EASL专访丨西班牙Andres Cardenas教授：肝硬化及其并发症中的创新技术

Prof. Andres Cardenas：HVPG has been the gold standard for measuring portal pressure and estimated hepatic venous pressure. The goal of this technique is to inform us of the degree of liver resistance in portal hypertension. It is an invasive technique that requires radiology, and also has the disadvantage of being invasive, and the patient has to come in to the hospital for that. Although it is the gold standard for measuring estimated portal pressure, it is invasive, and there are other techniques, such as CT scan, MRCP and special ultrasound imaging, that can probably tell us about the liver. There is new software in the CT scan area and ultrasound area that can help us try to estimate the degree of portal hypertension. That being said, these methods are still all being studied and need to be validated in order to tell us if there is a dynamic change in the value of portal pressure. So the future that lies ahead is non-invasive measurement of portal hypertension, and non-invasive estimation of HVPG and portal pressure.

Prof. Andres Cardenas：Endoscopy is a tool that we use for our patients with cirrhosis. The main indication for endoscopy in patients with cirrhosis is to see if the patient has varices or not. However, there are non-invasive ways of estimating the presence of varices with what we call FibroScan and platelet counts. So if you have a low FibroScan count and a high platelet count, these patients probably don’t need an endoscopy. For all the other patients who have cirrhosis or high FibroScan, we need to do an endoscopy to evaluate the presence, size and characteristics of gastric varices and esophageal varices if present.

The role of endoscopic ultrasound in cirrhosis is important. It can help you evaluate the liver surface, and it can also help you evaluate if there are liver nodules or not. There are also ways of measuring portal pressure with endoscopic ultrasound. This is still in its infancy, but is another way of measuring portal pressure. However, we need more validation and more information before we consider this a tool for estimating portal pressure. The future will tell us if this technique is something that can be implemented safely in our patients with cirrhosis.

Prof. Andres Cardenas：The new technologies that can be used in clinical practice are basically two. One is measurement of blood markers that can help us estimate risk of disease progression, and also help us estimate the presence or not of chronic liver disease. In addition to that, new technologies include the use of imaging techniques such as MRI, MR elastography, CT scan and CT scan dynamic imaging. These techniques will non-invasively help us to decide if a patient has cirrhosis or not; and if they have cirrhosis, to help us estimate the degree of liver disease that patient may have, and the degree of portal hypertension. These techniques will allow us to diagnose our patients better, and therapies will help us slow progression of disease. In some cases, patients with cirrhosis may benefit obviously from beta-blockers, antibiotics such as rifaximin, and in some cases, with statins, that can help lower portal pressure.

Prof. Andres Cardenas：This is a new journal that focuses on portal hypertension and cirrhosis. It is one-of-a-kind, and it is exciting to see that there is a journal that is going to be focusing on this area of liver disease. Obviously, the most important thing is to try to attract manuscripts that are original, and to review manuscripts that can be published and cited so the journal can gain some impact in the world of hepatology. With time, we will see if this is the case, and then hopefully we will have enough submissions to drive citations, drive the impact factor, and hopefully make it one of the important journals in hepatology.