertension 783
Classification of Portal Hypertension 784
Assessment of Disease Severity and Prognosis in Cirrhosis 784
Risk prediction in cirrhosis 784
Risk prediction in viral hepatitis 785
Alcoholic hepatitis 785
HVPG and liver transplantation 785
HVPG and hepatocellular carcinoma 786
Assessment of the response to pharmacologic therapy to decrease portal pressure 786
Assessment of new therapeutic agents 788
Summary 788
Acknowledgments 789
References 789
Endoscopic Band Ligation and Esophageal Stents for Acute Variceal Bleeding 793
Key points 793
Natural history/diagnosis 794
General management 795
Hemostatic therapies 795
Splanchnic Vasoconstrictors 795
Endoscopic Therapy 796
EBL 796
Esophageal stents 800
Failure to Control Bleeding 803
Summary 803
Supplementary data 803
References 803
Endoscopic Treatment of Gastric Varices 809
Key points 809
Introduction 809
Classification of gastric varices 810
Primary and Secondary GV 810
Hemodynamic features and relevant vascular anatomy 811
Segmental/Sinistral PHT 812
Management 812
Primary Prophylaxis 812
Risk Factors for GV Hemorrhage 813
Management of Acute GV Bleeding 813
Medical Management 813
Vasoactive drugs 813
Balloon Tamponade 814
Endoscopic Therapies 814
GV Sclerotherapy 814
GV Obturation 815
GV Band Ligation 816
Thrombin 817
Combined Endoscopic Therapy 818
EUS-guided Treatment 818
Radiologic interventions 819
Transjugular Intrahepatic Portosystemic Shunts 819
BRTO 819
Secondary prophylaxis 820
Medical Therapies 820
Endoscopic Therapies 820
Interventional Radiologic Approach 820
Partial Splenic Embolization 820
Summary 821
References 822
Endovascular Management of Gastric Varices 829
Key points 829
Introduction 829
Anatomy, definitions, and classifications 830
The BRTO procedure 833
Outcomes of BRTO-only for the management of gastric varices in Asian institutions 837
Outcomes of BRTO-only for the management of gastric varices in american institutions 844
Outcomes of TIPS-only for the management of gastric varices 846
Outcomes of combining TIPS with BRTO for the management of gastric varices 846
Summary 847
References 847
Transjugular Intrahepatic Portosystemic Shunt 853
Key points 853
Introduction 853
Indications for transjugular intrahepatic portosystemic shunt creation 854
Primary Prevention of Variceal Hemorrhage 854
Acute Variceal Bleeding 855
Refractory Acute Variceal Bleeding 855
Refractory Bleeding from Gastric Varices and Portal Hypertensive Gastropathy 857
Refractory Ascites 857
Refractory Hepatic Hydrothorax 858
Hepatopulmonary Syndrome 858
Hepatorenal Syndrome 859
Budd-Chiari Syndrome 859
Hepatic Venoocclusive Disease 859
Patient selection and pre–transjugular intrahepatic portosystemic shunt evaluation 859
Conventional technique 860
Hepatic Venous Access 861
Portal Venous Access and Transjugular Intrahepatic Portosystemic Shunt Insertion 861
Selective Embolization of Portosystemic Collaterals 863
Immediate Postprocedural Management 864
Advanced and alternative transjugular intrahepatic portosystemic shunt techniques 864
Complications 864
Technical-Access Related 864
Technical-Stent Related 865
Portosystemic-Shunting Related 866
Unique Complications 867
Post–transjugular intrahepatic portosystemic shunt follow-up and maintenance 867
Future considerations 867
Summary 867
Conflict of interest disclosure table, January 2014 (based on incomes over last 24 months) 868
References 869
Transarterial Chemoembolization and Yittrium-90 for Liver Cancer and Other Lesions 877
Key points 877
Introduction: nature of the problem 877
Indications/contraindications 879
Indications 879
Contraindications 879
Technique/Procedure 879
TACE 880
Conventional TACE 880
cTACE procedure 881
Drug-eluting bead TACE 882
Radioembolization 882
Pretreatment procedure 883
Radioembolization procedure 883
Complications and management 883
Side Effects 883
Complications 883
Postprocedure care 883
Postprocedure Management (TACE) 883
Postprocedure Management (Radioembolization) 884
Reporting, follow-up, and clinical implications 884
Outcomes 885
HCC 885
Metastatic CRC 885
Other Liver Tumors 886
Current controversies/Future considerations 886
Summary 888
References 888
Endoscopic Retrograde Cholangiopancreatography for Cholangiocarcinoma 891
Key points 891
Introduction 891
Indications/Contraindications 891
Technique/Procedure 892
Preparation 892
Patient Positioning 892
Approach 892
Technique/Procedure 893
Complications and management 894
Cholangitis 894
Pancreatitis 895
Bleeding 895
Perforation 895
Postoperative care 895
Outcomes 895
Current controversies/future considerations 896
Summary 896
References 896
Endoscopic Retrograde Cholangiopancreatography for Primary Sclerosing Cholangitis 899
Key points 899
Introduction 899
Diagnosis of PSC: ERC or magnetic resonance cholangiography? 900
Dominant stricture in PSC 900
Nonendoscopic versus endoscopic management of dominant stricture 901
Nonendoscopic Management of Dominant Stricture 901
Medical management of PSC and dominant stricture 901
Percutaneous management of dominant strictures 901
Surgical management of dominant stricture 902
Endoscopic Management of Dominant Stricture 902
Endoscopic sphincterotomy 902
Endoscopic stricture dilation 902
Endoscopic stent placement 903
Efficacy of endoscopic management in PSC 904
Complications of ERCP in PSC Patients 905
Bacterial colonization, cholangitis, and antibiotic prophylaxis 906
Differentiating benign stenosis versus CCA 906
Role of cholangioscopy in PSC 907
Summary 907
References 907
Endoscopic Retrograde Cholangiography for Biliary Anastomotic Strictures After Liver Transplantation 913
Key points 913
Types of biliary strictures 914
Risk factors 915
Diagnostic approach 915
Treatment strategies 917
Dilation and Plastic Stent Placement 917
Self-Expandable Metal Stents 917
Limitations of Endoscopic Therapy 918
Recurrence 920
LDLT and biliary strictures 920
Cholangioscopy 921
Complications of ERC 921
Summary 921
References 922
Cholangioscopy in Liver Disease 927
Key points 927
Introduction: Nature of the problem 927
Indications and contraindications 928
Preparation 928
Management of Anticoagulants 929
Antibiotic Prophylaxis 929
Patient Positioning 929
Sedation 929
Approach 929
Equipment 929
“Mother–Daughter” Systems 930
Catheter-Based System 930
Technique 930
Scope Insertion 930
Intraductal Lithotripsy 931
Intraductal Biopsy 931
Outcomes 932
Bile Duct Stones 932
Suspected Biliary Malignancies 934
PSC 937
Complications and management 938
Post-procedure care 938
Reporting, follow-up, and clinical implications (if procedure is used for diagnostic purposes) 938
Current controversies and future considerations 938
Summary 939
References 939
Molecular Adsorbent Recirculating System and Bioartificial Devices for Liver Failure 945
Key points 945
Introduction: why are liver support devices necessary? 945
Technical characteristics of extracorporeal liver support systems 946
Rationale for the use of liver support systems in liver failure 946
Elimination of Toxins 946
Improvement of Portal and Systemic Hemodynamics 947
Improvement of Liver Regeneration 948
Clinical efficacy 948
Bioartificial Liver Support Systems in ALF 948
Artificial Liver Support Systems in ALF 949
Artificial Liver Support Systems in ACLF 949
Comparative analysis of artificial and bioartificial liver support systems in clinical studies 953
Requirements of an ideal liver support system/Future considerations 953
References 954
Intensive Care Unit Management of Patients with Liver Failure 957
Key points 957
Acute liver failure 957
Definition of the Syndrome 957
Etiology and Relative Incidence 958
Management of Patients with ALF 959
Etiology-specific treatment of the liver injury 959
Non–etiology-specific treatment of the liver injury 960
Management of specific complications of ALF 960
General management 960
Neurologic complications 960
Cardiopulmonary complications 961
Renal failure 962
Infection 962
Coagulopathy 962
Liver transplantation for ALF 962
Acute-on-chronic liver failure 964
Pathophysiology 964
Initial Assessment of Prognosis in Patients with ACLF 964
Infection 964
Management of hemodynamic instability and septic shock 965
Acute kidney injury 967
Neurologic complications 967
Gastrointestinal bleeding 969
Pulmonary complications 970
Summary 970
References 970
Index 979