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    Management of acute variceal bleeding: Updated APASL guidelines
    (Springer Nature Link, 2025) Lesmana, Cosmas Rinaldi Adithya; Shukla, Akash; Kumar, Ashish; Shalimar; Qi, Xiaolong; Gani, Rino Alvani; Dökmeci, Abdul Kadir; Örmeci, Necati; Sarin, Shiv Kumar
    Acute variceal bleeding (AVB) is a common life-threatening complication of portal hypertension (PHT), having a six-week mortality of 10%-20%. Major advances in the hemodynamic management, risk stratification, pharmacotherapy, endoscopy techniques, hemostatic devices and radiological interventions have led to improved management and outcome of AVB patients in the recent past. Therefore, the APASL Portal Hypertension Working Party, chose a panel of experts, primarily from the Asia–Pacific region, to identify important developments and controversial areas in the field of AVB. They discussed through a pre-defined and structured process, advances in the field and proposed updates to the previous APASL AVB guidelines. These included emphasis on safe transportation, defining time frames for AVB episodes and re-bleeding, reporting of clinical outcomes, optimizing early intervention strategies, pharmacotherapy, medical management, endoscopic therapies, and salvage modalities, including TIPS and self-expanding metal stents. The current updates also cover variceal bleeding in special populations and situations, the skill sets required for managing AVB patients, and the research priorities in the field. The updated guidelines are based on the latest evidence and incorporate emerging trends to provide a contemporary template for management of AVB in both patients with cirrhosis and non-cirrhotic portal hypertension.
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    Tolerance and acceptance of hepatic venous pressure gradient measurement in cirrhosis (CHESS1904): An international multicenter study
    (Wiley, 2022) Sun, Jun‐Hui; Zhao, He; Zhang, Haijun; Lei, Li; Örmeci, Necati; Yu, Zi‐Niu; Li, Xun; Li, Shuangxi; Yang, Xujun; Wei, Huaping; Zhu, Xiaoliang; Zhang, Zhengcong; Wang, Yajin; Zhao, Zhongwei; Mao, Jianting; Wu, Qiaohong; Sun, Xiaole; Xiang, Huiling; Jia, Kefeng; Yang, Chao; Wu, Wei; Lin, Xiuqing; Yao, Haixin; Zuo, Changzeng; Wang, Jitao; Zhang, Bo; Zhang, Chunqing; Wu, Xiaoling; Wang, Guangchuan; Yao, Shengjuan; Wang, Ruihang; Zhou, Li; Huan, Hui; Tu, Qingli; Pu, Xue; Zhang, Feng; Yin, Qin; Zhang, Linpeng; Guo, Ying; Wang, Jian; Kotani, Kohei; Uchida‐Kobayashi, Sawako; Kawada, Norifumi; Zhu, He; Li, Li; Wang, Wei; Zhang, Guo; Yu, Lei; Cui, Xudong; Zhu, Qingliang; Zhang, Hailong; Hui, Xiaoli; O. Ximenes, Rafael; de Araújo, Adriano Gonçalves; Gardenghi, Giulliano; Zheng, Yubao; Wu, Zebin; Huang, Mingsheng; Chen, Xiaoyong; Wu, Jun; Xie, Feng; Bo, Yang; Hu, Shengjuan; Ma, Linke; Li, Xiao; Qi, Xiaolong
    Aim To determine the tolerance and acceptance of hepatic venous pressure gradient (HVPG) measurements in patients with liver cirrhosis. Methods This prospective international multicenter study included 271 patients with cirrhosis who were scheduled to undergo HVPG measurement between October 2019 and June 2020. Data related to the tolerance and acceptance of HVPG measurements were collected using descriptive questionnaires. Results HVPG measurements were technically successful in all 271 patients, with 141 (52.0%) undergoing HVPG measurement alone. The complication rate was 0.4%. Postoperative pain was significantly lower than preoperative expected pain (p < 0.001) and intraoperative pain (p < 0.001), and intraoperative pain was also significantly lower than preoperative expected pain (p = 0.036). No, mild, moderate, severe, and intolerable discomfort scores were reported by 36.9%, 44.6%, 11.1%, 6.3%, and 0.4% of these patients, respectively, during HVPG measurement and by 54.6% 32.5%, 11.4%, 1.5%, and 0%, respectively, after HVPG measurement. Of these patients, 39.5% had little understanding and 10% had no understanding of the value of HVPG measurement, with 35.1% and 4.1% regarding HVPG measurements as being of little or no help, respectively. Most patients reported that they would definitely (15.5%), probably (46.9%), or possibly (29.9%) choose to undergo additional HVPG measurements again, and 62.7% regarded the cost of the procedure as acceptable. Conclusion HVPG measurement was safe and well-tolerated in patients with cirrhosis, but patient education and communication are warranted to improve the acceptance of this procedure.