Chun Kit Hung, Monica Passi, M. Ullah, M. Ashamalla, Tai-ping Lee
{"title":"A Retrospective Review of the Diagnostic Rate of Liver Biopsy in Abnormal Liver Tests with Non-Diagnostic Serology and Biochemistry","authors":"Chun Kit Hung, Monica Passi, M. Ullah, M. Ashamalla, Tai-ping Lee","doi":"10.15226/2689-4432/2/1/00111","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00111","url":null,"abstract":"Abnormal liver function tests, defined as values greater than 2 standard deviations above the upper limits of normal, are noted to be present in up to 7.9% of the population in the United States. In about 69% of patients, they are unexplained by current standard serology or biochemistry markers investigating common viral, autoimmune, hereditary etiologies or inborn errors of metabolism [1, 2].Liver biopsy is considered the most accurate means of grading and staging of liver disease. However, there remains some controversy over whether or not it provides overall significant information in terms of establishing an etiology which would then be used to tailor patient management. [3] Moreover, there is the established possibility of sampling error and accompanying procedure complications during liver biopsy, albeit small [3, 4]. A number of studies have suggested that a high percentage of marker negative liver biopsies had fatty infiltration of the liver with varying degrees of inflammation, with mixed reports on whether there is an association with elements of the metabolic syndrome (obesity, diabetes, dyslipidemia) and improvement with reversal of this syndrome [5, 6, 7, 8]. Several other studies have also reported significant progressive liver disease and even cirrhosis in otherwise asymptomatic patients, who were biopsied with seemingly minor chronic elevations of liver enzymes. These findings subsequently significantly impacted the patient’s care [6, 9,10]. However, these were older studies where some biochemical markers were not excluded, and had conflicting conclusions with regards to the diagnostic rate of liver biopsies. [6, 8]. With rapidly advancing imaging technology and biochemical laboratory techniques, the current study seeks to re-evaluate the utility of liver biopsy. Specifically in patients with abnormal liver tests who have had non-diagnostic biochemical or radiographic workup, the rate at which liver biopsy provides a specific diagnosis that can lead to a change to management will be studied. Keywords: Liver biopsy; Metabolic syndrome; Fatty liver disease;","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121789148","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}
Cindy M Fajardo, Lynne A Sinclair, P. Marotta, J. Madill
{"title":"Illness Severity by MELD-Na is not Associated with Energy Expenditure in Cirrhotic Liver Transplant Candidates","authors":"Cindy M Fajardo, Lynne A Sinclair, P. Marotta, J. Madill","doi":"10.15226/2689-4432/2/1/00110","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00110","url":null,"abstract":"Purpose: Hypermetabolism contributes to malnutrition incirrhosis and it often goes undetected. Indirect calorimetry is a high-cost, time-consuming tool which is not accessible to many health care institutions. Predictive equations often underestimate true caloric requirements in cirrhosis. The aim of this study was to assess whether illness severity, defined by MELD-Na score, is associated with increases in measured Resting Energy Expenditure (REE) in patients awaiting liver transplantation. We also sought to quantify a stress factor for improved accuracy of predicted energy requirements in this population. Methods: Data from 40 patients awaiting liver transplantation were retrospectively assessed. MELD-Na was calculated from serum markers; measured REE was quantified using a indirect calorimetry; and predicted REE was determined by the Harris-Benedict equation. Results: MELD-Na scores were not associated with measured REE or prevalence of Hypermetabolism. Forty-three percent of patients required a 20-50% addition to predictive estimates to cover their basal metabolic needs. Conclusions: Our findings suggest a stress factor of 1.2 to 1.3 should be considered when predicting caloric requirements of candidates awaiting liver transplantation in the absence of indirect calorimetry. Illness severity by MELD-Na does not appear to be a useful marker in identifying patients who are hypermetabolic and at higher risk of underfeeding. Keywords: End-stage liver disease; Resting energy expenditure; Indirect calorimetry; Nutritional needs; Liver transplantation;","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115897971","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}
Sonali Verma, A. Agrawal, Chirag Verma, Vanny Arora, M. Narang
{"title":"Celiac Disease Presenting As Budd Chari Syndrome","authors":"Sonali Verma, A. Agrawal, Chirag Verma, Vanny Arora, M. Narang","doi":"10.15226/2689-4432/2/1/00109","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00109","url":null,"abstract":"An 11 year old female child presented with generalized body swelling, ascites and hepatomegaly. She had history of recurrent loose stools since last 5 years. Initial work up revealed ascites, and hepatomegaly. Serum proteins were within normal limits. Initial USG revealed isoechoeic space occupying lesion in segment VII of liver with ascites. USG Doppler revealed attenuation of blood flow in right hepatic vein. Ascites suddenly improved after 5 days, repeat USG revealed that all three hepatic veins and inferior vena cava were patent. CECT abdomen showed hemangioma measuring 2.1 X 2.6 X 1.36 cm in segment VII of liver with fatty liver with ascites with mesenteric lymphadenopathy. Serum tTGlevel carried out because of short stature and history of diarrhea was 372U/ml (normal 0-20 U/ml). Celiac disease was confirmed on biopsy. Hence the diagnosis of celiac disease with transient obstruction of hepatic veins due to hemangioma or thrombus. Keywords: Budd Chiari; Ascites; Celiac disease","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127967162","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":"Lymphoma of the Liver in a Developing Community","authors":"W. Onuigbo","doi":"10.15226/2689-4432/2/1/00108","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00108","url":null,"abstract":"Literature search revealed lymphoma of the liver in various countries as regards single or more cases. These data are compared with those obtained from patients of the Igbo ethnic group in Nigeria. As in different parts of the world, males were affected more often than females. Keywords: Liver; lymphoma; sex; developing community.","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133569400","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}
A. M. Ntumba Kennedy, Ciamala Mukendi Paul, Kanyiki Katala Moise, Banza Ndala Deca Blood, Mukendi Mukendi Jean Réne, Kazumba Nsaka Dieudonné, K. Michel
{"title":"Seroprevalence of Hepatitis C Virus Infection among Blood Donors in General Dipumba Hospital in Mbujimayi, Democratic Republic of Congo","authors":"A. M. Ntumba Kennedy, Ciamala Mukendi Paul, Kanyiki Katala Moise, Banza Ndala Deca Blood, Mukendi Mukendi Jean Réne, Kazumba Nsaka Dieudonné, K. Michel","doi":"10.15226/2689-4432/2/1/00107","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00107","url":null,"abstract":"Hepatitis C virus is one of the blood borne transmissible infections of public healthsignificance. It can be transmitted to a wider population through transfusion of contaminatedblood or blood products. The aim of this study was to determine the seroprevalence of HCV antibodies amongst potential blood donors in Dipumba’s hospital in Mbujimayi. Retrospective cross-sectional descriptive study of seroprevalence of hepatitis C were conducted from consented blood donors in the study area and were examined for anti-HCV antibody using HCVSCAN test. Results were analyzed using SPSS version, 23.0 statistical software Package of the 1584 blood donors examined in the study population 1, 9 % (n= 30) were sero-positive to Hepatitis C Virus (HCV), 77.8% were male (sex ratio M/F 3.5 and familial donors were 50.4%. No statistical significant association with the seroprevalence of Hepatitis C Virus and general characteristics of blood donors in Mbujimayi (age, sex, marital status, blood donation category). Our findings further confirm the presence of hepatitis C virusinfection among blood donors in Mbujimayi. Routine HCV screening of blood donors is therefore recommendedin order to reduce the risk of post transfusion hepatitis C. Keyword: Seroprevalence; hepatitis C; blood donors; Mbujimayi","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132720261","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":"\"OxyElite Pro\" Induced Fulminant Hepatotoxicity","authors":"A. Shanab, M. Iqbal, R. Merriman","doi":"10.15226/2689-4432/2/1/00106","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00106","url":null,"abstract":"Around 35% of adults or more are overweight according to a report by Global Health Observatory (GHO). In the absence of proven medical therapeutics, the use of dietary supplements to effect weight loss has increased and under much less scrutiny by regulatory agencies like the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). For many, these approaches represent apparent alternatives to failed attempts at weight loss with the use of more conventional approaches [1]. Hepatotoxicity from supplements is a growing problem while the internet facilitates obtaining these agents across national regulatory boundaries. OxyElite Pro capsules are sold as a dietary supplement for weight loss and ‘’super thermogenic’’ agent (Figure1A & B). According to the manufacture, the proposed mechanism of action is ‘fat burning via the contained ingredients which are: Rauwolfia Canescens, Thyroxine (T4) and Triiodothyronine (T3), Bauhinia Purpurea Trypsin Inhibitor (BPLTI), Bacopa monnieri, Geranium which contains a powerful constituent known as 1,3-Dimethylamylamine (DMAA), Cirsium Oligophyllum, and Caffeine’. A more recent formula of OxyElite Pro released in late 2012 contained a new ingredient, Aegeline. We describe a case of acute liver failure in an otherwise young healthy female after taking the newer OxyElite Pro formula to lose weight. Keywords: OxyElite Pro, Hepatotoxicity, acute liver failure, fulminant, herbal induced liver injury","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133568197","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":"Seroprevalence of Hepatitis B and C in the Blood Donors in Kolwezi, Democratic Republic of Congo","authors":"Nonon Mulubwa Kyalubile, Christel NzebaTshibanda, ArsèneTshilombaTshivwadi, Thierry Tshiningi Sonnhy, Tonny NKongal Nkongal, M. KabambaNzaji","doi":"10.15226/2689-4432/2/1/00105","DOIUrl":"https://doi.org/10.15226/2689-4432/2/1/00105","url":null,"abstract":"Introduction: The transmission of infectious agents such as Hepatitis B (HBV), Hepatitis C (HCV) is the biggest threat to blood safety in developing countries. This study has set a goal to determine the seroprevalence of hepatitis B and C among blood donors from the town of Kolwezi in general and particularly those of the Kolwezi Staff hospital. Methods: A retrospective cross-sectional descriptive study of seroprevalence of hepatitis B and C among blood donors over a period of 3 years period from 1 January 2014 to 31 December 2016 was performed. Results: The prevalence of hepatitis B and C was 3.9% and 0.7% respectively. We found a high prevalence in the age group between 20-45 years (4.2%) followed by those over 45 years (2.3%) and this difference was statistically significant (P=0.047). Discussion: These results confirm that the town of Kolwezi is in a highly endemic area and give a first idea of the circulation of hepatitis C in the blood donor population. Conclusion: Therefore, selection and rigorous screening of blood donors are highly recommended to ensure blood safety for the recipient.","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127848854","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}
Xiujuan Hao, Jianguo Sun, Jing Hao, Yan Huang, J. Xia, Huiming Ren, Wenting Li, Yaxian Zhou, Wen-Xue Zhang
{"title":"Generation of Monoclonal Antibodies against S-Adenosylmethionine and Their Application in Diagnosing Liver Diseases","authors":"Xiujuan Hao, Jianguo Sun, Jing Hao, Yan Huang, J. Xia, Huiming Ren, Wenting Li, Yaxian Zhou, Wen-Xue Zhang","doi":"10.15226/2689-4432/1/1/00103","DOIUrl":"https://doi.org/10.15226/2689-4432/1/1/00103","url":null,"abstract":"S-AdenosylMethionine (SAM) hapten-carrier conjugates were used to immunize BALB/c mice. Two strains of hybridoma cell lines that stably produced high-titer monoclonal antibodies against SAM were obtained. The biological properties of these two antibodies were characterized. A competitive ELISA (cELISA) was established using these antibodies. The sensitivity and specificity were analyzed, and human serum samples were measured using the SAM cELISA kit.Very little cross-reactivity (< 1%) was observed between the monoclonal antibodies and SAM analogues. These two antibodies are IgG2b-type antibodies. The affinity measured using the cELISA is 5.75 x 109 L/mol for the 118-6 antibody and 7.29 x 1010L/mol for the 84-3 antibody. According to the Immunohistochemistry (IHC) and flow cytometry results, normal liver cells contain much higher levels of SAM than liver cancer cells (p < 0.01). The results from 81 healthy subjects and 99 patients with liver disease showed the following sensitivity using the 240 nM cutoff: 95.65% (44/46) for hepatitis; 95% (19/20) for cirrhosis; 92.86% (13/14) for carcinoma; 100% (19/19) for liver failure; 30.86% (25/81) for healthy subjects; the detection specificity is 69.14% (56/81). Using the 120 nM cutoff, the sensitivitywas 80.43% for hepatitis; 85% for cirrhosis; 71.43% for carcinoma, 100% for liver failure; 3.70% for healthy subjects; the specificity is 96.30% (78/81). SAM, alanine transaminase and aspartate aminotransferase were compared in identifying liver diseases. Serum SAM allowed early detection of abnormal liver function and providing clinicians an important basis for a more accurate diagnosis of liver diseases than alanine transaminase and aspartate aminotransferase. Keywords: S-Adenosylmethionine (SAM); Monoclonal Antibody; Competitive ELISA; Liver Disease Diagnosis Abbreviations: Alanine Transaminase (ALT); Aspartate Aminotransferase (AST); Chronic Hepatitis B (CHB), Competitive ELISA (CELISA); Hematoxylin and Eosin (HE); Hepatocellular Carcinoma (HCC); Homocysteine (HCY); Immunohistochemistry (IHC); Keyhole Limpet Hemocyanin (KLH); L-Methionine(L-Met); Methionine Adenosine Transferase (MAT); Methylthioadenosine (MTA); Optical Density (OD); S-Adenosylhomocysteine(SAH); S-Adenosylmethionine(SAM).","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131035987","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":"Treatment of Hepatitis C with Sofosbuvir in Combination with Ribavirin and Peg Interferon; a Prospective Study Highlighting the Sustained Virological Response","authors":"J. I. Farooqi, N. Maheshwary, A. Anwar","doi":"10.15226/2689-4432/1/1/00104","DOIUrl":"https://doi.org/10.15226/2689-4432/1/1/00104","url":null,"abstract":"Objective: This study was intended to know the efficacy and safety of Sofobuvir in combination with Ribaviran and Peg Interferon on the basis of sustained virological response. Material and Methods: This was a prospective observational multicenter study with the use of non-probability convenient sampling technique. The duration of study was from January 2016 till July 2017. The study was conducted in lady reading hospital. The patients infected with HCV, belonging to both genders, and willing for treatment with standard interferon and Ribavirin were included in the study. The written consent was taken from all the patients with complete confidentiality of the data. HCV was diagnosed by detecting anti-HCV antibodies in serum with the help of Polymerase Chain Reaction (PCR). PCR was done at 12th week after the treatment and was classified as Sustained Virological Response (SVR). The therapy was categorized into dual containing Sofosbuvir and Ribavirin, triple containing Sofosbuvir, Ribavirin and Peg interferon. The dose of sofosbuvir, Ribavirin and Peg Interferon was 400 mg/OD, 1200 mg/OD and 180μcg/OD respectively. All data was entered and analyzed on SPSS version 20. Results: Total 386 patients were selected for the study including 172(45.5%) males and 214(54.5%) females with the male to female ratio of 1:1. They were divided into treatment naïve and experienced group with a frequency of 211(54.6%) and 175(45.4%). The frequency of genotypes of hepatitis C was found to be 4(1.9%), 1(0.5%), 2(0.9%), 1(0.5%), 178(84.3%), 20(9.5%), 3(1.4%) and 2(3.6%) for genotypes 1a, 2, 2a, 2b, 3, 3a, 3b and UT respectively in naïve patients and similarly it was 3(1.7%), 1(0.6%), 4(3.2%), 3(1.7%), 113(64.6), 44(25.2%), 5(2.9%) and 2(1.1%) respectively in experienced group. The overall SVR achieved regardless of the dual and triple therapy in naïve patients was 200(94.7%) and in treatment experienced patients were 144(82.3%). Conclusion: The Sofosbuvir is an effective drug for the achievement of sustained virological response in combination with Ribavirin and Peg Interferon. The uniformity in the high rates of achievement of SVR in dual and triple therapy suggests a powerful efficacy of Sofosbuvir in treating and eliminating the viral load in the patients infected with Hepatitis C Virus. Keywords: Hepatitis C; Sofosbuvir; Sustained virological response","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132579916","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}
D. Enjuto, N. Herrera, Antonio Ramos, P. Diaz, C. Ceinos, M. Pérez-González, J. Oriol, J. Fernández-Merino
{"title":"Modern Approach to Colorectal Liver Metastases","authors":"D. Enjuto, N. Herrera, Antonio Ramos, P. Diaz, C. Ceinos, M. Pérez-González, J. Oriol, J. Fernández-Merino","doi":"10.15226/2689-4432/1/1/00102","DOIUrl":"https://doi.org/10.15226/2689-4432/1/1/00102","url":null,"abstract":"PColorectal cancer is the third leading cause of death worldwide. Approximately 15-20 % of the patients present synchronic Colorectal Liver Metastases (CRLM) and 60 % will develop them metachronicaly. Surgical treatment is the only therapy that gives these patients the option of long-term survival. In the 1980s surgical treatment offered a 5-year survival rate of approximately 20 % for patients undergoing liver resection. Recent studies show 5-year overall survival rates ranging between 42 and 58 %. Systemic chemotherapy regimens are based on fluoropirimidines. These regimes include neoadjuvant, adjuvant or both depending on the disease stage. Adjuvant chemotherapy has shown better overall survival and progression free survival in patients treated surgically for CRLM. Surgical approach to CRLM has changed dramatically in the last years. There are hardly any contraindications for treating surgically CRLM, as long as the liver remnant is at least 30 % of the total volume for non-cirrhotic non-chemotherapy treated livers. In cirrhotic or chemotherapy-treated livers this amount should reach 40 %. Aspects concerning synchronic CRLM and irresectable metastases have shown greater advances. The reverse approach or liver-first approach has offered patients with advanced disease a better option for completing total resection. Portal vein embolization, two-stage hepatectomy or ALPPS procedure (associating liver partition and portal vein ligation) are the top developments in this field showing promising results. These developments are widening surgical indications in CRLM. Surgical and systemic treatment, as well as a better understanding of molecular alterations has definitely improved the perspective for patients with CRLM. Keywords: Colorectallivermetastases; Irresectablemetastases; Synchronicmestastases","PeriodicalId":283817,"journal":{"name":"Journal of Hepatology, Gallbladder and Biliary Disease Research","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127726847","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}