Clinical study of standard residual liver volume and transient elastography in predicting poor prognosis of patients after hemihepatectomy

BACKGROUND Liver cancer resection,especially in patients with hemihepatectomy or extended hemihepatectomy,often leads to poor prognosis,such as liver insufficiency and even liver failure and death,because the standard residual liver volume(SRLV)cannot be fully compensated after surgery.AIM To explore the risk factors of poor prognosis after hemihepatectomy for hepatocellular carcinoma and evaluate the application value of related prognostic approaches.METHODS The clinical data of 35 patients with primary liver cancer in Nantong Third People's Hospital from February 2016 to July 2020 were retrospectively analyzed.The receiver operating characteristic curve was created using medcac19.0.4 to compare the critical values of the SRLV in different stages of liver fibrosis after hemihepatectomy with those of liver dysfunction after hemihepatectomy.It was constructed by combining the Child-Pugh score to evaluate its application value in predicting liver function compensation.RESULTS The liver stiffness measure(LSM)value and SRLV were associated with liver dysfunction after hemihepatectomy.Logistic regression analysis showed that an LSM value≥25 kPa[odds ratio(OR)=6.254,P<0.05]and SRLV≤0.290 L/m^(2)(OR=5.686,P<0.05)were independent risk factors for postoperative liver dysfunction.The accuracy of the new liver reserve evaluation model for predicting postoperative liver function was higher than that of the Child-Pugh score(P<0.05).CONCLUSION SRLV and LSM values can be used to evaluate the safety of hemihepatectomy.The new liver reserve evaluation model has good application potential in the evaluation of liver reserve function after hemihepatectomy.

Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence

The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation.Living-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes.An accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver resection.Thus,ensuring donor safety and an appropriate graftto-recipient weight ratio.Manual LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver volume.However,the method has been limited by cost,subjectivity,and variability.Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual measurements.However,the accuracy of automated LV requires further investigation.The study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based approaches.Additionally,the study discusses the respective strengths and weaknesses of each of the aforementioned techniques.The use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near future.The implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the procedures.Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT.MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions.Moreover,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered by cost and availability.Therefore,the integration of multiple specialties is necessary to embrace technology and explore its possibilities,ranging from patient counseling to intraoperative decision-making through automation and AI.

Evaluation of standard liver volume formulae for Chinese adults

AIM:To evaluate different standard liver volume (SLV) formula and verify the applicability of the formulae for Chinese adults.METHODS: Data from 70 cases of living donor liver transplantation (LDLT) performed at our transplantation centers between January 2008 and April 2009 were analyzed. SLV was estimated using our recently reported formula [the Chengdu formula: SLV (mL)=11.5×body weight (kg) + 334] and other reported formulae used for Chinese adults. Actual intraoperative liver volumes were obtained from a review of the patients' medical records.RESULTS: The actual right liver volume was not significantly different from the estimated right liver volume determined by the Chengdu formula, but was significantly smaller than estimates using the Heinemann, Urata, Vauthey, and Lee formulae (P<0.01), and signif icantly larger than estimates using the Fan formula (P<0.05).CONCLUSION: The Chengdu formula was demonstrated to be reliable by its application in LDLT.

New formula for predicting standard liver volume in Chinese adults

AIM To obtain a reference range of morphological indices and establish a formula to accurately predict standard liver volume(SLV) in Chinese adults.METHODS Computed tomography(CT)-estimated total liver volume(CTLV) was determined in 369 Chinese adults. Age,sex,body weight,body height,body mass index,and body surface area(BSA) were recorded using CT. Total splenic volume,portal venous diameter(PVD),splenic venous diameter(SVD),and portal venous cross-sectional area(PVCSA) were also measured by CT. Stepwise multiple linear regression analysis was performed to evaluate the impact of each parameter on CTLV and to develop a new SLV formula. The accuracy of the new formula was compared with the existing formulas in a validation group.RESULTS The average CTLV was 1205.41 ± 257.53 cm3(range,593.80-2250.10 cm3). The average of PVD,SVD and PVCSA was 9.34 ± 1.51 mm,7.40 ± 1.31 mm and 173.22 ± 48.11 mm2,respectively. The CT-estimated splenic volume of healthy adults varied markedly(range,46.60-2892.30 cm3). Sex,age,body height,body weight,body mass index,and BSA were significantly correlated with CTLV. BSA showed the strongest correlation(r = 0.546,P < 0.001),and was used to establish a new model for calculating SLV: SLV(cm3) = 758.259 × BSA(m2)-124.272(R2 = 0.299,P < 0.001). This formula also predicted CTLV more accurately than the existing formulas,but overestimated CTLV in elderly subjects > 70 years of age,and underestimated liver volume when CTLV was > 1800 cm3.CONCLUSION Our new BSA-based formula is more accurate than other formulas in estimating SLV in Chinese adults.

Magnetic resonance-based total liver volume and magnetic resonance-diffusion weighted imaging for staging liver fibrosis in mini-pigs

AIM:To determine whether and how magnetic resonance imaging(MRI)-based total liver volume(TLV) and diffusion weighted imaging(DWI) could predict liver fibrosis.METHODS:Sixteen experimental mature mini-pigs(6 males,10 females),weighing between 20.0 and 24.0 kg were prospectively used to model liver fibrosis induced by intraperitoneal injection of 40% CCl4 dissolved in fat emulsion twice a week for 16 wk,and by feeding 40% CCl4 mixed with maize flour twice daily for the subsequent 5 wk.All the survival animals underwent percutaneous liver biopsy and DWI using b = 300,500 and 800 s/mm2 followed by abdominal gadolinium-enhanced MRI at the 0,5th,9th,16th and 21st weekend after beginning of the modeling.TLV was obtained on enhanced MRI,and apparent diffusion coefficient(ADC) was obtained on DWI.Hepatic tissue specimens were stained with hematoxylin and Masson' s trichrome staining for staging liver fibrosis.Pathological specimens were scored using the human METAVIR classification system.Statistical analyses were performed to determine whether and how the TLV and ADC could be used to predict the stage of liver fibrosis.RESULTS:TLV increased from stage 0 to 2 and decreased from stage 3(r = 0.211;P < 0.001).There was a difference in TLV between stage 0-1 and 2-4(P = 0.03) whereas no difference between stage 0-2 and 3-4(P = 0.71).TLV could predict stage ≥ 2 [area under receiver operating characteristic curve(AUC) = 0.682].There was a decrease in ADC values with increasing stage of fibrosis for b = 300,500 and 800 s/mm2(r =-0.418,-0.535 and-0.622,respectively;all P < 0.001).Differences were found between stage 0-1 and 2-4 in ADC values for b = 300,500 and 800 s/mm2,and between stage 0-2 and 3-4 for b = 500 or 800 s/mm2(all P < 0.05).For predicting stage ≥ 2 and ≥ 3,AUC was 0.803 and 0.847 for b = 500 s/mm2,and 0.848 and 0.887 for b = 800 s/mm2,respectively.CONCLUSION:ADC for b = 500 or 800 s/mm2 could be better than TLV and ADC for b = 300 s/mm2 to pre-dict fibrosis stage ≥ 2 or ≥ 3.

Donor safety and remnant liver volume in living donor liver transplantation

AIM:To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation(LDLT).METHODS:From July 2001 to January 2009,our liver transplant centers carried out 197 LDLTs.The clinical data from 151 cases of adult right lobe living donors(not including the middle hepatic vein) were analyzed.The conditions of the three groups of donors were well matched in terms of the studied parameters.The donors' preoperative data,intraoperative and postoperative data were calculated for the three groups:Group 1 remnant liver volume(RLV) < 35%,group 2 RLV 36%-40%,and group 3 RLV > 40%.Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions.Correlations between remnant liver volume and post-operative complications were also analyzed.RESULTS:The donors' anthroposomatology data,op-eration time,and preoperative donor blood test indicators were calculated for the three groups.No significant differences were observed between the donors' gender,age,height,weight,and operation time.According to the Chengdu standard liver volume formula,the total liver volume of group 1 was 1072.88 ± 131.06 mL,group 2 was 1043.84 ± 97.11 mL,and group 3 was 1065.33 ± 136.02 mL.The three groups showed no statistically significant differences.When the volume of the remnant liver was less than 35% of the total liver volume,the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time.In addition,the occurrence of complications was closely related to the remnant liver volume.When the volume of the remnant liver was more than 35% of the total liver volume,the remnant volume change had no significant effect on donor recovery.CONCLUSION:To ensure donor safety,the remnant liver volume should be greater than the standard liver volume(35%) in right lobe living donor liver transplantation.

Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices

AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study.All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume,and biochemical workup for testing ALB and Child-Pugh class.All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices.Right liver lobe volume(RV),left medial liver lobe volume(LMV),left lateral liver lobe volume(LLV),and caudate lobe volume(CV) were measured using enhanced magnetic resonance imaging.The ratios of RV to ALB(RV/ALB),LMV to ALB(LMV/ALB),LLV to ALB(LLV/ALB) and CV to ALB(CV/ALB) were calculated.Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis,and the presence of esophageal varices.RESULTS:RV,LMV,LLV and CV decreased(r =-0.51-0.373; all P < 0.05),while RV/ALB increased(r = 0.424; P < 0.05),with the progress of Child-Pugh classof liver cirrhosis.RV,LMV,CV,LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV,LMV,LLV,CV,RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV,RV/ALB and CV/ALB could identify presence of esophageal varices(all P < 0.05).Among these parameters,CV/ALB could best identify the presence of liver cirrhosis,with an area under receiver operating characteristic curve(AUC) of 0.860,a sensitivity of 82.0% and a specificity of 83.0%.LLV could best distinguish class A from B,with an AUC of 0.761,a sensitivity of 74.4% and a specificity of 73.1%.RV could best distinguish class A from C,with an AUC of 0.900,a sensitivity of 90.3% and a specificity of 84.5%.LLV/ALB could best distinguish class B from C,with an AUC of 0.900,a sensitivity of 93.8% and a specificity of 81.5%.RV/ALB could best identify esophageal varices,with an AUC of 0.890,a sensitivity of 80.0% and a specificity of 83.5%.CONCLUSION:The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis,and presence of esophageal varices.

Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT

AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS： CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as ＂CT grade＂ and the percentage of remnant liver volume （PRLV） [PRLV = predicted RLV/predicted total liver volume （PTLV） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × body mass （kg）] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 5.429, P = 0.026）. With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% （1/14）, and that below the line was 53.7% （22/41）, indicating a significant difference between the two rates （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.

3-Dimensional liver volume assessment in patients with hepatitis B virus-related liver cirrhosis during long-term oral nucleos(t)ide analogues therapy

AIMTo assess the effect of long-term oral nucleos(t)ide analogues (NUCs) therapy on liver volume change in patients with suppress hepatitis B virus (HBV)-related liver cirrhosis.METHODSWe reviewed the data of na&#x000ef;ve patients with HBV-related liver cirrhosis, who had taken oral NUCs therapy, between 2003 and 2007 at Chonbuk University Hospital. We analyzed two consecutive sets of abdominal computerized tomography scans-one at the time of treatment initiation and another at the second-year follow-up. Liver volume was calculated by 3-dimensional liver extraction volumetry program.RESULTSA total of 55 patients (34 males) were included. There was 114.3 mL &#x000b1; 167.8 mL (12.9% &#x000b1; 17.9%) of increase in liver volume during the two years of NUCs therapy (993.8 mL &#x000b1; 242.8 mL at baseline vs 1108.1 mL &#x000b1; 263.3 mL at two-year follow-up, P &#x0003c; 0.001). The ratio of the measured baseline liver volume to the estimated standard liver volume was improved from 70.8% to 78.0%. An increase in liver volume was shown not only in patients with compensated cirrhosis (P = 0.046) but also in those with decompensated cirrhosis (P &#x0003c; 0.001). Significant factors for volume increases were Child-Turcotte-Pugh grade and model for end-stage liver disease score improvement without virological breakthrough. In multiple linear regression analysis, delta albumin and delta alanine aminotransferase levels showed a significant association with the increase in liver volume (P = 0.002 and 0.005, respectively).CONCLUSIONLong-term oral NUCs therapy in patients with HBV-related liver cirrhosis lead to significant increase in liver volume assessed with 3-dimensional liver extraction volumetry program.

Liver volumetry:Is imaging reliable?Personal experience and review of the literature

The amount of the future liver remnant volume is fun-damental for hepato-biliary surgery, representing animportant potential risk-factor for the development ofpost-hepatectomy liver failure. Despite this, there isno uniform consensus about the amount of hepaticparenchyma that can be safely resected, nor about themodality that should be chosen for this evaluation. Thepre-operative evaluation of hepatic volume, along witha precise identification of vascular and biliar anatomyand variants, are therefore necessary to reduce surgi-cal complications, especially for extensive resections.Some studies have tried to validate imaging methods[ultrasound, computed tomography(CT), magneticresonance imaging] for the assessment of liver volume,but there is no clear evidence about the most accuratemethod for this evaluation. Furthermore, this volumet-ric evaluation seems to have a certain degree of error,tending to overestimate the actual hepatic volume,therefore some conversion factors, which should givea more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communica-tions in medicine images with their own personal com-puter, but very few studies have provided a validation of these methods. Moreover, while the pre-transplanta-tion volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is dis-cussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

Novel liver vein deprivation technique that promotes increased residual liver volume(with video):A case report

BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver tumors.As an alternative to associating liver partition and portal vein ligation(ALPPS)for staged hepatectomy and liver venous deprivation(LVD)using stage 1 interventional radiology for vascular embolization combined with stage 2 open liver resection have been used.CASE SUMMARY A novel modified LVD technique was performed in a patient with pancreatic neuroendocrine tumor with liver metastases by using stage 1 laparoscopic ligation of the right hepatic vein,right posterior portal vein,and short hepatic veins combined with local excision of three liver metastases in the left hemiliver.The operation was followed three days later by interventional radiology to embolize an anomalous right anterior portal vein to complete LVD.A stage 2 laparoscopic right hemihepatectomy and pancreaticosplenectomy were then carried out.CONCLUSION The minimally invasive technique promoted a rapid increase,comparable to ALPPS,in volume of the FLR after the stage 1 operation to allow the laparoscopic stage 2 resection to be performed.

Volumetric Modifications of Metastatic Liver Volumes after Dramatic Responses under Chemotherapy

Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.

Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice.The safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive results.We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of life.AIM To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.METHODS A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted.Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,respectively.Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.RESULTS Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP.The baseline characteristics were similar between the groups.Prophylactic antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP group.The overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain-related complications,respectively).CONCLUSION The use of LTAD in the management of refractory ascites in palliated end-stage liver disease is effective,safe,and may reduce hospital admissions and utilisation of healthcare resources compared to LVP.

Liver and spleen volume variations in patients with hepatic fibrosis

AIM： To study the liver and spleen volume variations in hepatic fibrosis patients at different histopathological stages. METHODS： Multidetector computed tomography （MDCT） scan was performed in 85 hepatic fibrosis patients. Liver volume （LV） and spleen volume （SV） were measured. Fifteen healthy individuals served as a control group （SO）. The patients were divided into stage 1 （S1） group （n = 34）, stage 2 （S2） group （n = 25）, stage 3 （S3） group （n = 16）, and stage 4 （S4） group （n = 10） according to their histopathological stage of liver fibrosis. RESULTS： The LV and standard LV （SLV） had a tendency to increase with the severity of fibrosis, but no statistical difference was observed in the 5 groups （LV： F = 0.245, P = 0.912; SLV： F = 1.902, P = 0.116）. The SV was gradually increased with the severity of fibrosis, and a statistically significant difference in SV was observed among the 5 groups （P 〈 0.01）. The LV/SV ratio and SLV/SV ratio were gradually decreased with the aggravation of hepatic fibrosis, and statistically significant differences in both LV/SV and SLV/SV were found among the 5 groups （P 〈 0.01）.CONCLUSION： The absence of obvious LV reduction in patients with chronic liver disease may be a morphological index of patients without liver cirrhosis. The SV is related to the severity of fibrosis, and the spleen of patients with advanced fibrosis is enlarged evidently. The LV/SV ratio and SLV/SV ratio are of a significant clinical value in the diagnosis of advanced liver fibrosis.

Kinetics of remnant liver volume and function after a major hepatectomy

Liver regeneration after a major hepatectomy(MH)is crucial for the patient postoperative recovery,with the first postoperative month(1M)being a critical period for the liver regeneration course.The risk of post hepatectomy liver failure(PHLF),which is the leading cause of death,is usually anticipated in the preoperative period by the measurement of the future remnant liver volume(RLV)via computed tomography(CT)with volumetry.

Predicting liver function after hemihepatectomy in patients with hepatocellular carcinoma using different modalities

In response to Dr.Yue et al's study on prognostic factors for post-hemihep-atectomy outcomes in hepatocellular carcinoma(HCC)patients,this critical review identifies methodological limitations and proposes enhancements for future research.While the study identifies liver stiffness measure and standard residual liver volume as potential predictors,concerns regarding small sample size,reliance on biochemical markers for safety assessment,and inadequate ad-justment for confounding variables are raised.Recommendations for rigorous methodology,including robust statistical analysis,consideration of confounding factors,and selection of outcome measures with clinical components,are proposed to strengthen prognostic assessments.Furthermore,validation of novel evaluation models is crucial for enhancing clinical applicability and advancing understanding of postoperative outcomes in patients with HCC undergoing hem-ihepatectomy.

Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.

Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases:A systematic review and meta-analysis

BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.