{"title":"Air Leak Syndrome After Percutaneous-endoscopic Rendezvous for Malignant Biliary Obstruction: A Case Report","authors":"Jie Tan, Zhuo Li, Zhi-Jun Li, Peng Yan","doi":"10.1016/j.jceh.2025.103158","DOIUrl":"10.1016/j.jceh.2025.103158","url":null,"abstract":"<div><div>Endoscopic retrograde cholangiopancreatography (ERCP) is a key therapeutic tool for biliary access, but cannulation failure occurs in 5%–10% of cases. We report a 92-year-old woman with obstructive jaundice and complete distal common bile duct obstruction, in whom standard ERCP failed. A percutaneous-endoscopic rendezvous (PE-RV) approach successfully established biliary drainage via a transhepatic guidewire and stent placement. However, the patient developed pneumoperitoneum, tension pneumothorax, and subcutaneous emphysema following abrupt catheter removal. These manifestations are collectively referred to as “air leak syndrome,” which encompasses the abnormal presence of air in the peritoneal cavity, pleural space, and subcutaneous tissue. Imaging showed no pneumoretroperitoneum, suggesting gas migration through an immature percutaneous tract. Urgent drainage and antibiotics led to gradual recovery. This case highlights PE-RV as a valuable salvage technique but underscores the risk of rare gas-related complications when percutaneous tract closure is premature. To minimize the risk of such complications, procedural protocols may need to incorporate delayed catheter removal or tract embolization to ensure safe outcomes. Careful catheter management, delayed removal, and interdisciplinary coordination are essential for safe outcomes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103158"},"PeriodicalIF":3.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Noncirrhotic Portal Fibrosis","authors":"Sagnik Biswas , Prasenjit Das , Shalimar","doi":"10.1016/j.jceh.2025.103157","DOIUrl":"10.1016/j.jceh.2025.103157","url":null,"abstract":"<div><div>Noncirrhotic portal hypertension describes a cohort of patients with features of portal hypertension (esophageal and gastric varices and splenomegaly) in the absence of injury to the hepatic parenchyma. Multiple hypotheses are proposed to explain the development of non-cirrhotic portal fibrosis in an individual-underlying prothrombotic disease, endothelial-to-mesenchymal transformation, and endotoxin-induced portal hypertension. The disease course is predominantly characterized by recurrent episodes of variceal bleeding with transient, mild, self-resolving ascites. Treatment algorithms focus on the prevention of variceal bleeding. Recent advances in management include endovascular interventions, transjugular intrahepatic portosystemic shunts for recurrent variceal hemorrhage. Liver transplantation may be considered for patients with features of poor hepatic function.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103157"},"PeriodicalIF":3.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adopting Early Extubation in Pediatric Living Donor Liver Transplantation: A Focus on Feasibility and Safety of the Practice","authors":"Prachi Gokula , Nitin Shanker , Gaurav Dubey , Sachin Anand , Vinod Choudhary , Amit Kumar Singhal , Abhideep Chaudhary","doi":"10.1016/j.jceh.2025.103153","DOIUrl":"10.1016/j.jceh.2025.103153","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric living donor liver transplant (LDLT) presents with its own unique challenges and requires considerable surgical and anesthetic expertise for a favorable outcome. One of the critical determinants of improved outcomes following liver transplantation is early extubation (EE). We conducted this study to determine our rate of EE and evaluate the predictive factors for successful EE in pediatric patients undergoing LDLT.</div></div><div><h3>Methods</h3><div>We performed a retrospective observational study and analyzed our data on pediatric patients (Aged 3 months to 10 years) who underwent LDLT from January 2022 to <strong><em>June 2024</em></strong>. Our primary objective was to evaluate the rate of EE after liver transplant in the pediatric population and demonstrate its safety across all ages. The secondary outcome was to determine predictive factors for successful EE in this population.</div></div><div><h3>Results</h3><div>A total of 28 patients were enrolled in the study and were divided into 2 groups: Early extubation (EE group (extubated on-table or ≤4 h postoperatively) and delayed extubation (DE) group (mechanically ventilated >4 h postoperatively). Out of 28 patients, 23 patients (82.1%) were successfully extubated on-table whereas 5 patients (17.9%) were included in the DE group. In our study, both the groups were comparable in demographic, preoperative, and intraoperative parameters except for age of children and duration of surgery, which were statistically significant between the groups.</div></div><div><h3>Conclusion</h3><div>Early extubation in pediatric patients is not only feasible but also a safe practice. Although, the retrospective nature of the study, small cohort, and exclusion of high-risk groups such as acute liver failure limit statistical power, the results are encouraging. Generalizability and validation of our clinical protocols warrant prospective studies with larger cohorts.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103153"},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yue-Meng Wan , Hua-Mei Wu , Yu-Hua Li , Song-Quan Huang , Hong-Jing Yin , Ying Xu
{"title":"The Mortality Risk of Acute Kidney Injury Stage 1A and 1B in Cirrhosis: A Systematic Review and Meta-Analysis","authors":"Yue-Meng Wan , Hua-Mei Wu , Yu-Hua Li , Song-Quan Huang , Hong-Jing Yin , Ying Xu","doi":"10.1016/j.jceh.2025.103154","DOIUrl":"10.1016/j.jceh.2025.103154","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Acute kidney injury (AKI) stage 1 in cirrhosis is divided into 1A and 1B, which have greatly varied prevalence in different studies. It remains controversial whether AKI stage 1A has increased mortality risk over non-acute kidney injury (NAKI), and few studies quantified the mortality risks across AKI stage 1A, 1B, and NAKI. This systematic review and meta-analysis aims to evaluate both the prevalence and mortality risks of AKI stage 1A and 1B.</div></div><div><h3>Method</h3><div>Pubmed, Cochrane library, EMBASE, Scopus, and Chinese National Knowledge Infrastructure databases were searched. Search terms included “acute kidney injury,” “cirrhosis,” “mortality,” and corresponding synonyms. Comparisons across AKI stage 1A, 1B, and NAKI were included. A meta-analysis was conducted to estimate the prevalence and mortality risk of AKI stage 1A and 1B in cirrhotic patients.</div></div><div><h3>Results</h3><div>Eleven studies were included, enrolling 2647 patients with AKI stage 1A, 3052 with stage 1B, and 1395 without AKI, which resulted into a pooled prevalence of 16.3% (95% confidence interval [CI]: 11.3-22.9%) for AKI stage 1A and 15.7% (95% CI: 9.3-25.3%) for stage 1B. Compared to NAKI, AKI stage 1A increased the mortality risk by about 2 folds (odds ratio [OR]: 1.98, 95% CI: 1.33-2.97, <em>P</em> = 0.004) and stage 1B increased it by 4.8 folds (OR: 4.79, 95% CI: 3.30-6.95, <em>P</em> < 0.001). Compared to AKI stage 1A, AKI stage 1B further increased the mortality risk by 1.6 folds (OR: 1.55, 95% CI: 1.03-2.31, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>About one in six cirrhotic patients had AKI stage 1A and 1B and both AKI stage 1A and 1B significantly increased the mortality risks of cirrhotic patients.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103154"},"PeriodicalIF":3.2,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adjustable Intragastric Balloon for Metabolic Dysfunction–associated Steatotic Liver Disease—Enhanced Weight Loss and Histological Improvement","authors":"Rakesh Kalapala , Nitin Jagtap , Hardik Rughwani , Shujaath Asif , Anuradha Sekaran , Mithun Sharma , Anand Kulkarni , P.N. Rao , Abhishek Tyagi , D.N. Reddy","doi":"10.1016/j.jceh.2025.103152","DOIUrl":"10.1016/j.jceh.2025.103152","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Metabolic dysfunction–associated steatotic liver disease/metabolic dysfunction–associated steatohepatitis (MASLD/MASH) with obesity significantly increases the risk of cirrhosis unless substantial weight loss is achieved. This prospective study evaluates the impact of adjustable intragastric balloon (aIGB) placement on metabolic and histological parameters of MASLD/MASH, highlighting its efficacy in achieving weight loss necessary for disease resolution.</div></div><div><h3>Methods</h3><div>Thirty-six patients (17 females; mean age: 39.8 years; mean body mass index: 35.4 kg/m<sup>2</sup>) underwent aIGB placement with endoscopic ultrasound–guided liver biopsy at baseline and six months post procedure (September 2020 to February 2023). Patients with inadequate biopsy or early balloon removal were excluded. Primary outcomes included changes in the non-alcoholic fatty liver disease Activity Score (NAS); secondary outcomes were weight loss, alanine transaminase (ALT), fibrosis regression, and adverse events (NCT04182646).</div></div><div><h3>Results</h3><div>At six months, the mean total body weight loss (TBWL) was 12.65% (95% confidence interval: 10.38-14.92), with ≥5% TBWL achieved in 88.9% of patients. Balloon volume adjustments were required in 25 patients (75%) to address weight-loss plateau or intolerance. ALT levels improved significantly (86.36 ± 27.14 vs. 38.53 ± 16.57; <em>P</em> < 0.001). NASs improved in 91.7% of patients (median [interquartile range]: 3 [3-4] to 1 [0-1.75]), and fibrosis improvement was observed in 55.56%. Upward balloon adjustments were associated with greater improvements in NAS (<em>P</em> < 0.001) and steatosis (<em>P</em> = 0.002). No serious adverse events were reported.</div></div><div><h3>Conclusion</h3><div>aIGB effectively induces significant weight loss and improves metabolic and histological parameters in MASLD/MASH patients, with upward volume adjustments enhancing outcomes. The procedure demonstrated an excellent safety profile.</div></div><div><h3>Clinical trial registration</h3><div>This study was registered under registration number NCT04182646.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103152"},"PeriodicalIF":3.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shreyas H. Karunakara, Rohit Mehtani, Gopalakrishna Ramaswamy, Vinutha S. Puttamallapa, Prashant M. Vishwanath, Prasanna K. Santhekadur
{"title":"A Brief Report on Identification of Splice Variants in an In Vitro 3D Spheroid Model for Differentiated Hepatocellular Carcinoma","authors":"Shreyas H. Karunakara, Rohit Mehtani, Gopalakrishna Ramaswamy, Vinutha S. Puttamallapa, Prashant M. Vishwanath, Prasanna K. Santhekadur","doi":"10.1016/j.jceh.2025.103151","DOIUrl":"10.1016/j.jceh.2025.103151","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) represents the major form of primary liver cancer. Alternative splicing events (ASEs) are critical to generating mRNA splice variants that can dictate cell fate during HCC development. We report different ASEs in a 3D <em>in vitro</em> HCC spheroid model. This short study serves as a template to design functional studies to target different splicing events in different subtypes of hepatocellular carcinoma.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103151"},"PeriodicalIF":3.2,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Ceiling Is Real: MASH Needs Combination, Not Celebration","authors":"Ashish Kumar, Praveen Sharma, Anil Arora","doi":"10.1016/j.jceh.2025.103147","DOIUrl":"10.1016/j.jceh.2025.103147","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103147"},"PeriodicalIF":3.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dismal Prognosis of Primary Biliary Cholangitis and Its Overlap with Autoimmune Hepatitis","authors":"Nikhil Sirohi, Venkatesh Vaithiyam, Ajay Kumar, Ashok Dalal, Ujjwal Sonika, Siddharth Srivastava, Barjesh C. Sharma, Sanjeev Sachdeva, Puja Sakhuja","doi":"10.1016/j.jceh.2025.103146","DOIUrl":"10.1016/j.jceh.2025.103146","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103146"},"PeriodicalIF":3.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial Intelligence in Liver Pathology: Precision Histology for Accurate Diagnoses","authors":"Parikshit Sanyal , Dipanwita Biswas , Suvradeep Mitra","doi":"10.1016/j.jceh.2025.103145","DOIUrl":"10.1016/j.jceh.2025.103145","url":null,"abstract":"<div><div>Artificial intelligence (AI) is a technique or tool to simulate or emulate human “intelligence.” Precision medicine or precision histology refers to the subpopulation-tailored diagnosis, therapeutics, and management of diseases with its sociocultural, behavioral, genomic, transcriptomic, and pharmaco-omic implications. The modern decade experiences a quantum leap in AI-based models in various aspects of daily routines including practice of precision medicine and histology. These AI-based models aid in the curation of clinical data, reduce the time and expense in decision-making, provide a smooth workflow, and predict the outcomes based on an algorithmic approach. Histopathologists can effectively implement image-based algorithms with the advent of whole-slide imaging and digital pathology generating objective histological data through machine learning and deep learning, branches of AI. Thus, AI-powered models can be implemented in liver histology to reduce the burden of repetitive and tedious tasks, predict various outcomes, reduce inter-observer and intra-observer variability between pathologists, and glean diverse supra-histological predictive data. This review article provides a brief overview of AI in liver pathology and deals with the basic principles of AI, its utility in precision liver histology, and its challenges.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103145"},"PeriodicalIF":3.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patterns of Liver Injury and Adaptation in Patients With Abdominal Tuberculosis on Antituberculosis Treatment: A Prospective Cohort Study","authors":"Abhishek Kumar , Ramesh Kumar , Vijay Kumar , Sudhir Kumar , Sudheer Marrapu , Utpal Anand , Rajeev N. Priyadarshi","doi":"10.1016/j.jceh.2025.103124","DOIUrl":"10.1016/j.jceh.2025.103124","url":null,"abstract":"<div><h3>Background</h3><div>Extra-pulmonary tuberculosis is associated with a higher risk of drug-induced liver injury (DILI) with antituberculosis treatment (ATT). Nevertheless, hepatic dysfunctions in some patients can also regress to normalization due to hepatic adaptation (HA). Prospective data specifically addressing these issues in patients with abdominal tuberculosis (ATB) is lacking. This study was aimed to evaluate the patterns of hepatic injury, HA, and their predictors in patients with ATB receiving ATT.</div></div><div><h3>Methods</h3><div>This was a prospective cohort study involving 140 patients with ATB and normal baseline liver function tests (LFTs). Patients received standard four-drug ATT, and LFTs were serially monitored. Predictive factors were evaluated using multivariable logistic regression.</div></div><div><h3>Results</h3><div>LFT abnormalities occurred in 71 patients (50.7%). Of these, 20 (14.2%) met DILI criteria at first abnormality. Among the remaining 51, 18 (35.3%) progressed to DILI, while 33 (64.7%) showed spontaneous resolution, consistent with HA. Overall, 27.1% patients developed DILI, and 46.4% of LFT abnormalities resolved due to HA. The majority (89%) of DILI occurred within the first 8 weeks of treatment, and median time for HA was 21 days. Low serum albumin and vitamin D independently predicted DILI progression. Full reintroduction of ATT was successful in 65.8% of cases. Pyrazinamide was most commonly associated with reintroduction failure. None of DILI cases progressed to acute liver failure.</div></div><div><h3>Conclusion</h3><div>LFT abnormalities is common in ATB patients receiving ATT; however, nearly half experience spontaneous resolution due to HA. Hypoalbuminemia and vitamin D deficiency independently predicted progression to DILI, highlighting the need for vigilant LFT monitoring.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 6","pages":"Article 103124"},"PeriodicalIF":3.2,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}