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ESMO Open 2020 Jun;5(3)

Oncology Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.

Purpose: Pseudocirrhosis is a radiological term used to describe rapid changes in the contour of liver invaded by metastases and treated with chemotherapy. Our primary objectives were to analyse the clinical and biological characteristics of those patients with breast cancer and to assess the prevalence of complications generally associated with decompensated cirrhosis. We have also assessed associated treatments and response. Read More

Am J Med Qual 2020 Jun 2:1062860620929423. Epub 2020 Jun 2.

Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Annual influenza epidemics are associated with high morbidity and mortality worldwide, with vaccinations being the main preventive intervention; however, the compliance rate of health care employees remains low. Study aims were to examine vaccination rates among physicians and nurses in surgical and medicine wards, compare between medium and large tertiary hospitals, and identify factors associated with increased vaccination rates. Structured questionnaires were distributed. Read More

Zhonghua Yi Xue Za Zhi 2020 Jun;100(21):1654-1657

Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China.

To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis. The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson's correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. Read More

Clin Transplant 2020 Jun 2:e13995. Epub 2020 Jun 2.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.

Background: Evaluation of pulmonary arterial pressure is crucial among cirrhotic patients considering moderate portopulmonary hypertension (POPH) is a contraindication for liver transplant. Although right heart catheterization (RHC) is the most accurate method to diagnose POPH, it is invasive.

Objective: Aim is to evaluate the performance of echocardiography in detecting POPH in liver transplant candidates. Read More

Endoscopy 2020 May 29. Epub 2020 May 29.

Division of Gastroenterology, Department of Internal Medicine at Tongji Hospital, Tongji Medical College, HUST, Wuhan, China.

Medicine (Baltimore) 2020 May;99(22):e19889

Department of Radiology, Korea University College of Medicine, Seoul, South Korea.

This study aimed to investigate the association between the degree of thoracic duct dilatation and the progression of chronic liver disease.In this cross-sectional and retrospective study, 179 patients (mean age, 60.9 years; 114 men) with chronic liver disease who underwent chest CT were enrolled. Read More

World J Gastroenterol 2020 May;26(18):2221-2231

Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia.

Background: Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.

Aim: To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care. Read More

PLoS One 2020 29;15(5):e0233778. Epub 2020 May 29.

HepatoGastro Lab, Servicio de Ap. Digestivo del HGU Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.

The selection of the anesthetic regime is a crucial component in many experimental animal studies. In rodent models of liver disease, the combination of ketamine and diazepam (KD), generally by the intramuscular (i.m. Read More

Hepatology 2020 May 28. Epub 2020 May 28.

Institut für Pathologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany.

Schistosomiasis is a chronic helminthic disease caused by parasitic flatworms called schistosomes, infecting more than 207 million people in 78 countries worldwide, and provoking over 200,000 deaths annually. Schistosomiasis is the cause of a spectrum of serious diseases affecting several organs, belonging to the genitourinary, digestive, and nervous systems. In the liver, schistosomiasis induces hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Read More

Arch Cardiol Mex 2020 ;90(2):169-177

Servicio Social en Investigación. Hospital Regional ISSSTE Puebla. Puebla, México.

Cirrhotic cardiomyopathy is characterized by the presence of structural and functional cardiac alterations in patients suffering from hepatic cirrhosis, without previously known cardiac causes that may explain it. Clinically, it is characterized by the presence of variable grades of diastolic and systolic dysfunction, alterations in the electric conductance (elongation of corrected QT interval) and inadequate chronotropic response. This pathology has been related to substandard response in the management of patients with portal hypertension and poor outcome after transplant. Read More

Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2020 Apr;32(2):154-158

Department of Infectious Diseases/Intensive Care Unit of Hepatology, The First Hospital Affiliated of Soochow University, Suzhou 215006, China.

Objective: To investigate the clinical characteristics and the distribution of peripheral blood T lymphocyte sub-sets in patients with schistosomal hepatic cirrhosis in Suzhou City.

Methods: A total of 32 inpatients with liver diseases due to advanced schistosomiasis at the Department of Infectious Diseases, The First Affiliated Hospital of Soochow University from January 2016 to January 2018 were recruited and assigned into the infection and non-infection groups according to presence of co-infections, and 20 old healthy volunteers served as controls. Venous blood samples were collected on the day of admission, and the proportions of CD4 T cells, CD8 T cells, regulatory T (Treg) cells and Th17 cells were detected in peripheral blood using flow cytometry. Read More

Surg Case Rep 2020 May 26;6(1):116. Epub 2020 May 26.

Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.

Background: Although endoscopic interventions for chronic pancreatitis are highly developed, surgery for severe complicated cases such as the coexistence of bile duct, duodenum, and portal vein stenosis is a challenging issue for surgeons. In such instances, pancreaticoduodenectomy could lead to massive intraoperative bleeding due to severe collateral veins. A surgical drainage procedure, instead of pancreatic resection, may be a reasonable and safer option in such cases, but the literature on a surgical drainage technique to resolve all obstructions of the pancreatic duct, bile duct, and duodenum at once is limited. Read More

Ann Hepatobiliary Pancreat Surg 2020 May;24(2):168-173

Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.

Backgrounds/aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Read More

HPB (Oxford) 2020 May 23. Epub 2020 May 23.

Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China. Electronic address:

Background: Hepatocellular carcinoma (HCC) is a recognized sequalae of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. This study aimed to identify long-term survival and prognostic factors after curative resection for HCC among patients with chronic HCV infection.

Methods: From a Chinese multicenter database, the data of consecutive patients with HCV infection undergoing curative liver resection for initial HCC between 2006 and 2015 were retrospectively reviewed. Read More

Transplant Proc 2020 May 23. Epub 2020 May 23.

Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

Background And Objective: Liver transplantation (LT) is the gold-standard treatment for end-stage liver disease; however, late-onset complications such as fatty liver can occur in the absence of metabolic comorbidities. We report a unique case of post-transplant hepatic steatosis developing in only a part of the liver graft.

Case Report: A 1-year-old boy underwent ABO-incompatible living donor liver transplantation (LDLT) with a left lateral liver graft donated from his mother for biliary atresia. Read More

J Trop Med 2020 6;2020:4083252. Epub 2020 May 6.

Department of Medical Parasitology, CMHS, University of Gondar, Gondar, Ethiopia.

Background: Schistosomiasis is a parasitic disease that resides in the vascular system of vertebrates, causing a chronic, debilitating disease that affects more than 200 million people and 800,000 deaths per year in over 70 countries. This parasite causes liver dysfunction and disorders normal hematological and biochemical profiles in addition to portal vein hypertension syndrome, ascites, and liver fibrosis. The general objective of the current study is to assess hematological and biochemical profiles of patients infected with in comparison with apparently healthy individuals (control group) in Sanja town, northwest Ethiopia. Read More

Clin Transplant 2020 May 26:e13992. Epub 2020 May 26.

Liver Transplant Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.

Objective: To analyze the incidence and risk factors of portal vein stenosis (PVS) in pediatric liver transplantation (LT).

Methods: This retrospective analysis of 396 cases of pediatric LT (patients aged ≤14 years old) was conducted at the Liver Transplantation Center of Beijing Friendship Hospital (China) from June 2013 to December 2017. We collected relevant data and calculated the incidence. Read More

J Gastroenterol Hepatol 2020 May 26. Epub 2020 May 26.

Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea.

To evaluate whether presence of varices on CT could predict treatment outcome for hepatocellular carcinoma (HCC) patients.

Methods: We enrolled 241 patients with single HCC≤5cm treated by surgery. Using preoperative CT/endoscopy, patients were classified into: presence of standard clinically significant portal hypertension (CSPH) surrogate, defined as varices on esophagogastroduodenoscopy and/or thrombocytopenia with splenomegaly (group 1, n=47); Varices on CT without standard CSPH surrogate (group 2, n=45); and none of both (group 3, n=149). Read More

Aliment Pharmacol Ther 2020 May 26. Epub 2020 May 26.

Liver Unit, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.

Background: Early-transjugular intrahepatic porto-systemic shunt (TIPSS) has been recommended in international guidelines for high-risk patients with oesophageal variceal bleeding.

Aims: To validate the results of a previous randomised control trial which supports use of early-TIPSS.

Methods: In a two-centre open-label parallel-group randomised control trial, patients with cirrhosis and acute variceal bleeding were recruited following haemostasis with vaso-active drugs and endoscopic band ligation. Read More

Abdom Radiol (NY) 2020 May 25. Epub 2020 May 25.

Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.

Background: To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance.

Materials And Methods: Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. Read More

HPB (Oxford) 2020 May 22. Epub 2020 May 22.

Consultant Liver Transplant and HPB Surgeon, Apollo Hospital, Bangalore, India. Electronic address:

The pathogenesis of portal hypertension differs in patients with small for size syndrome (SFSS) after living donor liver transplantation (LDLT) and postoperative liver failure (POLF) after liver resection. This difference has important implications in the prevention and management of POLF. Read More

Clin Res Hepatol Gastroenterol 2020 May 21. Epub 2020 May 21.

Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général-Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases FILFOIE, Saint-Antoine Hospital, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.

J Hepatol 2020 May 21. Epub 2020 May 21.

Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Guoxue Lane, Chengdu 610041, China. Electronic address:

Abdom Radiol (NY) 2020 May 23. Epub 2020 May 23.

Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To investigate the associated Multi-Detector Computed Tomography (MDCT) features for esophageal varices (EVs) and esophageal variceal hemorrhage (EVH), with particular emphasis on different collateral veins.

Materials And Methods: All cirrhotic patients who had undergone both Upper Gastrointestinal Tract (UGIT) endoscopy and contrast-enhanced MDCT within 6 months from 2013 to 2019 were included in the study. MDCT of 124 patients, 76 males and 48 females, aged between 21 and 73 years old were evaluated for presence of EV and presence and size of different collaterals. Read More

Cell Mol Gastroenterol Hepatol 2020 May 21. Epub 2020 May 21.

Gastroenterology Research Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905. Electronic address:

Background And Aims: Transforming growth factor (TGF-β) induced activation of quiescent hepatic stellate cells (HSC) and their transformation to myofibroblasts is a key event in liver fibrosis and portal hypertension. GIPC (also referred to as synectin) is a downstream signal activation molecule of TGF-β and other receptors. In this study, we sought to identify novel genes targeted by TGF-β and GIPC and elucidate if and how they may contribute to liver fibrosis. Read More

J Hepatol 2020 May 21. Epub 2020 May 21.

Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBEREHD, Universidad de Alcalá, Madrid, Spain. Electronic address:

Background And Aims: The safety of non-selective -blockers (NSBB) has been questioned in refractory ascites (RA). We studied the effects of NSBB on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive (DRA) and RA.

Methods: Prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBB for variceal bleeding prophylaxis. Read More

J Hepatol 2020 May 20. Epub 2020 May 20.

Oxford Liver Unit, Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK. Electronic address:

J Med Imaging Radiat Oncol 2020 May 22. Epub 2020 May 22.

Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.

Introduction: Balloon-occluded retrograde transvenous obliteration (BRTO) is recommended for secondary prevention of gastric variceal bleeding in the American Association for the Study of Liver Disease (AASLD) guidelines, as an alternative to Transjugular intrahepatic portosystemic shunt (TIPS). However, there is significant heterogeneity in how BRTO is performed, including how and how long to occlude the outflow venous shunt amongst other variables such as variceal size, flow rate, agent used, and preparation technique. We propose a method using foam sclerotherapy and reducing balloon occlusion to as little as 30 min, with assessment of the efficacy of this shorter balloon inflation time. Read More

Surg Endosc 2020 May 21. Epub 2020 May 21.

Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.

Background: Patients with hepatic schistosomiasis are at high risk of gastroesophageal variceal bleeding, which is highly torrential and life threatening. This study aimed to assess the effects of splenectomy on patients with schistosomiasis-induced variceal bleeding, especially those influences related to overall survival (OS) rate.

Methods: From January 2005 to December 2018, 112 patients with schistosomiasis-induced varices were enrolled. Read More

Hepatol Int 2020 May 22. Epub 2020 May 22.

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

Background: The clinical characteristics and disease course in COVID-19 patients with pre-existing decompensated cirrhosis has not been described so far.

Methods: In this case series, we report three patients with confirmed COVID-19 and pre-existing decompensated cirrhosis from three hospitals in Hubei, the epicenter of the outbreak in China.

Result: Patient 1 was a 53-year-old man with hepatitis B virus-related cirrhosis, portal hypertension, and ascites. Read More

Dig Dis Sci 2020 May 21. Epub 2020 May 21.

Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.

Background: The expanded Baveno-VI criteria may further reduce the need for screening gastroscopy compared to Baveno-VI criteria.

Aim: We sought to validate the performance of these criteria in a cohort of compensated advanced chronic liver disease (cACLD) patients with predominantly hepatitis B infection.

Methods: Consecutive cACLD patients from 2006 to 2012 with paired liver stiffness measurements and screening gastroscopy within 1 year were included. Read More

ACG Case Rep J 2020 Feb 2;7(2):e00333. Epub 2020 Mar 2.

Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Myelofibrosis is a hematologic condition that predisposes to the formation of large and small portal venous clots. Portal injury is believed to underlie the mechanism of development of noncirrhotic portal hypertension in this population. We describe a patient with myelofibrosis, proven portal hypertension, and extramedullary hematopoiesis with no imaging or pathologic evidence of microvascular or macrovascular portal clot. Read More

Rev Esp Anestesiol Reanim 2020 May 18. Epub 2020 May 18.

Unidad de Cirugía Hepatobiliar y Trasplante Hepático, Hospital Universitario Cruces, Baracaldo, Vizcaya, España.

Background: Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor.

Methods: We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. Read More

J Allergy Clin Immunol 2020 May 10. Epub 2020 May 10.

University Medical Center Groningen, Department of Hematology, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Background: Advanced systemic mastocytosis (advSM) is characterized by the presence of the KIT D816V mutation and pathologic accumulation of neoplastic mast cells (MCs) in various tissues, leading to severe symptoms and organ damage, eg, cytopenias, liver dysfunction, portal hypertension, malabsorption, and weight loss. Treatment with midostaurin, an orally active multikinase/KIT inhibitor now approved for advSM in the United States and the European Union, resulted in a high rate of response accompanied by reduced MC infiltration of the bone marrow and lowered serum tryptase level.

Objective: We aimed to determine whether midostaurin improves health-related quality of life (QOL) and MC mediator-related symptoms in patients with advSM. Read More

PLoS One 2020 21;15(5):e0233350. Epub 2020 May 21.

Geriatric Unit, Università Campus Bio-Medico, Roma, Lazio, Italy.

Background: Serum-ascites albumin gradient (SAAG) remains the most sensitive and specific marker for the differentiation of ascites due to portal hypertension from ascites due to other causes. SAAG has some limitations and may fail in selected conditions. Voltammetric analysis (VA) has been used for the detection of electroactive species of biological significance and has proven effective for detection infections in biological fluids. Read More

Gut 2020 May 20. Epub 2020 May 20.

Division of Gastroenterology and Hepatology, Medical University South Carolina, Charleston, South Carolina, USA.

Chin Clin Oncol 2020 May 14. Epub 2020 May 14.

Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. In early stage HCC, current practice guidelines recommend surgical resection with 5-year overall survival (OS) rates approaching 60%. Due to heterogeneity of the patient population and underutilization of HCC screening, in the past only 10-37% of patients were eligible for surgical resection at the time of initial HCC diagnosis. Read More

AJR Am J Roentgenol 2020 May 20:1-8. Epub 2020 May 20.

Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN.

The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. Read More

Front Med (Lausanne) 2020 5;7:149. Epub 2020 May 5.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.

Cholestatic liver diseases are a significant cause of morbidity and mortality and the leading indication for pediatric liver transplant. These include diseases such as biliary atresia, Alagille syndrome, progressive intrahepatic cholestasis entities, ductal plate abnormalities including Caroli syndrome and congenital hepatic fibrosis, primary sclerosing cholangitis, bile acid synthesis defects, and certain metabolic disease. Medical management of these patients typically includes supportive care for complications of chronic cholestasis including malnutrition, pruritus, and portal hypertension. Read More

Ann Surg Oncol 2020 May 19. Epub 2020 May 19.

Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China.

Background: Anatomical liver resection has shown advantages in the treatment of hepatocellular carcinoma (HCC).1 Pure laparoscopic hepatectomy for some deep lesions remains challenging, especially for anatomical resection.2 Because of many kinds of hepatic venous variations, resection along the hepatic vein may not be a "real" anatomical resection. Read More

J Gastrointest Surg 2020 May 18. Epub 2020 May 18.

Department of Vascular and Endovascular Surgery, Gonda Vascular Center, Hepatobiliary Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Background: Surgical portosystemic shunts are rare. We reviewed indications, operative details, and outcomes of patients undergoing surgical portosystemic shunt procedures.

Methods: We retrospectively reviewed clinical data of consecutive patients between 1997 and 2018 from a single institution. Read More

World J Clin Cases 2020 May;8(9):1745-1751

Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China.

Background: Biliary hamartomas (BH) are a rare benign disease caused by malformation of the intrahepatic bile ducts. BH are occasionally diagnosed, but often lack obvious clinical symptoms. They are usually diagnosed by biopsy and imaging tests in clinical practice. Read More

Cardiovasc Intervent Radiol 2020 May 17. Epub 2020 May 17.

Department of Radiology, Radiology Associates, P.A., Little Rock, AR, USA.

Int J Surg Case Rep 2020 May 11;70:83-86. Epub 2020 May 11.

Department of Surgery, The Chinese University of Hong Kong, Hong Kong.

Introduction: Upper gastrointestinal bleeding (UGIB) in patients suffering from hepatocellular carcinoma (HCC) is usually due to oesophageal or gastric varices secondary to portal hypertension. Very rarely, HCC can directly invade into the stomach or duodenum resulting in UGIB.

Presentation Of Case: A 62-year-old man presented to the emergency department for haematemesis and tarry stool. Read More

Transplant Proc 2020 May 13. Epub 2020 May 13.

Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.

Some liver transplant recipients may present with persistent hypersplenism post transplant. Persistent thrombocytopenia and leukopenia may put immunosuppressed transplant recipients at a higher risk of serious, even life-threatening bleeding and infection and limit the use of some drugs (such as mycophenolate mofetil) that could reduce white blood cell and platelet counts during the postoperative period. Herein, we report the first case, to the best of our knowledge, of successful simultaneous anatomic subtotal splenectomy during living donor liver transplantation in a 6-year-old girl with biliary atresia, cirrhotic portal hypertension, severe hypersplenism, and massive splenomegaly. Read More

Digestion 2020 May 14:1-9. Epub 2020 May 14.

Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany.

Background: Before the discovery of immunological and haematological functions of the spleen, it had for centuries been considered to be a digestive organ of variable size with a role in the portal vein system and nutritional metabolism. In the 19th and 20th centuries, volume changes in the spleen related to nutrition were studied using plethysmographic measurements. Rhythmical and regulatory functions of the spleen were demonstrated in the haemodynamics of the splanchnic region and were described as a "hepatolienal pendulum," a "Windkessel function," or a "pressure compensation. Read More

ANZ J Surg 2020 May 14. Epub 2020 May 14.

Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China.

Background: Research about the long-term outcomes of oesophagogastric devascularization and splenectomy (OGDS) to treat portal hypertension (PH) is scarce. This study aimed to evaluate the safety and long-term treatment efficacy of OGDS, especially in elderly patients.

Methods: During 2010-2016, open splenectomy and oesophagogastric devascularization (OSOD) and laparoscopic splenectomy and oesophagogastric devascularization were performed in 124 (group A) and 29 (group C) patients diagnosed with PH and liver cirrhosis, respectively. Read More

ANZ J Surg 2020 May 14. Epub 2020 May 14.

Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.

Bleeding related to rectal varices associated with portal hypertension is rare but life-threatening, and requires prompt treatment. We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68-year-old man with Child-Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life-threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. Read More

Cardiol Young 2020 May 14:1-3. Epub 2020 May 14.

Division Pediatric Cardiology and Pediatric Intensive Care Medicine, Tuebingen University Children's Hospital, Germany.

A 25-year-old patient with signs of cirrhosis on ultrasound and CT presented with portal vein thrombosis on routine follow-up examinations; retrograde hepatic wedge angiography demonstrated only the right-sided portal vein branch. Development of a portosystemic collateral vessel to the left-sided renal vein prevented signs of hypersplenism. This unique complication of portal vein thrombosis should be considered during long-term surveillance. Read More