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| 1 | Transjugular intrahepatic portosystemic shunts and portal hypertension-related complications显示文摘Portal hypertension(PH)plays an important role in the natural history of cirrhosis,and is associated with several clinical consequences.The introduction of transjugular intrahepatic portosystemic shunts(TIPS)in the 1980s has been regarded as a major technical advance in the management of the PH-related complications.At present,polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents.TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment.Recently,applying TIPS early(within 72 h after admission)has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding.In addition,TIPS is recommended as the second-line treatment for secondary prophylaxis.For bleeding gastric varices,applying TIPS was able to achieve hemostasis in more than 90%of patients.More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities,including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices.TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy.In patients with refractory ascites,there is growing evidence that TIPS not only results in better control of ascites,but also improves long-term survivalin appropriately selected candidates.In addition,TIPS is a promising treatment for refractory hepatic hydrothorax.However,the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined.The advantage of TIPS is offset by a risk of developing hepatic encephalopathy,the most relevant postprocedural complication.Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome.This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH. | Sith Siramolpiwat | 2014 | World Journal of Gastroenterology2014，20，45： | 41 |
| 2 | Hepatopulmonary syndrome: What we know and what we would like to know显示文摘Hepatopulmonary syndrome(HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations(IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation(LT) varies between 4% and 32%, with a predominance of mild or moderate cases. Although it is generally asymptomatic it does have an impact on their quality of life and survival. The diagnosis requires taking an arterial blood gas sample of a seated patient with alveolar-arterial oxygen gradient(AaO 2) ≥ 15 mm Hg, or ≥ 20 mm Hg in those over 64 years of age. The IPVD are identified through a transthoracic contrast echocardiography or a macroaggregated albumin lung perfusion scan(99mTc-MAA). There is currently no effective medical treatment. LT has been shown to reverse the syndrome and improve survival rates, even in severe cases. Therefore the policy of prioritizing LT would appear to increase survival rates. This paper takes a critical and clinical look at the current understanding of HPS, as well as the controversies surrounding it and possible future research. | Israel Grilo-Bensusan Juan Manuel Pascasio-Acevedo | 2016 | World Journal of Gastroenterology2016，22，25： | 9 |
| 3 | Portopulmonary hypertension and hepatopulmonary syndrome显示文摘Portopulmonary hypertension(POPH) and hepatopulmonary syndrome(HPS) are two frequent complications of liver disease, with prevalence among liver transplant candidates of 6% and 10%, respectively. Both conditions result from a lack of hepatic clearance of vasoactive substances produced in the splanchnic territory. Subsequently, these substances cause mainly pulmonary vascular remodeling and some degree of vasoconstriction in POPH with resulting elevated pulmonary pressure and right ventricular dysfunction. In HPS the vasoactive mediators cause intrapulmonary shunts with hypoxemia. Medical treatment is disappointing overall. Whereas liver transplantation(LT) results in the disappearance of HPS within six to twelve months, its effect on POPH is highly unpredictable. Modern strategies in managing HPS and POPH rely on a thorough screening and grading of the disease's severity, in order to tailor the appropriate therapy and select only the patients who will benefit from LT. The anesthesiologist plays a central role in managing these high-risk patients. Indeed, the important hemodynamic and respiratory modifications of the perioperative period mustbe avoided through continuation of the preoperatively initiated drugs, appropriate intraoperative monitoring and proper hemodynamic and respiratory therapies. | Florence Aldenkortt Marc Aldenkortt Laurence Caviezel Jean Luc Waeber Anne Weber Eduardo Schiffer | 2014 | World Journal of Gastroenterology2014，20，25： | 7 |
| 4 | Pulmonary complications of hepatic diseases显示文摘Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients. | Salim R Surani Yamely Mendez Humayun Anjum Joseph Varon | 2016 | World Journal of Gastroenterology2016，22，26： | 3 |
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