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Modified model incorporating sarcopenia and myosteatosis for predicting severe hepatic encephalopathy after transjugular intrahepatic portosystemic shunt:Multicenter study 认领 引用
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作者 Jing-Qiu Zhang Liang Yin +10 位作者 Yi-Jiang Zhu Li Dong Chang-Long Hou Shi-Jiang Tian Pin Chen Xiang-Zhong Huang Hao Xu Zhi-Yang Chen Xin-Jian Xu Chun-Ze Zhou De-Lei Cheng 《World Journal of Gastroenterology》 SCIE CAS 2026年第29期59-73,共15页
BACKGROUND Severe hepatic encephalopathy(SHE)following transjugular intrahepatic portosystemic shunt(TIPS)worsens the prognosis of cirrhotic patients.Despite established associations with nutritional and muscle-relate... BACKGROUND Severe hepatic encephalopathy(SHE)following transjugular intrahepatic portosystemic shunt(TIPS)worsens the prognosis of cirrhotic patients.Despite established associations with nutritional and muscle-related factors,no integrated predictive model has yet been developed.This study developed and validated a model combining the Freiburg post-TIPS survival(FIPS)score with nutrition and sarcopenia-related indicators.AIM To develop and validate a predictive model combining the FIPS score with nutrition and sarcopenia-related indicators for SHE after TIPS.METHODS This retrospective study included 590 cirrhotic patients who underwent TIPS at four Chinese hospitals between April 2015 and March 2025.Patients from Center I were divided into training and internal validation cohorts at a ratio of 7:3,while those from the remaining centers formed the external validation cohort.Independent risk factors identified via Cox regression were incorporated into a base model using FIPS and preoperative computed tomography-derived nutritionsarcopenia indices.Model performance was evaluated in terms of discrimination(concordance index and area under the receiver operating characteristic curve),calibration,and clinical utility.RESULTS Independent predictors of post-TIPS SHE included FIPS[hazard ratio(HR)=1.753;95%CI:1.266-2.428;P=0.001],myosteatosis(HR=1.921;95%CI:1.114-3.312;P=0.019),and sarcopenia(HR=2.722;95%CI:1.596-4.641;P<0.001).The modified model demonstrated area under the receiver operating characteristic curves of 0.766,0.745,and 0.751 at 3 months,6 months,and 12 months in the training cohort;0.733,0.718,and 0.793 in the internal validation cohort;and 0.811,0.797,and 0.854 in the external validation cohort,respectively,outperforming the original FIPS score.Predictive accuracy improved by 4.4%(P=0.001),with calibration and decision curve analyses confirming its clinical utility.CONCLUSION The modified model demonstrated superior predictive performance for post-TIPS SHE and provides a reliable tool for risk stratification and clinical decision-making. 展开更多
关键词 Hepatic encephalopathy Cirrhosis Transjugular intrahepatic portosystemic shunt Freiburg transjugular intrahepatic portosystemic shunt post-survival index score Nutritional status
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Transjugular intrahepatic portosystemic shunt improves survival in anticoagulation-resistant hepatic sinusoidal obstructive syndrome patients:A multicenter retrospective study 认领 引用
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作者 Jing-Jing Tu Han Zhang +11 位作者 De-Run Kong Yan-Hong Feng Yue-Cheng Yu Tai-Shun Li Feng Zhang Wei Zhang Hui Xu Qin Yin Lei Wang Ming Zhang Jiang-Qiang Xiao Yu-Zheng Zhuge 《World Journal of Hepatology》 2026年第2期167-177,共11页
BACKGROUND Anticoagulation therapy is recommended during the acute or subacute stage for patients with pyrrolizidine alkaloid-hepatic sinusoidal obstruction syndrome(PAHSOS).Transjugular intrahepatic portosystemic shu... BACKGROUND Anticoagulation therapy is recommended during the acute or subacute stage for patients with pyrrolizidine alkaloid-hepatic sinusoidal obstruction syndrome(PAHSOS).Transjugular intrahepatic portosystemic shunts(TIPS)is suggested as a step-up treatment when patients do not respond to anticoagulants.However,more evidence of the efficacy of TIPS is needed.AIM To evaluate the effect of TIPS in these patients.METHODS Between January 2013 and September 2020,we retrospectively enrolled patients with PA-HSOS who did not respond to short-term anticoagulation therapy at four hospitals.The patients were divided into a TIPS treatment group and an anticoagulation therapy group.Baseline information and clinical characteristics were collected and recorded.Survival in both groups was the primary study endpoint and the risk factors for patient death were further analyzed.RESULTS A total of 99 patients were enrolled according to the inclusion and exclusion criteria(63 in the TIPS group and 36 in the anticoagulation therapy group).There were 17 deaths during the median follow-up time of 32.5 months.Treatment,age,aspartate aminotransferase,and serum total bilirubin were independent risk factors for predicting death.The survival of patients in the TIPS group was significantly greater than that of patients in the continuing anticoagulation therapy group(P=0.028).When stratified by the Drum-Tower Severity Scoring,in the TIPS group,mild and moderate patients had better outcomes than severe patients.CONCLUSION TIPS can improve the transplant-free survival rate in patients with PA-HSOS who do not respond to short-term anticoagulation therapy,and patients with mild and moderate Drum-Tower Severity Scoring grade can benefit from TIPS. 展开更多
关键词 Hepatic sinusoidal obstruction syndrome Hepatic veno-occlusive disease No response to anticoagulation therapy Gynura segetum Pyrrolizidine alkaloids Transjugular intrahepatic portosystemic shunts Transplant-free survival
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Letter to the Editor:Decoding intrahepatic cholangiocarcinoma through lactate metabolism-from cellular states to therapeutic targets 认领 引用
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作者 Yasser Fouad Ahmed Gomaa Gamal Esmat 《World Journal of Gastroenterology》 SCIE CAS 2026年第29期155-158,共4页
Intrahepatic cholangiocarcinoma(ICC)is a highly aggressive liver cancer characterized by significant intratumoral heterogeneity and limited treatment options.In the recent issue of World Journal of Gastroenterology,Wu... Intrahepatic cholangiocarcinoma(ICC)is a highly aggressive liver cancer characterized by significant intratumoral heterogeneity and limited treatment options.In the recent issue of World Journal of Gastroenterology,Wu et al revealed that lactate metabolism(LM)is a key determinant of malignant cell states in ICC,extending beyond its traditional role as a metabolic byproduct.Distinct tumor subpopulations exhibit a gradient of lactate metabolic activity,defining a hierarchy linked to differentiation,plasticity,and clinical aggressiveness.High LM states correlate with stemness features,enhanced mitochondrial function,and immunosuppressive interactions within the tumor microenvironment.Mitochondrial regulators such as cytochrome c1 connect lactate utilization to oxidative phosphorylation and redox homeostasis.Deciphering ICC through LM provides a unifying framework for tumor stratification and reveals potential metabolic-immune therapeutic targets. 展开更多
关键词 Intrahepatic cholangiocarcinoma Lactate metabolism Tumor heterogeneity Single-cell transcriptomics Tumor microenvironment Metabolic reprogramming
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Intraductal papillary neoplasm of the left intrahepatic bile duct found during early gastric cancer treatment:A case report 认领 引用
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作者 Wen-Juan Fan Xin-Xia Feng +4 位作者 Zhi-Cheng Zhang Shuai Xiang Wan-Guang Zhang Ying Wang Mei Liu 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第6期427-433,共7页
BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare disease of the bile duct.It is characterized by a papillary growth within the bile duct lumen.IPNB was formally recognized as a distinct diseas... BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a rare disease of the bile duct.It is characterized by a papillary growth within the bile duct lumen.IPNB was formally recognized as a distinct disease entity in 2010,and its etiology remains unknown.IPNB is a complex disease and generally requires multidisciplinary investigation.CASE SUMMARY We report the case of a 67-year-old patient who was asymptomatic but diagnosed with IPNB during treatment of early gastric cancer due to an obvious elevation ofγ-glutamyl transpeptidase.Computed tomography,magnetic resonance cholangiopancreatography,endoscopic ultrasonography,and endoscopic retrograde cholangiopancreatography with EyeMaxÔdirect visualization system were crucial for the diagnosis of IPNB.Hepatic surgery was performed,and the patient was discharged without complications.CONCLUSION IPNB is a complicated disease and difficult to diagnose,especially when the patient is asymptomatic.Aggressive surgical resection can achieve adequate clinical outcomes,particularly when IPNB is diagnosed in early stages. 展开更多
关键词 Intraductal papillary neoplasm of the bile duct Premalignant neoplasm Intrahepatic Extrahepatic Jaundice Case report
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Letter to the Editor:Beyond the liver-integrating emerging predictors in hepatic encephalopathy after transjugular intrahepatic portosystemic shunt 认领 引用
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作者 Cristian Lindner Andrés Concha David Clemo 《World Journal of Radiology》 2026年第6期82-85,共4页
We read with great interest the prospective study by Zhuang et al published in the recent issue of the World Journal of Radiology,regarding the cerebral blood flow changes following transjugular intrahepatic portosyst... We read with great interest the prospective study by Zhuang et al published in the recent issue of the World Journal of Radiology,regarding the cerebral blood flow changes following transjugular intrahepatic portosystemic shunt creation provides a vital hemodynamic correlate to the pathogenesis of hepatic encephalopathy.However,this letter argues that cerebrovascular alterations should not be interpreted in isolation but rather as the downstream consequence of broader systemic dysregulation.We highlight the critical role of emerging predictors such as sarcopenia,shunt magnitude,and portal vein anatomy,in modulating the neurotoxic burden within the gut-liver-brain axis.By integrating these systemic variables with cerebral hemodynamic metrics,we propose a multidimensional approach to improve risk stratification.This perspective is essential for developing personalized transjugular intrahepatic portosystemic shunt planning strategies that minimize hepatic encephalopathy risk while maintaining shunt efficacy. 展开更多
关键词 Hepatic encephalopathy Transjugular intrahepatic portosystemic shunt Cerebral blood flow Sarcopenia Portal hypertension
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Lactate metabolism-driven tumor heterogeneity and molecular signatures in intrahepatic cholangiocarcinoma 认领 引用 被引量：1
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作者 An-Ke Wu Jun-Yi Li +9 位作者 Kai Zhang Martin Meng Xue Wang Yue Liu Peng Xie Wei-Qi Rong Fan Wu Hong-Guang Wang Xuan Meng Jian-Xiong Wu 《World Journal of Gastroenterology》 SCIE CAS 2026年第7期109-134,共26页
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is a highly aggressive liver malignancy with limited therapeutic options and poor prognosis.Recent evidence indicates that lactate metabolism(LM)plays a pivotal role in t... BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is a highly aggressive liver malignancy with limited therapeutic options and poor prognosis.Recent evidence indicates that lactate metabolism(LM)plays a pivotal role in tumor metabolic reprogramming,immune evasion,and disease progression;however,the heterogeneity and regulatory mechanisms of LM activity within ICC remain largely undefined.AIM To systematically characterize LM-driven heterogeneity and its molecular and functional implications in ICC.METHODS Single-cell RNA sequencing and bulk transcriptomic datasets were integrated to characterize LM heterogeneity in ICC.High-dimensional weighted gene coexpression network analysis and multiple machine-learning algorithms(least absolute shrinkage and selection operator,random forest,gradient boosting machine,adaptive best subset selection,and decision tree)were employed to identify LM-associated feature genes.CytoTRACE and CellChat analyses were used to assess differentiation potential and intercellular communication among malignant epithelial subpopulations.Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses were performed to elucidate biological functions.A random forest model combined with SHapley Additive exPlanation(SHAP)interpretability analysis identified the most predictive LM-related gene.Functional assays,including quantitative polymerase chain reaction,cell counting kit-8,colony formation,woundhealing,and transwell experiments,were conducted to validate CYC1 in ICC cell lines.RESULTS Malignant ICC cells were stratified into three LM-activity subtypes(high,intermediate,and low)exhibiting distinct transcriptional programs and differentiation trajectories.Twelve LM-associated feature genes GPX3,CYC1,NME1,GSTP1,MGST1,ALDH3A1,TALDO1,SNRPB,TKT,NAA20,G6PD,and RPL13A were identified as key molecular markers linked to aggressive phenotypes and poor prognosis.Among them,CYC1 showed the highest predictive accuracy(area under the curve=0.844)and strongest model contribution(SHAP=0.091),marking it as the principal LM-related driver gene.Functional experiments confirmed that CYC1 knockdown significantly suppressed ICC cell proliferation,migration,and invasion,validating its oncogenic role in promoting malignant progression.CONCLUSION This integrative single-cell and machine-learning study delineates the molecular heterogeneity of LM in ICC and identifies twelve feature genes linking LM with tumor aggressiveness.These findings provide novel insight into LM-driven oncogenic mechanisms and propose CYC1 and other LM-associated genes as potential biomarkers and therapeutic targets for ICC. 展开更多
关键词 Intrahepatic cholangiocarcinoma Lactate metabolism Single-cell RNA sequencing Metabolic heterogeneity Tumor microenvironment
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Role of cerebral blood flow changes in post-transjugular intrahepatic portosystemic shunts hepatic encephalopathy 认领 引用 被引量：2
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作者 Wan-Li Zhuang Shang-Wen Xu +6 位作者 Jian Fang Zhi-Qiang Zhang Shi-An Zhang Jie-Long Wang Jiao-Long Zheng Xiao-Yang Wang Dong-Liang Li 《World Journal of Radiology》 2026年第2期81-91,共11页
BACKGROUND Hepatic encephalopathy(HE)is the most common serious complication after transjugular intrahepatic portosystemic shunts(TIPS)surgery,the pathogenesis of which is not well understood.AIM To explore the mechan... BACKGROUND Hepatic encephalopathy(HE)is the most common serious complication after transjugular intrahepatic portosystemic shunts(TIPS)surgery,the pathogenesis of which is not well understood.AIM To explore the mechanisms of HE after TIPS from a cerebral hemodynamic perspective and provide a theoretical basis for clinical treatment,three-dimen-sional arterial spin labeling and resting-state functional magnetic resonance imaging were applied in patients with portal hypertension post-TIPS to analyze dynamic changes in cerebral blood flow(CBF)and spontaneous brain activity,respectively.METHODS Patients who meet the inclusion criteria were selected as the case group,and 18 healthy volunteers were assigned as the control group.The differences in am plitude of low-frequency fluctuation(ALFF)and CBF between the case group and the control group before TIPS surgery and the differences in ALFF and CBF between the case group at each detection time point were compared and analyzed,and analyze the correlation between the changes in ALFF and CBF in the case group and the changes in clinical data.RESULTS Compared with the healthy control group,the CBF values of patients with cirrhosis and portal hypertension who were treated with TIPS were reduced in the area centered on the right orbitofrontal gyrus and the left superior temporal gyrus.ALFF scores decreased in the area centered on the left superior temporal gyrus,the left inferior frontal gyrus of the operculum and the right precuneus.Compared with preoperatively,CBF in the TIPS group increased in the area centered on the left fusiform gyrus at 1 month after surgery and the difference in CBF in this area was negatively correlated with the difference in the Child-Pugh liver function score.ALFF values increased in the area centered on the left superior temporal gyrus and the ALFF difference in this area was positively correlated with the portal vein pressure difference.There was no significant difference in CBF 3 months after TIPS in comparison to pre-TIPS.ALFF scores increased in the area centered on the left orbitofrontal gyrus and the left precuneus 3 months after TIPS surgery and the difference in ALFF in the left orbitofrontal gyrus was negatively correlated with the difference in the Digit Symbol Substitution Test score.Compared to 1 month after TIPS surgery,CBF values decreased in the area centered on the right fusiform gyrus and increased in the area centered on the left angular gyrus 3 months after TIPS surgery.The difference in CBF in the right fusiform gyrus was positively correlated with the difference in the Number Connection Test Part A score.ALFF values decreased in the area centered on the right insula and in the cerebellum.CONCLUSION TIPS surgery has a certain effect on spontaneous brain activity in patients with portal hypertension and cirrhosis for the increase in plasma ammonia as well as postoperative hemodynamic changes increasing CBF and may be factors causing HE.Resting-state functional magnetic resonance imaging is a sensitive diagnostic tool for HE,especially mild HE. 展开更多
关键词 Hepatic encephalopathy Transjugular intrahepatic portosystemic shunt Cerebral blood flow Arterial spin labeling Resting-state functional magnetic resonance imaging
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Development and validation of a nomogram predicting rebleeding in cirrhotic patients with patent transjugular intrahepatic portosystemic shunt 认领 引用
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作者 Yang-Tian Ren Jun-Yi Wen +4 位作者 Jing-Jing Tu Han Zhang Chuan-Fu Ding Jiang-Qiang Xiao Yu-Zheng Zhuge 《World Journal of Gastroenterology》 SCIE CAS 2026年第23期22-33,共12页
BACKGROUND Even with stent patency following transjugular intrahepatic portosystemic shunt(TIPS)placement,some patients still experience recurrent variceal bleeding.AIM To identify risk factors and develop a predictiv... BACKGROUND Even with stent patency following transjugular intrahepatic portosystemic shunt(TIPS)placement,some patients still experience recurrent variceal bleeding.AIM To identify risk factors and develop a predictive model for rebleeding in patients with patent TIPS stents.METHODS Cirrhotic patients(n=647)undergoing TIPS(2010-2024)were retrospectively analyzed and grouped by rebleeding status.Propensity score matching(1:3)was performed for age,sex,and model for end-stage liver disease score.Independent predictors identified via univariate and multivariate logistic regression were used to construct a nomogram.The model was internally validated using bootstrapping and evaluated via area under the receiver operating characteristic curve(AUC),calibration curves,and decision curve analysis.RESULTS Of the 73 patients with rebleeding following patent TIPS placement,variceal rebleeding was the primary etiology(n=45).Univariate analysis revealed that platelet count(PLT),pre-procedural pressure gradient(pre-PPG),spleen dimensions(length,width,volume),and splenic vein parameters(diameter,flow)were significantly associated with rebleeding(all P<0.001).Multivariate regression identified PLT[odds ratio(OR)=0.980,95%confidence interval(CI):0.963-0.996],spleen length(OR=1.177,95%CI:1.002-1.381),spleen width(OR=1.425,95%CI:1.088-1.866),pre-PPG(OR=1.182,95%CI:1.067-1.309),and splenic vein diameter(OR=1.501,95%CI:1.074-2.097)as independent predictors(all P<0.05).The nomogram exhibited strong discrimination(AUC=0.883,95%CI:0.831-0.936)and favorable calibration(mean absolute error=0.046).Decision curve analysis confirmed a positive clinical net benefit.CONCLUSION The nomogram developed in this study enables the precise prediction of post-TIPS placement rebleeding risk,assisting clinicians in individualized risk stratification and postoperative therapeutic strategies. 展开更多
关键词 Transjugular intrahepatic portosystemic shunt Oesophagogastric variceal rebleeding Nomogram Predictive model Portal hypertension Stent patency Propensity score matching
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Transjugular intrahepatic portosystemic shunt for variceal bleeding due to hereditary hemorrhagic telangiectasia with cirrhosis:A case report 认领 引用
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作者 Tong-Qin Zhang Liang Zhang +5 位作者 Xin Yong Chao Tian Bei-Jin Chen Jian-Ping Qin Dong Mu Shan-Hong Tang 《World Journal of Gastroenterology》 SCIE CAS 2026年第12期132-138,共7页
BACKGROUND The co-occurrence of hereditary hemorrhagic telangiectasia(HHT)and hepatitis C cirrhosis represents an exceptionally rare clinical entity,which can pose a diagnostic and therapeutic challenge.CASE SUMMARY W... BACKGROUND The co-occurrence of hereditary hemorrhagic telangiectasia(HHT)and hepatitis C cirrhosis represents an exceptionally rare clinical entity,which can pose a diagnostic and therapeutic challenge.CASE SUMMARY We reported a patient with portal hypertension-induced esophageal and gastric variceal rupture due to HHT-hepatic arterioportal fistula and hepatitis C cirrhosis.Computed tomography confirmed hepatic diffuse arteriovenous fistula.Following initial embolization of arterioportal fistula,persistent gastrointestinal bleeding recurred,indicating suboptimal embolization efficacy.Subsequent transjugular intrahepatic portosystemic shunt(TIPS)treatment was performed and resulted in significant portal hypertension reduction.Endoscopic evaluation demonstrated marked improvement in esophageal and gastric varices,achieving remarkable therapeutic outcomes.CONCLUSION TIPS is an effective treatment option for esophageal and gastric variceal bleeding secondary to portal hypertension in patients with both HHT and liver cirrhosis. 展开更多
关键词 Transjugular intrahepatic portosystemic shunt Hereditary hemorrhagic telangiectasia Hepatic arterioportal fistula Portal hypertension Variceal bleeding Case report
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Impact of rebleeding after transjugular intrahepatic portosystemic shunt on liver-related death based on liver function categories 认领 引用
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作者 Jun-Yuan Zhu Jun Tie +18 位作者 Yi-Fu Xia Guang-Chuan Wang Yu-Zheng Zhuge Hao Wu Xiao-Li Zhu Hui Xue Jiao Xu Feng Zhang Lian-Hui Zhao Guang-Jun Huang Ming-Yan Zhang Zhen Li Bo Wei Pei-Jie Li Ze Wang Wei Wu Chao Chen Cheng-Wei Tang Chun-Qing Zhang 《World Journal of Gastroenterology》 SCIE CAS 2026年第17期44-55,共12页
BACKGROUND The effect of post-transjugular intrahepatic portosystemic shunt(TIPS)rebleeding on liver-related mortality remains uninvestigated.AIM To investigate the relationship between post-TIPS rebleeding and liver-... BACKGROUND The effect of post-transjugular intrahepatic portosystemic shunt(TIPS)rebleeding on liver-related mortality remains uninvestigated.AIM To investigate the relationship between post-TIPS rebleeding and liver-related mortality in patients with cirrhosis and to conduct subgroup analyses based on liver function.METHODS This study included 1782 patients who underwent covered TIPS at seven medical centers to prevent rebleeding.The primary endpoints were liver-related death and all-cause rebleeding.Propensity score matching,adjusted survival curves,and competing risk analyses based on liver transplantation and non-liver death were performed to ensure the robustness of the results.RESULTS During a median follow-up period of 32.25 months,346 patients(19.4%)developed post-TIPS rebleeding,and 429(24.1%)died from liver-related causes.Chronic HBV infection was the predominant cirrhosis etiology.Multivariable analysis identified older age,higher Child-Pugh and model for end-stage liver disease-Na scores,and post-TIPS rebleeding as independent predictive factors for liver-related mortality.Liver-related mortality increased by approximately 49.4%in the rebleeding group compared with the no-bleeding group.These findings remained consistent after propensity score matching,survival curve adjustment,and competing risk assessment.Similar findings were observed across different liver function subgroups.CONCLUSION Post-TIPS rebleeding was significantly associated with higher mortality in patients with cirrhosis and variceal bleeding irrespective of liver function category. 展开更多
关键词 Liver cirrhosis Portal hypertension Variceal rebleeding Mortality Transjugular intrahepatic portosystemic shunt
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Patterns and risk factors of early recurrence after radical resection for intrahepatic cholangiocarcinoma 认领 引用
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作者 Chen-Yang Zhou Jing-Yuan Chen +2 位作者 Dan Wang Shu Zhu Hong-Chang Luo 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第1期185-195,共11页
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)represents the second-most prevalent primary hepatic malignancy,demonstrating increasing worldwide occurrence.Although surgical methods have progressed,outcomes following... BACKGROUND Intrahepatic cholangiocarcinoma(ICC)represents the second-most prevalent primary hepatic malignancy,demonstrating increasing worldwide occurrence.Although surgical methods have progressed,outcomes following curative resection remain suboptimal due to substantial recurrence frequencies.Recurrence occurring early,usually during the initial postoperative year,indicates aggressive tumor characteristics and predicts inferior outcomes compared with delayed recurrence.Comprehending patterns and predictive indicators of early relapse is essential for refining postoperative monitoring approaches and directing adjuvant treatment choices.The present investigation concentrated on determining risk indicators and recurrence characteristics to enhance personalized patient management strategies for ICC.AIM To determine the characteristics and predictive indicators of early disease recurrence following curative surgical resection of ICC.METHODS We conducted a retrospective evaluation of 386 consecutive individuals who received curative surgical resection for ICC at our institution during the period spanning January 2017 through December 2021.Early disease recurrence was operationally defined as tumor relapse occurring within the first 12 postoperative months.Predictive indicators were examined through univariate and multivariate Cox proportional hazards regression analyses.RESULTS Within our cohort of 386 individuals,237 patients(61.4%)demonstrated disease recurrence throughout the observation period,with 178 cases(75.1%)manifesting early recurrence.The predominant anatomical locations of recurrent disease included hepatic tissue(66.7%),regional lymph nodes(18.1%),and peritoneal surfaces(8.0%).Independent predictive indicators of early recurrence encompassed:Neoplasm diameter exceeding 5 cm[hazard ratio(HR)=2.14,95%confidence interval(CI):1.52-3.01,P<0.001],presence of multiple tumor foci(HR=1.89,95%CI:1.34-2.67,P<0.001),metastatic lymph node involvement(HR=2.43,95%CI:1.71-3.45,P<0.001),microscopic vascular invasion(HR=1.76,95%CI:1.25-2.48,P=0.001),carbohydrate antigen 19-9 concentrations surpassing 200 U/mL(HR=1.92,95%CI:1.37-2.69,P<0.001),and incomplete surgical margins(HR=2.01,95%CI:1.38-2.93,P<0.001).Individuals experiencing early recurrence demonstrated markedly reduced overall survival relative to those with delayed recurrence(median:18.5 months vs 42.3 months,P<0.001).CONCLUSION Early disease recurrence following ICC resection occurs frequently and correlates with unfavorable clinical outcomes.Several neoplasm-associated and treatment-associated characteristics predict early relapse.These indicators can facilitate identification of patients at elevated risk who might benefit from intensive monitoring protocols or adjuvant therapeutic interventions. 展开更多
关键词 Intrahepatic cholangiocarcinoma Early recurrence Radical resection Risk factors Prognosis Survival
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Association of severe thrombocytopenia with prognosis following transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension 认领 引用
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作者 Liu Zhang Shi-Qi Xu +6 位作者 Yi-Jiang Zhu Li Dong Liang Yin Jin-Chang Xiao De-Lei Cheng Rui-Feng Wang Chun-Ze Zhou 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第7期102-114,共13页
BACKGROUND Cirrhotic portal hypertension(CPH)is frequently complicated by variceal bleeding and ascites,for which transjugular intrahepatic portosystemic shunt(TIPS)represents a key therapeutic intervention.Thrombocyt... BACKGROUND Cirrhotic portal hypertension(CPH)is frequently complicated by variceal bleeding and ascites,for which transjugular intrahepatic portosystemic shunt(TIPS)represents a key therapeutic intervention.Thrombocytopenia(TCP)is prevalent in these patients;however,the prognostic significance of severe TCP,defined as a platelet count<50×109/L,on TIPS outcomes remains unclear.AIM To evaluate the impact of severe TCP(platelet count<50×109/L)on mortality and bleeding risk following TIPS.METHODS This multicenter,retrospective cohort study included CPH patients who underwent TIPS between 2014 and 2023 and were stratified into non-severe and severe TCP groups.Overall survival(OS)served as the primary outcome.To reduce potential confounding,we conducted 1:1 propensity score matching(PSM).RESULTS A total of 434 patients were analyzed(131 with severe TCP and 303 with non-severe TCP).Prior to PSM,the severe TCP group had significantly worse 90-day[hazard ratio(HR)=2.65]and 1-year(HR=2.18)survival.After PSM(n=90 per group),however,no significant difference in survival was observed at any time point.Multivariate analysis further confirmed that severe TCP was not independently associated with OS after adjustment via PSM.Severe TCP was linked to a higher incidence of minor bleeding(47.1%vs 33.5%,P=0.026)but showed no association with moderate-to-severe or procedural bleeding.CONCLUSION Severe TCP is not an independent predictor of mortality after TIPS once liver disease severity is accounted for.Baseline liver dysfunction,not platelet count,is the principal determinant of post-TIPS survival.Clinicians should prioritize comprehensive assessment of liver function over platelet levels when evaluating prognosis in TIPS candidates. 展开更多
关键词 Thrombocytopenia Transjugular intrahepatic portosystemic shunt Portal hypertension Liver cirrhosis Prognosis
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Surgery-assisted transmesenteric transjugular intrahepatic portosystemic shunt for esophagogastric bleeding in patients with cavernous transformation of the portal vein 认领 引用
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作者 Si-Ze Wu Guang-Qing Liu 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第2期19-24,共6页
This editorial provides commentary on the study by Wu et al,which investigates a novel intervention for a challenging clinical scenario:Transjugular intrahepatic portosystemic shunt(TIPS)placement with the assistance ... This editorial provides commentary on the study by Wu et al,which investigates a novel intervention for a challenging clinical scenario:Transjugular intrahepatic portosystemic shunt(TIPS)placement with the assistance of surgery in patients with cavernous transformation of the portal vein.The authors compared surgically assisted TIPS(SATIPS)in 54 patients to endoscopic sclerotherapy in 53 patients.While 3-month survival rates were similar(94.4%vs 92.5%),a significant difference emerged at 6 months,with survival rates of 94.4%for SATIPS vs 73.6%for endoscope sclerotherapy.The SATIPS group also demonstrated significantly lower incidences of liver failure,esophagogastric bleeding,and hepatic encephalopathy at 6 months.However,the SATIPS procedure was not without risk,as four patients experienced major complications,including intraoperative hemorrhage.The study concludes that SATIPS is an effective alternative for cavernous transformation of the portal vein patients with esophagogastric bleeding,but its findings must be interpreted in light of its limitations.This research represents a significant contribution to the field. 展开更多
关键词 Portal hypertension Esophagogastric variceal bleeding Cavernous transformation of the portal vein Transjugular intrahepatic portosystemic shunt Abdominal surgery
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Impact of chronic proliferative cholangitis on stone recurrence and biliary strictures after intrahepatic stone treatment:A meta-analysis 认领 引用
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作者 Tauqeer Muhammad Ting-Ting He +6 位作者 Zhu-Ying Lin Jia-Lin Shi Tian-Gui Zhang Yao Yang Xiao-Lei Yang Hashim Nazir Chattha Jiang Li 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第3期315-326,共12页
BACKGROUND Intrahepatic bile duct stones often come back after treatment.One possible cause is chronic proliferative cholangitis(CPC).This is a long-term inflammation of the bile ducts that can cause scarring and narr... BACKGROUND Intrahepatic bile duct stones often come back after treatment.One possible cause is chronic proliferative cholangitis(CPC).This is a long-term inflammation of the bile ducts that can cause scarring and narrowing.This inflammation may remain even after stones are removed.Its effect on stone recurrence and bile duct narrowing is still unclear.We hypothesized that CPC increases the risk of stone recurrence and bile duct strictures after treatment.AIM To determine whether CPC is associated with stone recurrence and bile duct strictures after treatment.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.PubMed,Scopus,Web of Science,and ScienceDirect were searched for studies published from 2015 to 2025.Only observational studies in adults treated for intrahepatic bile duct stones were included.Two reviewers independently collected data.Pooled results were calculated using random-effects statistical models.RESULTS Six observational studies including 1248 patients were analyzed.Stone removal was successful in 91% of patients.Stone recurrence occurred in 21.5% of patients.Bile duct narrowing occurred in 18% of patients.Adverse events occurred in 12% of patients.Studies reporting chronic bile duct inflammation showed higher rates of stone recurrence and bile duct narrowing.Differences between studies were moderate.CONCLUSION Stone removal is effective,but stones and bile duct narrowing often return,especially with chronic bile duct inflammation.Treating inflammation may help improve long-term results. 展开更多
关键词 Hepatolithiasis Chronic proliferative cholangitis Stone recurrence Biliary stricture Intrahepatic bile duct stones Systematic review Meta-analysis
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Spleen stiffness accurately tracks early and sustained portal pressure changes after transjugular intrahepatic portosystemic shunt 认领 引用
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作者 Rui-Quan Zhou Pei-Jun Yang +3 位作者 Li-Guo Liu Jian-Bin Zhang Zhi-Dong Ye Hai-Dong Tan 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第5期253-263,共11页
BACKGROUND Clinically significant portal hypertension(CSPH)drives major complications in cirrhosis.While hepatic venous pressure gradient is the gold standard for CSPH diagnosis,its invasiveness limits routine use.Liv... BACKGROUND Clinically significant portal hypertension(CSPH)drives major complications in cirrhosis.While hepatic venous pressure gradient is the gold standard for CSPH diagnosis,its invasiveness limits routine use.Liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)offer non-invasive alternatives,but their utility in tracking transjugular intrahepatic portosystemic shunt(TIPS)-induced hemodynamic changes remains unclear.AIM To assess the correlation of LSM/SSM with baseline portocaval pressure gradient(PPG)andΔPPG,and to evalutate their predictive value for hemodynamic success(post-PPG≤10 mmHg).METHODS We retrospectively analyzed 39 patients underwent TIPS.LSM and SSM were measured via vibration-controlled transient elastography pre-and post-TIPS.PPG was recorded invasively during the procedure.Correlations between stiffness parameters and PPG were assessed using Spearman’s test;diagnostic performance was evaluated by receiver operating characteristic analysis.RESULTS PPG dropped from 17.6±4.1 mmHg to 7.0±2.3 mmHg(P<0.001).SSM decreased significantly(61.7±17.1 kPa to 26.9±11.6 kPa;P<0.001)and correlated with baseline PPG(r=0.41,P<0.001)and ΔPPG(r=-0.57,P<0.001).LSM showed no significant correlation with PPG orΔPPG.None of the stiffness metrics reliably predicted successful TIPS response(all area under the curve<0.7).CONCLUSION SSM dynamically reflects TIPS-induced portal pressure changes,outperforming LSM as a non-invasive marker.Despite limited predictive value here(small cohort,etiological heterogeneity),it remains valuable for TIPS monitoring when invasive measures are impractical. 展开更多
关键词 Portal hypertension Transjugular intrahepatic portosystemic shunt Spleen stiffness measurement Liver stiffness measurement Clinically significant portal hypertension Vibration-controlled transient elastography
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Letter to the Editor:Hemodynamic role in hepatic encephalopathy pathogenesis following transjugular intrahepatic portosystemic shunt placement 认领 引用
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作者 John Halphen Jr Yash S Dayal +3 位作者 Cameron Laurie Mohadese Ahmadzade David Wynne Mohammad Ghasemi-Rad 《World Journal of Radiology》 2026年第6期86-90,共5页
Hepatic encephalopathy(HE)is a common complication following transjugular intrahepatic portosystemic shunt(TIPS)placement and is thought to result from reduced hepatic detoxification of neurotoxins.However,Zhuang et a... Hepatic encephalopathy(HE)is a common complication following transjugular intrahepatic portosystemic shunt(TIPS)placement and is thought to result from reduced hepatic detoxification of neurotoxins.However,Zhuang et al in the World Journal of Radiology demonstrate that this understanding may be incomplete through exploration of the pathophysiology from a hemodynamic perspective.They found significant changes in cerebral blood flow(CBF)and spontaneous brain activity following TIPS.Initially,CBF increased in specific areas within the first month,followed by a return to baseline at three months.These CBF changes coincided with increased spontaneous brain activity that persisted in some areas,suggesting compensation for functional loss in other regions.Together with the fact that serum ammonia remained unchanged in this cohort and prior work showing that,after three months,HE risk returns to pre-TIPS levels,these results suggest that HE may develop in individuals susceptible to these hemodynamic and adaptive changes,warranting further research. 展开更多
关键词 Arterial spin labeling Cerebral blood flow Hemodynamics Hepatic encephalopathy Digit symbol substitution test Resting-state functional magnetic resonance imaging Transjugular intrahepatic portosystemic shunt
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Preoperative prediction of textbook outcome in intrahepatic cholangiocarcinoma by interpretable machine learning: A multicenter cohort study 认领 引用 被引量：6
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作者 Ting-Feng Huang Cong Luo +9 位作者 Luo-Bin Guo Hong-Zhi Liu Jiang-Tao Li Qi-Zhu Lin Rui-Lin Fan Wei-Ping Zhou Jing-Dong Li Ke-Can Lin Shi-Chuan Tang Yong-Yi Zeng 《World Journal of Gastroenterology》 SCIE CAS 2025年第11期33-45,共13页
BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperat... BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability. 展开更多
关键词 Intrahepatic cholangiocarcinoma Textbook outcome Interpretable machine learning Prediction Prognosis
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Conversion treatment for advanced intrahepatic cholangiocarcinoma:Opportunities and challenges 认领 引用 被引量：3
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作者 Jun-Jie Liu Mi Zhou +2 位作者 Tong Yuan Zhi-Yong Huang Zun-Yi Zhang 《World Journal of Gastroenterology》 SCIE CAS 2025年第15期24-41,共18页
The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the p... The prevalence of intrahepatic cholangiocarcinoma(ICC)is increasing globally.Despite advancements in comprehending this intricate malignancy and formulating novel therapeutic approaches over the past few decades,the prognosis for ICC remains poor.Owing to the high degree of malignancy and insidious onset of ICC,numerous cases are detected at intermediate or advanced stages of the disease,hence eliminating the chance for surgical intervention.Moreover,because of the highly invasive characteristics of ICC,recurrence and metastasis postresection are prevalent,leading to a 5-year survival rate of only 20%-35%following surgery.In the past decade,different methods of treatment have been investigated,including transarterial chemoembolization,transarterial radioembolization,radiotherapy,systemic therapy,and combination therapies.For certain patients with advanced ICC,conversion treatment may be utilized to facilitate surgical resection and manage disease progression.This review summarizes the definition of downstaging conversion treatment and presents the clinical experience and evidence concerning conversion treatment for advanced ICC. 展开更多
关键词 Intrahepatic cholangiocarcinoma Conversion treatment Downstaging Combination therapy Chemotherapy Immunotherapy Locoregional therapies
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Clinical efficacy of surgically assisted transjugular intrahepatic portosystemic shunt for cavernous transformation of portal vein 认领 引用 被引量：2
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作者 Yi-Fan Wu Zhen-Dong Yue +9 位作者 Zhen-Hua Fan Cheng-Bin Dong Yu Zhang Qi-Mei Li Dong-Fang Liu Guang-Zhong Xu De-Zhong Wang Hai-Ming Zhao Zhi-Ping Wu Lei Wang 《World Journal of Gastroenterology》 SCIE CAS 2025年第27期57-65,共9页
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assiste... BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival. 展开更多
关键词 Surgically assisted transjugular intrahepatic portosystemic shunt Cavernous transformation of portal vein Esophagogastric variceal bleeding Portal hypertension Portal vein thrombosis
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Cardiovascular risk assessment and predictors of cardiac decompensation after transjugular intrahepatic portosystemic shunt in patients with cirrhosis 认领 引用
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作者 Davide R Tomassoni Tamar Schildkraut +2 位作者 Vivekananda Ramachandran Jennifer C Cooke Rohit Sawhney 《World Journal of Gastroenterology》 SCIE CAS 2025年第27期146-167,共22页
BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est... BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation. 展开更多
关键词 Portal hypertension Transjugular intrahepatic portosystemic shunt Pre-emptive transjugular intrahepatic portosystemic shunt Diastolic dysfunction N-terminal pro-B-type natriuretic peptide Echocardiography Left atrial strain Multidisciplinary team Risk stratification Heart failure
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