Update of endoscopy in liver disease: More than just treating varices

Abstract

The management of complications in liver disease is often complex and challenging. Endoscopy has undergone a period of rapid expansion with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. In this review, relevant literature search and expert opinions have been used to provide a brief overview and update of the current endoscopic management of patients with liver disease and portal hypertension. The main areas covered are safety of endoscopy in patients with liver disease, the use of standard endoscopy for the treatment of varices and the role of new endoscopic modalities such as endoscopic ultrasound, esophageal capsule, argon plasma coagulation, spyglass and endomicroscopy in the investigation and treatment of liver-related gastrointestinal and biliary pathology. It is clear that the role of the endoscopy in liver disease is well beyond that of just treating varices. As the technology in endoscopy expands, so does the role of the endoscopist in liver disease.

Perioperative Risk Assessment and Management of Cirrhotic Patients

“…As can be expected, surgical morbidity and mortality rates [157] in LC vary greatly depending not only on underlying liver disease severity, but also the nature of the disease and advancement of surgical techniques [144] (Table 4). Limitations of the current literature include studies that often do not provide information on liver disease severity, are retrospective, or have limited patient size [97,134].…”

“…Conclusion: Laparoscopy has reduced overall blood loss, postoperative complications, shorter length-of stay, with overall costs and operative time being similar, but most studies are small with exclusively CTP-A/B patients. Also, these studies demonstrate the advancement of surgical techniques over the last decade [144].…”

“…Induction agents, with the exception of ketamine and propofol, decrease HBF [63,149] without a change in clearance [140]. Care should be taken with benzodiazepines and paralytics, due to a reduction in both CYP-3A4 metabolism and PBP resulting in prolonged duration [1,[140][141][142]144,147,150,151], whereas atracurium, lorazepam, oxazepam, and temazepam undergo non-hepatic conjugation [140,152]. Opioids in LC have significantly reduced metabolism [141,147,153] and prolonged half-lives, potentially exaggerating sedative and respiratory depressant effects, in contrast to fentanyl [1,141,147].…”

“…Although the uptake and onset of anesthetic drug action is unaffected, hepatic clearance is dependent upon volume of distribution, functional hepatic blood flow (HBF), hepatic extraction ratio, hepatic microsomal and cytochrome-P450 enzyme activity, decreased plasma-binding proteins (PBP), and decreased biliary excretion (Table 3) [63, [140][141][142][143][144][145][146][147]. In general, short to intermediate halflive drugs at lower doses with longer dose intervals should be used [140,141].…”

Surgical Treatment of Complications of Portal Hypertension Using Splenorenal Anastomosis

“…Социально-эпидемиологическая значимость определяется прогрессирующей тенденцией к росту заболеваемости хрониче-скими гепатитами и циррозами печени (ЦП) [3,31]. За послед-нее десятилетие во всех странах мира отмечается рост числа больных ЦП, являющимся наиболее частой причиной развития портальной гипертензии (ПГ), что связано с ростом потребления алкоголя, увеличением заболеваемости вирусными гепатитами и количества потребляемых лекарств, а также недостаточностью знаний многих вопросов патогенеза заболеваний печени [18,28,39]. Для некоторых стран цирроз печени можно считать краевой патологией, связанной с эпидемиологическим неблагополучием в отношении вирусных гепатитов, воздействием неблагопри-ятных экологических факторов и некоторыми особенностями питания [33].…”