Evidence‐based clinical practice guidelines for liver cirrhosis 2020

Yoshiji, Hitoshi; Nagoshi, Sumiko; Akahane, Takemi; Asaoka, Yoshinari; Ueno, Yoshiyuki; Ogawa, Koji; Kawaguchi, Takumi; Kurosaki, Masayuki; Sakaida, Isao; Shimizu, Masahito; Taniai, Makiko; Terai, Shuji; Nishikawa, Hiroki; Hiasa, Yoichi; Hidaka, Hiroyoshi; Miwa, Hiroto; Chayama, Kazuaki; Enomoto, Nobuyuki; Shimosegawa, Tooru; Takehara, Tetsuo; Koike, Kazuhiko

doi:10.1111/hepr.13678

Cited by 142 publications

(172 citation statements)

References 217 publications

(308 reference statements)

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“…Therapeutic strategy for gastric variceal bleeding has not yet been established. Usefulness of endoscopic therapies and that of BRTO were shown in the clinical practice guideline for liver cirrhosis in Japan [ 14 , 15 ], while the indication of each therapy and the significance of combined BRTO plus endoscopic therapies were to be clarified in the future. Thus, at our institution, we undertake endoscopic therapies with or without BRTO for patients with gastric variceal bleeding, depending on the types and hemodynamics of the varices.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

et al. 2022

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Aim To establish a therapeutic strategy for cirrhosis patients with gastric variceal bleeding. Methods The outcomes of 137 patients with bleeding gastric varices were evaluated. Results The bleeding source was gastroesophageal varices (GOV) in 86 patients, and gastric fundal varices (FV) in 51 patients. The Child-Turcotte-Pugh classes were A, B, and C in 26, 79, and 32 patients, respectively; 34 patients (24.8%) had hepatocellular carcinoma (HCC), of which 11 also had complicating portal venous tumor thrombosis (PVTT). Patients with GOV were treated by endoscopic variceal ligation or endoscopic injection sclerotherapy (EIS) with ethanolamine oleate, while those with FV were treated by EIS with cyanoacrylate; 29 patients with FV also underwent additional balloon-occluded retrograde transvenous obliteration (BRTO). Hemostasis was successfully achieved in 136 patients (99.3%), and the cumulative 1-year, 3-year, and 5-year rebleeding rates were 18.1%, 30.8%, and 30.8%, respectively, in the patients with GOV, and 2.2%, 12.5% and 12.5%, respectively, in the patients with FV. The overall 1-year, 3-year, and 5-year survival rates were 79.7%, 71.5% and 64.4%, respectively, in the patients with GOV, and 91.0%, 76.9% and 59.5%, respectively, in the patients with FV. Multivariable analysis identified PVTT and alcoholic cirrhosis as a significant risk factor associated with rebleeding, model for end-stage liver disease (MELD) score and PVTT as significant factors associated with survival. Conclusions Endoscopic therapies with or without BRTO appeared to be useful therapeutic strategies to prevent rebleeding in patients with gastric variceal bleeding, and favorable outcomes were obtained, except in patients with underlying HCC associated with PVTT and/or severe liver damage.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

et al. 2022

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“…Clinicians should be fully aware of these. In our ROC analysis, the AUC of SARC-F for the mild or more severe malnutrition and for the moderate or more severe malnutrition was higher than that of BMI, which is a good indicator of nutritional status [39]. The SARC-F score rather than BMI can be a good indicator for malnutrition.…”

Section: Discussionmentioning

confidence: 58%

The Relationship between the SARC-F Score and the Controlling Nutritional Status Score in Gastrointestinal Diseases

Ikegami

Nishikawa

Goto

et al. 2022

JCM

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We sought to examine the relationship between the SARC-F score and the Controlling Nutritional Status (CONUT) score in patients with gastrointestinal diseases (GDs, n = 735, median age = 71 years, and 188 advanced cancer cases). The SARC-F score ≥ 4 (highly suspicious of sarcopenia) was found in 93 cases (12.7%). Mild malnutritional condition was seen in 310 cases (42.2%), moderate in 127 (17.3%) and severe in 27 (3.7%). The median SARC-F scores in categories of normal, mild, moderate and severe malnutritional condition were 0, 0, 1 and 1 (overall p < 0.0001). The percentage of SARC-F score ≥ 4 in categories of normal, mild, moderate and severe malnutritional condition were 4.4%, 12.9%, 26.8% and 25.9% (overall p < 0.0001). The SARC-F score was an independent factor for both the CONUT score ≥ 2 (mild, moderate or severe malnutrition) and ≥5 (moderate or severe malnutrition). In the receiver operating characteristic (ROC) curve analysis for the CONUT score ≥ 2, C reactive protein (CRP) had the highest area under the ROC (AUC = 0.70), followed by the SARC-F score (AUC = 0.60). In the ROC analysis for the CONUT score ≥ 5, CRP had the highest AUC (AUC = 0.79), followed by the SARC-F score (AUC = 0.63). In conclusion, the SARC-F score in patients with GDs can reflect malnutritional status.

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“…HCC is well known to develop frequently in patients with chronic liver disease, who are often complicated with amino acid imbalance. Furthermore, it has been recommended that nutritional intervention be considered for cases of chronic liver disease with a serum albumin level ≤3.5 g/dL [39,40]. Additionally, it was recently reported that the borderline of amino acid imbalance shown by an ALBI score of −2.588 is similar to the cut-off value for ALBI grade 1 (−2.600) [9].…”

Section: Discussionmentioning

confidence: 99%

Predicting Complications following Surgical Resection of Hepatocellular Carcinoma Using Newly Developed Neo-Glasgow Prognostic Score with ALBI Grade: Comparison of Open and Laparoscopic Surgery Cases

Kaibori

Hiraoka

Matsui

et al. 2022

Cancers

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Background/Aim: Nutritional assessment is known to be important for predicting prognosis in patients with malignant diseases. This study examined the usefulness of a prognostic predictive nutritional assessment tool for hepatocellular carcinoma (HCC) patients treated with surgical resection. Materials/Methods: HCC patients (n = 429) classified as Child–Pugh A who underwent an R0 resection between 2010 and 2020 were retrospectively analyzed (median age 73 years, males 326 (76.0%), Child–Pugh score 5:6 = 326:103, single tumor 340 (79.2%), median tumor size 3.5 cm, open:laparoscopic = 304:125). Glasgow prognostic score (GPS) and the newly developed neo-GPS method, which uses albumin–bilirubin grade 1 instead of albumin, were evaluated to compare their usefulness for prognosis prediction. Results: Median survival time for patients with a GPS score of 0, 1, and 2 was 120, 51, and 20 months, respectively. As for neo-GPS, that for those with a score of 0, 1, and 2 was not applicable (NA), 53 months, and 35 months, respectively (each p < 0.001; c-index: 0.556 and 0.611, respectively). Furthermore, median progression-free survival was 33, 22, and 9 months, and 41, 24, and 15 months, respectively (each p < 0.001; c-index: 0.539 and 0.578, respectively). As compared to patients with a high GPS (≥1), those with a high neo-GPS (≥1) showed a greater rate of high Clavien–Dindo classification (≥3) (39.2% vs. 65.1%). A comparison of patients with a high GPS (≥1) with those with a high neo-GPS (≥1) showed no significant difference regarding frequency of open or laparoscopic hepatectomy (17.4% vs. 15.2%, p = 0.670; 44.7% vs. 43.2%, p = 0.831, respectively), while the frequency of high Clavien–Dindo classification (≥3) was lower in patients who underwent a laparoscopic hepatectomy (11.2% vs. 22.7%, p = 0.007). Conclusion: The present findings suggest that the newly developed neo-GPS based on ALBI grade is an effective prognostic nutritional assessment tool and can be used for prediction of postoperative complications.

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Evidence‐based clinical practice guidelines for liver cirrhosis 2020

Cited by 142 publications

References 217 publications

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

Long-term outcomes of patients with cirrhosis presenting with bleeding gastric varices

The Relationship between the SARC-F Score and the Controlling Nutritional Status Score in Gastrointestinal Diseases

Predicting Complications following Surgical Resection of Hepatocellular Carcinoma Using Newly Developed Neo-Glasgow Prognostic Score with ALBI Grade: Comparison of Open and Laparoscopic Surgery Cases

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