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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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    Non‑cirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and management
    (Springer Nature, 2024) Shukla, Akash; Rockey, Don C.; Kamath, Patrick S.; Kleiner, David E.; Singh, Ankita; Vaidya, Arun; Koshy, Abraham; Goel, Ashish; Dökmeci, A. Kadir; Meena, Babulal; Philips, Cyriac Abby; Sharma, Chhagan Bihari; Örmeci, Necati; Sarin, Shiv Kumar
    Since the Asian Pacific Association for the Study of the Liver (APASL) published guidelines on non-cirrhotic portal fibrosis/idiopathic portal hypertension in 2007, there has been a surge in new information, especially with the introduction of the term porto-sinusoidal vascular disorder (PSVD). Non-cirrhotic intra-hepatic causes of portal hypertension include disorders with a clearly identifiable etiology, such as schistosomiasis, as well as disorders with an unclear etiology such as non-cirrhotic portal fibrosis (NCPF), also termed idiopathic portal hypertension (IPH). This entity is being increasingly recognized as being associated with systemic disease and drug therapy, especially cancer therapy. An international working group with extensive expertise in portal hypertension was assigned with formulating consensus guidelines to clarify the definition, diagnosis, histological features, natural history, and management of NCPF/IPH, especially in the context of PSVD. The guidelines were prepared based on evidence from existing published literature. Whenever there was paucity of evidence, expert opinion was included after detailed deliberation. The goal of this manuscript, therefore, is to enhance the current understanding and help create global consensus on the issues surrounding NCPF/IPH.