Portal Hypertension VII: Proceedings of the 7th Baveno Consensus Workshop: Personalized Care in Portal Hypertension

Description

This book, the seventh in a series of proceedings volumes that began in 1995, reviews the latest developments in the diagnosis and management of cirrhosis and portal hypertension. It addresses a broad range of topics, including: risk stratification, HVPG, non-invasive surrogates for cACLD, CSPH, varices, progression and regression of cirrhosis, impact of etiological therapy on cirrhosis, impact of non-etiological novel therapies on cirrhosis, prevention of first/further decompensation, acute variceal hemorrhage, and Vascular Liver Disorders in Cirrhosis (VALDIG). The book is a compilation of lectures and important consensus statements from the Seventh Baveno International Consensus Workshop on Portal Hypertension, the latest in a series of workshops held every five years for hepatologists with an interest in the field. Portal Hypertension VII offers a valuable reference guide for clinical and research fellows in Gastroenterology and Hepatology and will inspire new research projects in the promising areas identified by the experts of the Baveno VII Faculty. Preface Thomas D. Boyer, MD (1943–2018)—A Tribute Memories of Prof Andrew K. Burroughs, MD (1953–2014) Tribute to Roberto J. Groszmann Tribute to Prof Luigi Pagliaro (1931–2020) Contents Contributors Part I: Introductory Lectures 1: Introduction: Baveno I to Baveno VII … and Beyond Baveno I to VI Attendance at the Baveno Workshops Publications Derived from the Baveno Workshops Impact of the Baveno Consensus on the Medical Literature Validation of the Baveno Definitions and Recommendations Beyond Baveno VII, the Baveno Cooperation The Baveno I–VII Workshops Were a Concerted Effort of the Following Speakers and Chairpersons References 2: New Concepts in Risk Stratification Introduction Risk Prediction and Probabilistic Thinking Diagnosis as a Risk Prediction Problem Decision Thresholds and Risk Stratification Risk Prediction and the Interpretation of Treatment Effects in Randomized Controlled Trials Conclusion References 3: Clinical Stages and Ordinal Outcomes in Portal Hypertension Background Definition and Incidence of Decompensation Clinical Stages of Cirrhosis Ordinal Outcomes Examples of Application of an Ordinal Outcome in Compensated Cirrhosis Ordinal Outcomes for Randomized Clinical Trials in Cirrhosis Sample Size Estimation with Ordinal Compared to Binary Outcomes Using Ordinal Outcomes in Portal Hypertension Conclusions References 4: Lifestyle and Genetic Modifiers of Liver Disease Progression Lifestyle Modifiers of Liver Disease Progression Unhealthy Lifestyle Alcohol Obesity Malnutrition, Sarcopenia, and Frailty Cigarette Smoke Healthy Lifestyle—Protective Factors Physical Activity and Exercise Coffee Consumption and Mediterranean Diet Genetic Modifiers of Progression of cACLD Individual Genetic Variants PNPA3 and HSD17B13 SERPINA1/Alpha-1 Antitrypsin Deficiency NOD2 NR1H4/FXR Conclusions and Outlook References Part II: HVPG as a Gold Standard 5: HVPG as a Gold Standard: Accuracy Is Essential Procedure Technique Pressure Measurements and Data Recording Technical Aspects Diagnosis of Clinically Significant Portal Hypertension (CSPH) and Prediction of Main Outcomes in Patients with Different Etiologies of Cirrhosis Variceal Hemorrhage Hepatocellular Carcinoma (HCC) Survival Assessment of HVPG in Patients Receiving NSBBs for Prevention of Variceal Hemorrhage and Decompensation HVPG Predicts Risk of Decompensation and Mortality after Hepatic and Non-hepatic Surgery Patients with Cirrhosis and HCC: Candidates for Hepatic Resection Patients with Cirrhosis Who Undergo Extrahepatic Surgery PPG in the Setting of Tips PPG Measurement Anatomic Location for PPG Measurement Optimal PPG Threshold for Portal Hypertensive Bleeding/Ascites PPG Thresholds in Overshunting Adverse Events References 6: HVPG as a Gold Standard: Consensus Statements of Panel 1 Descriptions of HVPG Measurement Diagnosis of CSPH in Patients with Cirrhosis Inclusion of HVPG Assessment in Trial Design Assessment of Surgical Risks Portal Pressure Gradient (PPG) in the Setting of TIPS Research Agenda Part III: Noninvasive Tools for cACLD and Portal Hypertension 7: Results of the Baveno VII Questionnaire on the Use of Noninvasive Tools for cACLD and Portal Hypertension Introduction Concept and Cutoffs of cACLD Use of NITs to Diagnose CSPH Triage of Patients for Screening Endoscopy Use of NITs to Monitor cACLD Use of Spleen Stiffness Emerging NITs in the Above-Mentioned Settings 8: Compensated Advanced Chronic Liver Disease (cACLD) From Baveno VI to Baveno VII From Histological Staging to a Noninvasive Clinical Staging of Chronic Liver Disease Excluding cACLD (LSM 15 kPa) Suggestive cACLD (Grey Zone/LSM ≥10 to