A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure.

Acute liver failure (ALF) is a rare and specific form of severe hepatic dysfunction characterized by coagulopathy and hepatic encephalopathy in a patient with no known liver disease. ALF carries a high morbidity and mortality. Careful attention should be given to hemodynamics and metabolic parameters along with the active surveillance of infections. Timely transfer and supportive management are important in an intensive care unit in a liver transplant center. Identifying patients who will and will not improve with medical management and may need emergent liver transplantation is critical. In this review, we provide a comprehensive update on the etiology, diagnosis, and management of ALF.

Comparison of endoscopic ultrasound-guided coil deployment with and without cyanoacrylate injection for gastric varices.

BACKGROUND AND STUDY AIMS: Gastric variceal bleeding is more severe than esophageal variceal bleeding, and is associated with higher rebleeding and mortality rates. The benefits of endoscopic ultrasound-guided coil deployment alone for treating gastric varices, compared with concomitant cyanoacrylate injection, remain unclear. Therefore, this study aimed to compare the outcomes of both modalities. PATIENTS AND METHODS: Data of patients who underwent endoscopic ultrasound-guided coil deployment with/without concomitant cyanoacrylate injection for gastric varices between 2010 and 2021 were reviewed. The rates of rebleeding, reintervention, and survival were assessed. RESULTS: Twenty-eight patients (mean age, 55.9 ± 12.9 years; 17 men) underwent endoscopic ultrasound-guided coil deployment, either alone (EUS-coil) (n = 19) or with cyanoacrylate injection (EUS-coil/CYA) (n = 9), to treat cardiofundal varices. Among the 20 patients treated for secondary prophylaxis, including 3 actively bleeding patients (11 via EUS-coil, 9 with EUS-coil/CYA), no significant differences were observed in the rates of rebleeding (1 vs. 2), reintervention (1 vs. 0) or adverse events (1 vs. 1) (all P > 0.05). The 6-month, 1-year, and 3-year overall survival rates did not differ between the treatment groups (crude survival ratio: 76.9% vs. 77.8%; survival rates: 0.923, 0.682, and 0.615 vs. 0.778 for each year; log-rank = 0.227; P = 0.633). In patients treated for primary prophylaxis (n = 8; all via EUS-coil alone), no bleeding episodes were observed after 433 days of follow-up; however, one patient required reintervention for the reappearance of varices without bleeding. CONCLUSION: EUS-coil alone was not inferior to EUS-coil/CYA combination concerning rebleeding, reintervention, or survival.