BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est...BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.展开更多
The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the p...The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the prognosis for ICC remains poor.Owing to the high degree of malignancy and insidious onset of ICC,numerous cases are detected at intermediate or advanced stages of the disease,hence eliminating the chance for surgical intervention.Moreover,because of the highly invasive characteristics of ICC,recurrence and metastasis postresection are prevalent,leading to a 5-year survival rate of only 20%-35%following surgery.In the past decade,different methods of treatment have been investigated,including transarterial chemoembolization,transarterial radioembolization,radiotherapy,systemic therapy,and combination therapies.For certain patients with advanced ICC,conversion treatment may be utilized to facilitate surgical resection and manage disease progression.This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.展开更多
BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperat...BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incide...BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.展开更多
Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recent...Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(...BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic c...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.展开更多
Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an...Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?展开更多
BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,includin...BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.展开更多
BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmaphe...BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.展开更多
BACKGROUND Dual-phenotype hepatocellular carcinoma(HCC)is a relatively new subtype of HCC.Studies have shown that in the context of chronic hepatitis,liver cirrhosis,and other liver conditions,some intrahepatic cholan...BACKGROUND Dual-phenotype hepatocellular carcinoma(HCC)is a relatively new subtype of HCC.Studies have shown that in the context of chronic hepatitis,liver cirrhosis,and other liver conditions,some intrahepatic cholangiocarcinomas(ICCs)exhibit an enhancement pattern similar to that of HCC.Both dual-phenotype HCC(DPHCC)and ICC can express biliary markers,making imaging and pathology differentiation difficult.Currently,radiomics is widely used in the differentiation,clinical staging,and prognosis assessment of various diseases.Radiomics can effectively differentiate DPHCC and ICC preoperatively.AIM To evaluate the value of radiomics in the differential diagnosis of DPHCC and ICC and to validate its clinical applicability METHODS In this retrospective study,the data of 53 DPHCC patients and 124 ICC patients were collected retrospectively and randomly divided into training and testing sets at a ratio of 7:3.After delineation of regions of interest and feature extraction and selection,radiomics models were constructed.Receiver operating characteristic curve analysis was conducted to calculate the area under the curve(AUC)for each model.The AUC values of radiologists with and without assistance from the model were also assessed.RESULTS In the training set,the AUC value of the radiomic model was the highest,and the combined model and the radiomic model had similar AUC(P>0.05);the differences in the AUC values between the combined model and the clinical-sign model was statistically significant(P<0.05).In the testing set,the AUC value of the combined model was the highest,and the differences in the AUC values between the combined model and the clinical-sign model was statistically significant(P<0.05).With model assistance,the AUC values of Doctor D(10 years of experience in abdominal imaging diagnosis)and Doctor E(5 years of experience in abdominal imaging diagnosis)both increased.CONCLUSION Radiomics can differentiate DPHCC and ICC,and with assistance from the developed model,the accuracy of less experienced doctors in the differential diagnosis of these two diseases can be improved.展开更多
BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively ...BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.展开更多
Intrahepatic cholangiocarcinoma(ICC)is a primary liver malignancy with increasing global incidence and mortality rates.The 5-year overall survival rate for patients with ICC is approximately 9%.Surgical resection curr...Intrahepatic cholangiocarcinoma(ICC)is a primary liver malignancy with increasing global incidence and mortality rates.The 5-year overall survival rate for patients with ICC is approximately 9%.Surgical resection currently represents the only curative treatment option.However,due to the high aggressiveness,insidious onset,and atypical clinical presentation of ICC,many patients either miss the optimal surgical window or experience early postoperative recurrence and metastasis.This poses significant challenges for hepatobiliary surgeons worldwide.Artificial intelligence(AI),as a prominent driver of technological advancement,offers promising new avenues for managing ICC.By leveraging powerful machine learning and deep learning algorithms,AI has demonstrated promising outcomes in ICC diagnosis,particularly in differentiating it from hepatocellular carcinoma,and in predicting critical prognostic factors such as early recurrence,lymph node metastasis,and microvascular invasion.These innovations can support clinical decision-making and ultimately improve patient outcomes.Future efforts should prioritize robust clinical studies evaluating the effectiveness of AI in ICC management.展开更多
The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preop...The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.展开更多
Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinica...Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.展开更多
A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces proce...A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.展开更多
Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impa...Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impairs neuropsychiatric function and motor control,remains the primary adverse effect of TIPS,limiting its utility.Prompt prevention and treatment of post-TIPS HE are critical,as they are strongly associated with readmission rates and poor quality of life.This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE,explores advanced biomarkers and predictive tools,and discusses current management strategies and future directions to prevent or reverse HE following TIPS.These strategies include preoperative patient assessment,individualized shunt diameter optimization,spontaneous portosystemic shunt embolization during the TIPS procedure,postoperative preventive and therapeutic measures such as nutrition management,medical therapy,fecal microbiota transplantation,and stent reduction.展开更多
文摘BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.
文摘The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the prognosis for ICC remains poor.Owing to the high degree of malignancy and insidious onset of ICC,numerous cases are detected at intermediate or advanced stages of the disease,hence eliminating the chance for surgical intervention.Moreover,because of the highly invasive characteristics of ICC,recurrence and metastasis postresection are prevalent,leading to a 5-year survival rate of only 20%-35%following surgery.In the past decade,different methods of treatment have been investigated,including transarterial chemoembolization,transarterial radioembolization,radiotherapy,systemic therapy,and combination therapies.For certain patients with advanced ICC,conversion treatment may be utilized to facilitate surgical resection and manage disease progression.This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC.
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
基金Supported by National Key Research and Development Program,No.2022YFC2407304Major Research Project for Middle-Aged and Young Scientists of Fujian Provincial Health Commission,No.2021ZQNZD013+2 种基金The National Natural Science Foundation of China,No.62275050Fujian Province Science and Technology Innovation Joint Fund Project,No.2019Y9108Major Science and Technology Projects of Fujian Province,No.2021YZ036017.
文摘BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
文摘BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.
文摘Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
基金Supported by the Guangzhou Science and Technology Plan Project,No.2023A04J0419National Natural Science Foundation Cultivation Project at the Third Affiliated Hospital of Sun Yat-sen University,No.2022GZRPYQN04.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(iCCA)is the second most common liver malignancy with poor prognosis and limited treatment options.AIM To identify the most effective drug for transarterial chemoembolization(TACE)in cholangiocarcinoma and evaluate the efficacy and safety of combining it with gemcitabine and cisplatin(GemCis)for unresectable iCCA.METHODS Cholangiocarcinoma cell lines(RBE,HuCC-T1)were treated with 10 chemotherapeutic drugs,and cytotoxicity was assessed by cell counting kit-8 assays.Tumorbearing nude mice were treated with idarubicin or GemCis,and tumor growth was monitored.Clinical data from 85 iCCA patients were analyzed to evaluate the efficacy and safety of idarubicin-TACE combined with GemCis.RESULTS Idarubicin demonstrated the highest cytotoxicity,significantly outperforming GemCis,the standard first-line therapies.In tumor-bearing mouse models,idarubicin and GemCis treatments significantly slowed tumor growth,with idarubicin showing particularly pronounced effects on days 12 and 15(P<0.05).In retrospective analysis,the median overall survival(OS)and progression-free survival(PFS)in the combination therapy group were significantly longer than those in the GemCis alone group(median OS,16.23 months vs 10.07 months,P=0.042;median PFS,7.73 months vs 6.30 months,P=0.023).Additionally,major grade 3/4 adverse events(AEs)in the combination therapy group were abdominal pain(26.3%vs 6.5%,P=0.049)and elevated transaminases(42.1%vs 12.9%,P=0.038).Most AEs were mild to moderate and manageable.CONCLUSION Idarubicin demonstrated higher cytotoxicity than GemCis,significantly inhibiting tumor growth in tumor-bearing mouse models.Preliminary clinical results suggest that local idarubicin-TACE combined with GemCis may offer improved survival outcomes for iCCA patients with a manageable safety profile.
基金Supported by Shenzhen Clinical Research Center for Gastroenterology(Gastrointestinal Surgery),No.LCYSSQ20220823091203008.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.
文摘Trans-jugular intrahepatic portosystemic stent shunting(TIPSS)has been in use for many years with great results and many evolutions.The procedure essentially involves the insertion of a metal covert stent to create an Hepato-Hepatic portosystemic shunt.Over time,TIPSS has become the subject of many studies aimed at examining its clinical utility and evaluating the results of using TIPSS to manage complications related to portal hypertension.From the outset,this procedure has been met with hope and enthusiasm and give the chance to consider another possibility to treat the complications of portal hypertension without the use of surgery.Considering that TIPSS is an attractive alternative to shunt surgery because it does not require the use of general anesthesia or laparotomy,in fact this method is applicable to many patients with severe liver disease not suitable for it.TIPSS has been studied for the management of variceal bleeding,ascites,hepatic hydrothorax,hepatorenal syndrome,and other types of cirrhosis.However,some drawbacks of the TIPSS,such as shunt stenosis and hepatic encephalopathy,have also been reported in the literature.On the basis of the available evidence and the new epidemiological findings regarding liver disease,the following question may be posed:What is the place of TIPSS in current clinical practice?
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.
文摘BACKGROUND Benign recurrent intrahepatic cholestasis(BRIC)is a rare autosomal recessive liver disease,causing episodic cholestasis with intense pruritus.This case report highlights the effectiveness of early plasmapheresis as a therapeutic option for BRIC type 2,offering rapid symptom relief and early termination of cholestatic episodes.It contributes to the limited evidence supporting plasmapheresis as a treatment for BRIC flares resistant to conventional therapies.CASE SUMMARY A 43-year-old male with BRIC type 2 presented with fatigue,jaundice,and severe pruritus,triggered by a recent mild severe acute respiratory syndrome coronavirus 2 infection.Laboratory results confirmed cholestasis with elevated bilirubin and alkaline phosphatase.First-line pharmacological treatments,including cholestyramine and rifampicin,failed.Endoscopic nasobiliary drainage was ineffective,prompting initiation of plasmapheresis.This intervention rapidly relieved pruritus,with complete biochemical normalisation after 11 sessions.Two years later,a similar episode occurred,and early reinitiation of plasmapheresis led to symptom resolution within two sessions and biochemical recovery within two weeks.The patient tolerated the procedure well,with no adverse effects observed.Follow-up showed no signs of cholestasis recurrence.CONCLUSION Plasmapheresis is a safe and effective option for therapy-refractory BRIC type 2,particularly when initiated early in cholestasis.
文摘BACKGROUND Dual-phenotype hepatocellular carcinoma(HCC)is a relatively new subtype of HCC.Studies have shown that in the context of chronic hepatitis,liver cirrhosis,and other liver conditions,some intrahepatic cholangiocarcinomas(ICCs)exhibit an enhancement pattern similar to that of HCC.Both dual-phenotype HCC(DPHCC)and ICC can express biliary markers,making imaging and pathology differentiation difficult.Currently,radiomics is widely used in the differentiation,clinical staging,and prognosis assessment of various diseases.Radiomics can effectively differentiate DPHCC and ICC preoperatively.AIM To evaluate the value of radiomics in the differential diagnosis of DPHCC and ICC and to validate its clinical applicability METHODS In this retrospective study,the data of 53 DPHCC patients and 124 ICC patients were collected retrospectively and randomly divided into training and testing sets at a ratio of 7:3.After delineation of regions of interest and feature extraction and selection,radiomics models were constructed.Receiver operating characteristic curve analysis was conducted to calculate the area under the curve(AUC)for each model.The AUC values of radiologists with and without assistance from the model were also assessed.RESULTS In the training set,the AUC value of the radiomic model was the highest,and the combined model and the radiomic model had similar AUC(P>0.05);the differences in the AUC values between the combined model and the clinical-sign model was statistically significant(P<0.05).In the testing set,the AUC value of the combined model was the highest,and the differences in the AUC values between the combined model and the clinical-sign model was statistically significant(P<0.05).With model assistance,the AUC values of Doctor D(10 years of experience in abdominal imaging diagnosis)and Doctor E(5 years of experience in abdominal imaging diagnosis)both increased.CONCLUSION Radiomics can differentiate DPHCC and ICC,and with assistance from the developed model,the accuracy of less experienced doctors in the differential diagnosis of these two diseases can be improved.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.
基金Supported by National Natural Science Foundation of China,No.81902499 and No.81874205Key Research Project of Tongji Hospital Scientific Research Fund,No.2023A18.
文摘Intrahepatic cholangiocarcinoma(ICC)is a primary liver malignancy with increasing global incidence and mortality rates.The 5-year overall survival rate for patients with ICC is approximately 9%.Surgical resection currently represents the only curative treatment option.However,due to the high aggressiveness,insidious onset,and atypical clinical presentation of ICC,many patients either miss the optimal surgical window or experience early postoperative recurrence and metastasis.This poses significant challenges for hepatobiliary surgeons worldwide.Artificial intelligence(AI),as a prominent driver of technological advancement,offers promising new avenues for managing ICC.By leveraging powerful machine learning and deep learning algorithms,AI has demonstrated promising outcomes in ICC diagnosis,particularly in differentiating it from hepatocellular carcinoma,and in predicting critical prognostic factors such as early recurrence,lymph node metastasis,and microvascular invasion.These innovations can support clinical decision-making and ultimately improve patient outcomes.Future efforts should prioritize robust clinical studies evaluating the effectiveness of AI in ICC management.
文摘The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.
基金Supported by Hefei Natural Science Foundation,No.202341.
文摘Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.
基金Supported by National Natural Science Foundation of China,No.82330061The PUMC Graduate Curriculum Informatization Development Special Fund Project,No.2024YXX004The CAMS Initiative for Innovative Medicine,No.2021-I2M-1-015.
文摘A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.
基金Supported by the National Natural Science Foundation of China,No.82270649.
文摘Transjugular intrahepatic portosystemic shunts(TIPSs)are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis.However,hepatic encephalopathy(HE),which impairs neuropsychiatric function and motor control,remains the primary adverse effect of TIPS,limiting its utility.Prompt prevention and treatment of post-TIPS HE are critical,as they are strongly associated with readmission rates and poor quality of life.This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE,explores advanced biomarkers and predictive tools,and discusses current management strategies and future directions to prevent or reverse HE following TIPS.These strategies include preoperative patient assessment,individualized shunt diameter optimization,spontaneous portosystemic shunt embolization during the TIPS procedure,postoperative preventive and therapeutic measures such as nutrition management,medical therapy,fecal microbiota transplantation,and stent reduction.
