Hepatology

Brett E. Fortune, MD, MSc

Our understanding and management of advanced liver disease, particularly in the setting of portal hypertension, have made many advancements over the past several years, and utilizing a multidisciplinary approach is imperative. We clearly acknowledge that the presence of portal hypertension in the setting of advanced liver disease promotes severe clinical complications including variceal bleeding, ascites, and hepatic encephalopathy. In addition, portal hypertension is strongly linked with higher risk for adverse outcomes among those who need to have surgery or other interventions.

In this issue of Digestive Disease Interventions, we are fortunate to have several renowned experts in the field to discuss the current multidisciplinary approaches in the management of portal hypertension and advanced liver disease. This issue begins with the current practice and future techniques to manage patients with portal hypertension and its complications. The discussion starts on the advances of “endohepatology,” interventional endoscopy within hepatology, and methods that can further evolve advanced liver disease care. Then we expand on our knowledge in the treatment of gastric and ectopic varices based on the endoscopist's perspective. Next, we review a clinical dilemma that is often seen in patients with portal hypertension, portal and mesenteric venous thrombosis, and expand on the various therapeutic options and their outcomes. Continuing with another clinical complication due to advanced liver disease, this issue then expands on the various aspects of embolic therapy to treat malignancies within the liver.

Our issue next shifts to multidisciplinary approaches where we can directly decompress portal pressure using either endovascular or surgical portosystemic shunts. Our experts specifically focus on how to apply transjugular intrahepatic portosystemic shunt in “high-risk” patients, as well as the appropriate indications for surgical shunt placement. Lastly, our authors review the current perspective on patients with advanced liver disease and portal hypertension who require surgery and how to avoid adverse outcomes. We hope that this extraordinary collection of reviews will better elucidate our knowledge and reveal the future to the evolving multidisciplinary approach focused toward high-value patient care among those with advanced liver disease and portal hypertension.