In recent years,hepatology has undergone a transformative evolution driven by significant advancements in diagnostic and therapeutic technologies.The expanding integration of endoscopic modalities into hepatology has ...In recent years,hepatology has undergone a transformative evolution driven by significant advancements in diagnostic and therapeutic technologies.The expanding integration of endoscopic modalities into hepatology has enforced the diagnosis,staging,management of liver diseases beside integration into transplantation.This review highlights the evolving discipline of“endo-hepatology”,where endoscopic ultrasound,endoscopic retrograde cholangiopancreatography,and novel interventional tools are employed to address the critical challenges in chronic liver disease.The review provides a comprehensive synthesis of current evidence and different clinical applications,while also exploring future directions including revolution of artificial intelligence-assisted endoscopies and enhanced imaging endoscopies.By bridging the anatomical and functional interface between the gastrointestinal lumen and the liver,endo-hepatology is not only improving diagnostic accuracy and therapeutic precision but also reshaping multidisciplinary paradigms in hepatology practice.展开更多
Fibrolamellar carcinoma(FLC)is a rare variant of hepatocellular carcinoma(HCC),comprising 1%–9%of all HCCs.FLC is a poorly understood malignancy,which seems to be more prevalent in young patients with no underlying l...Fibrolamellar carcinoma(FLC)is a rare variant of hepatocellular carcinoma(HCC),comprising 1%–9%of all HCCs.FLC is a poorly understood malignancy,which seems to be more prevalent in young patients with no underlying liver diseases.The term“fibrolamellar”is derived from thick fibrous collagen bands surrounding the tumor cells.Unlike HCC,cirrhosis and viral hepatitis infection are not predisposing to FLC,and it is not associated with elevations in serum alpha-fetoprotein.FLC patients often present with vague abdominal pain,nausea,malaise,and weight loss.Most cases present are at an advanced stage at the time of initial diagnosis.However,curative treatment options can still be offered to up to 70%of patients.Surgery(resection/liver transplantation)is the mainstay of treatment and the only potentially curative option.FLCs have been less chemoresponsive than the conventional HCC,however,in advanced cases,multimodality treatments can be effective.Recent advances in molecular studies of FLC have found a unique DNAJB1–PRKACA fusion transcript in most of the cases studied.The review aims to describe clinical characteristics,diagnostic methods,and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.展开更多
The critical shortage of liver transplant donors necessitates innovative solutions,with xenotransplantation emerging as a promising alternative.Despite significant ethical,scientific,and practical challenges,recent ad...The critical shortage of liver transplant donors necessitates innovative solutions,with xenotransplantation emerging as a promising alternative.Despite significant ethical,scientific,and practical challenges,recent advancements in liver xenotransplantation,particularly using pigs as donors for non-human primates(NHPs),have extended graft survival duration.However,life-threatening issues such as thrombocytopenia and coagulation disorders persist,limiting survival to under a month.Advances in genetic engineering have enabled the modification of pig genomes to match the human immune system better,targeting genes responsible for immune rejection and increasing compatibility.While these breakthroughs enhance the potential for human transplantation,the challenges of immune rejection and long-term functionality remain substantial.This review highlights recent progress in liver xenotransplantation from pigs to NHPs and explores the implications for potential human clinical application.展开更多
Hepatocellular carcinoma(HCC),the sixth most common cancer globally,is associated with high mortality rates and more than 830,000 annual deaths.Despite advances in the available management options including surgical r...Hepatocellular carcinoma(HCC),the sixth most common cancer globally,is associated with high mortality rates and more than 830,000 annual deaths.Despite advances in the available management options including surgical resection and local ablative therapies,recurrence rates after the initial treatment exceed 50%,even among patients who have undergone curative-intent therapy.Moreover,postsurgical HCC recurrence occurs in about 70%of cases five years postoperatively.The management of recurrent HCC remains undefined.This review discusses different predictors for HCC recurrence after each treatment modality and different approaches available to stratify these patients.More specific guidelines for managing HCC recurrence and strict surveillance protocols for such recurrence after initial HCC management are needed.展开更多
Hepatitis B virus(HBV)infection is a significant health problem that can result in progression to liver cirrhosis,decompensation,and the development of hepatocellular carcinoma(HCC).On a country level,the prevalence o...Hepatitis B virus(HBV)infection is a significant health problem that can result in progression to liver cirrhosis,decompensation,and the development of hepatocellular carcinoma(HCC).On a country level,the prevalence of chronic HBV infection varies between 0.1%and 35.0%,depending on the locality and the population being investigated.One-third of all liver cancer fatalities worldwide are attributable to HBV.The adoption of standard birth-dose immunization exerted the most significant impact on the decline of HBV prevalence.HCC incidence ranges from 0.01%to 1.40%in noncirrhotic patients and from 0.9%to 5.4%annually,in the settings of liver cirrhosis.Although antiviral therapy significantly reduces the risk of developing HBV-related HCC,studies have demonstrated that the risk persists,and that HCC screening is still essential.This review discusses the complex relationship between HBV infection and HCC,recent epidemiological data,different aspects of clinical disease characteristics,and the impact of antiviral therapy in this context.展开更多
Hepatocellular carcinoma(HCC)is the sixth most prevalent form of cancer globally and the third leading cause of cancer-related mortality.The incidence of portal vein tumor thrombosis(PVTT)in HCC patients is 21%at one ...Hepatocellular carcinoma(HCC)is the sixth most prevalent form of cancer globally and the third leading cause of cancer-related mortality.The incidence of portal vein tumor thrombosis(PVTT)in HCC patients is 21%at one year and 46%at three years.The presence of PVTT has consistently been associated with a poor prognosis for HCC patients over the past decades.Notably,HCC prognosis is influenced not only by the presence of PVTT but also by the degree or extent of PVTT.Currently,there is a lack of global consensus or established protocols regarding the optimal management of HCC with associated PVTT.The Barcelona Clinic for Liver Cancer classifies HCC patients with PVTT as stage C,indicating an advanced stage,and limiting treatment recommendations for these patients to systemic therapy.In recent years,there has been an increase in the availability of therapeutic options for HCC patients with PVTT.Treatment modalities include systemic therapy,transarterial chemoembolization,surgical resection,stereotactic body radiotherapy,transarterial radioembolization,and liver transplantation.An ideal therapy for each patient necessitates a multidisciplinary approach.This review article presents the latest updates in managing HCC patients with PVTT.展开更多
文摘In recent years,hepatology has undergone a transformative evolution driven by significant advancements in diagnostic and therapeutic technologies.The expanding integration of endoscopic modalities into hepatology has enforced the diagnosis,staging,management of liver diseases beside integration into transplantation.This review highlights the evolving discipline of“endo-hepatology”,where endoscopic ultrasound,endoscopic retrograde cholangiopancreatography,and novel interventional tools are employed to address the critical challenges in chronic liver disease.The review provides a comprehensive synthesis of current evidence and different clinical applications,while also exploring future directions including revolution of artificial intelligence-assisted endoscopies and enhanced imaging endoscopies.By bridging the anatomical and functional interface between the gastrointestinal lumen and the liver,endo-hepatology is not only improving diagnostic accuracy and therapeutic precision but also reshaping multidisciplinary paradigms in hepatology practice.
文摘Fibrolamellar carcinoma(FLC)is a rare variant of hepatocellular carcinoma(HCC),comprising 1%–9%of all HCCs.FLC is a poorly understood malignancy,which seems to be more prevalent in young patients with no underlying liver diseases.The term“fibrolamellar”is derived from thick fibrous collagen bands surrounding the tumor cells.Unlike HCC,cirrhosis and viral hepatitis infection are not predisposing to FLC,and it is not associated with elevations in serum alpha-fetoprotein.FLC patients often present with vague abdominal pain,nausea,malaise,and weight loss.Most cases present are at an advanced stage at the time of initial diagnosis.However,curative treatment options can still be offered to up to 70%of patients.Surgery(resection/liver transplantation)is the mainstay of treatment and the only potentially curative option.FLCs have been less chemoresponsive than the conventional HCC,however,in advanced cases,multimodality treatments can be effective.Recent advances in molecular studies of FLC have found a unique DNAJB1–PRKACA fusion transcript in most of the cases studied.The review aims to describe clinical characteristics,diagnostic methods,and therapeutic modalities for this rare tumor to raise awareness among clinicians and surgeons.
文摘The critical shortage of liver transplant donors necessitates innovative solutions,with xenotransplantation emerging as a promising alternative.Despite significant ethical,scientific,and practical challenges,recent advancements in liver xenotransplantation,particularly using pigs as donors for non-human primates(NHPs),have extended graft survival duration.However,life-threatening issues such as thrombocytopenia and coagulation disorders persist,limiting survival to under a month.Advances in genetic engineering have enabled the modification of pig genomes to match the human immune system better,targeting genes responsible for immune rejection and increasing compatibility.While these breakthroughs enhance the potential for human transplantation,the challenges of immune rejection and long-term functionality remain substantial.This review highlights recent progress in liver xenotransplantation from pigs to NHPs and explores the implications for potential human clinical application.
文摘Hepatocellular carcinoma(HCC),the sixth most common cancer globally,is associated with high mortality rates and more than 830,000 annual deaths.Despite advances in the available management options including surgical resection and local ablative therapies,recurrence rates after the initial treatment exceed 50%,even among patients who have undergone curative-intent therapy.Moreover,postsurgical HCC recurrence occurs in about 70%of cases five years postoperatively.The management of recurrent HCC remains undefined.This review discusses different predictors for HCC recurrence after each treatment modality and different approaches available to stratify these patients.More specific guidelines for managing HCC recurrence and strict surveillance protocols for such recurrence after initial HCC management are needed.
文摘Hepatitis B virus(HBV)infection is a significant health problem that can result in progression to liver cirrhosis,decompensation,and the development of hepatocellular carcinoma(HCC).On a country level,the prevalence of chronic HBV infection varies between 0.1%and 35.0%,depending on the locality and the population being investigated.One-third of all liver cancer fatalities worldwide are attributable to HBV.The adoption of standard birth-dose immunization exerted the most significant impact on the decline of HBV prevalence.HCC incidence ranges from 0.01%to 1.40%in noncirrhotic patients and from 0.9%to 5.4%annually,in the settings of liver cirrhosis.Although antiviral therapy significantly reduces the risk of developing HBV-related HCC,studies have demonstrated that the risk persists,and that HCC screening is still essential.This review discusses the complex relationship between HBV infection and HCC,recent epidemiological data,different aspects of clinical disease characteristics,and the impact of antiviral therapy in this context.
文摘Hepatocellular carcinoma(HCC)is the sixth most prevalent form of cancer globally and the third leading cause of cancer-related mortality.The incidence of portal vein tumor thrombosis(PVTT)in HCC patients is 21%at one year and 46%at three years.The presence of PVTT has consistently been associated with a poor prognosis for HCC patients over the past decades.Notably,HCC prognosis is influenced not only by the presence of PVTT but also by the degree or extent of PVTT.Currently,there is a lack of global consensus or established protocols regarding the optimal management of HCC with associated PVTT.The Barcelona Clinic for Liver Cancer classifies HCC patients with PVTT as stage C,indicating an advanced stage,and limiting treatment recommendations for these patients to systemic therapy.In recent years,there has been an increase in the availability of therapeutic options for HCC patients with PVTT.Treatment modalities include systemic therapy,transarterial chemoembolization,surgical resection,stereotactic body radiotherapy,transarterial radioembolization,and liver transplantation.An ideal therapy for each patient necessitates a multidisciplinary approach.This review article presents the latest updates in managing HCC patients with PVTT.
