Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most widespread chronic liver disease signified by serious life-threatening conditions.The prevalence of MASLD increases along the growing prevalen...Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most widespread chronic liver disease signified by serious life-threatening conditions.The prevalence of MASLD increases along the growing prevalence in obesity and metabolic syndrome.To minimize costs and complications,non-invasive diagnostic tools,including transient elastography(TE),were introduced for assessment of MASLD.TE measures liver stiffness(LS),a clinical marker for the diagnosis of liver fibrosis and cirrhosis.LS measurements are based on ultrasound wave imaging and quantification.Vibration-controlled TE,including FibroScan®,is commonly used TE methods which can accurately identify the degree of liver fibrosis and cirrhosis progression.TE was reported to predict the progression towards hepatocellular carcinoma,portal hypertension,and varices.However,the accuracy of LS diagnostics alone in patients with MASLD remains controversial.TE measurements have several limitations,including inadequate precision due to focal liver lesions,cholestasis,inflammation,and other pathological and anatomical factors which can lead to the stiffness variability.Overestimations of TE readings were reported in obese patients with body mass index(BMI)over 30 kg/m2,and older patients with ascites,diabetes,or hypertension.Not all MASLD patients have high BMI.The prevalence of obesity among MASLD patients varies worldwide,indicating the urgent need for comprehensive diagnostic tools.In patients with MASLD,improved diagnostic accuracy has been demonstrated by combining LS measurements with other blood test-based scores and simple clinical parameters(agile scores based on age,sex,platelet count,aminotransferases,and diabetes).This study reviews the limitations of TE-based diagnostics and discusses the combined scoring algorithm.In conclusion,the sequence of LS measurements along assessment of other important clinical markers is an effective,low-cost,reliable tool to identify and monitor fibrosis progression in MASLD.展开更多
The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplat...The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).展开更多
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most widespread chronic liver disease signified by serious life-threatening conditions.The prevalence of MASLD increases along the growing prevalence in obesity and metabolic syndrome.To minimize costs and complications,non-invasive diagnostic tools,including transient elastography(TE),were introduced for assessment of MASLD.TE measures liver stiffness(LS),a clinical marker for the diagnosis of liver fibrosis and cirrhosis.LS measurements are based on ultrasound wave imaging and quantification.Vibration-controlled TE,including FibroScan®,is commonly used TE methods which can accurately identify the degree of liver fibrosis and cirrhosis progression.TE was reported to predict the progression towards hepatocellular carcinoma,portal hypertension,and varices.However,the accuracy of LS diagnostics alone in patients with MASLD remains controversial.TE measurements have several limitations,including inadequate precision due to focal liver lesions,cholestasis,inflammation,and other pathological and anatomical factors which can lead to the stiffness variability.Overestimations of TE readings were reported in obese patients with body mass index(BMI)over 30 kg/m2,and older patients with ascites,diabetes,or hypertension.Not all MASLD patients have high BMI.The prevalence of obesity among MASLD patients varies worldwide,indicating the urgent need for comprehensive diagnostic tools.In patients with MASLD,improved diagnostic accuracy has been demonstrated by combining LS measurements with other blood test-based scores and simple clinical parameters(agile scores based on age,sex,platelet count,aminotransferases,and diabetes).This study reviews the limitations of TE-based diagnostics and discusses the combined scoring algorithm.In conclusion,the sequence of LS measurements along assessment of other important clinical markers is an effective,low-cost,reliable tool to identify and monitor fibrosis progression in MASLD.
文摘The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).
