de Franchis Roberto, Bosch Jaime, Garcia-Tsao Guadalupe, Reiberger Thomas, Ripoll Cristina
Department of Biomedical and Clinical Sciences, University of Milan, Italy.
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Instituts d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and CIBERehd, University of Barcelona, Spain.
J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30.
To expand on the work of previous meetings, a virtual Baveno VII workshop was organised for October 2021. Among patients with compensated cirrhosis or compensated advanced chronic liver disease (cACLD - defined at the Baveno VI conference), the presence or absence of clinically significant portal hypertension (CSPH) is associated with differing outcomes, including risk of death, and different diagnostic and therapeutic needs. Accordingly, the Baveno VII workshop was entitled "Personalized Care for Portal Hypertension". The main fields of discussion were the relevance and indications for measuring the hepatic venous pressure gradient as a gold standard, the use of non-invasive tools for the diagnosis of cACLD and CSPH, the impact of aetiological and non-aetiological therapies on the course of cirrhosis, the prevention of the first episode of decompensation, the management of an acute bleeding episode, the prevention of further decompensation, as well as the diagnosis and management of splanchnic vein thrombosis and other vascular disorders of the liver. For each of these 9 topics, a thorough review of the medical literature was performed, and a series of consensus statements/recommendations were discussed and agreed upon. A summary of the most important conclusions/recommendations derived from the workshop is reported here. The statements are classified as unchanged, changed, and new in relation to Baveno VI.
为拓展以往会议的工作内容,于2021年10月组织了一次线上巴韦诺VII研讨会。在代偿期肝硬化或代偿期晚期慢性肝病(cACLD,在巴韦诺VI会议上定义)患者中,临床显著性门静脉高压(CSPH)的有无与不同的预后相关,包括死亡风险,以及不同的诊断和治疗需求。因此,巴韦诺VII研讨会的主题为“门静脉高压的个性化治疗”。主要讨论领域包括作为金标准测量肝静脉压力梯度的相关性和指征、用于诊断cACLD和CSPH的非侵入性工具的应用、病因性和非病因性治疗对肝硬化病程的影响、失代偿首次发作的预防、急性出血发作的处理、进一步失代偿的预防,以及脾静脉血栓形成和肝脏其他血管疾病的诊断和管理。针对这9个主题中的每一个,都对医学文献进行了全面回顾,并讨论并商定了一系列共识声明/建议。本文报告了该研讨会得出的最重要结论/建议的总结。这些声明根据与巴韦诺VI的关系分为未改变、改变和新增三类。