BOOK
Interventional Procedures in Hepatobiliary Diseases, An Issue of Clinics in Liver Disease, E-Book
(2015)
Additional Information
Book Details
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 |