EASL clinical practice guidelines for the management of occupational liver diseases

Abstract

The Clinical Practice Guidelines (CPG) on Occupational Liver Diseases (OLD) of the European Association for the Study of the Liver (EASL) have been developed to increase awareness, recognition and improve management of patients with OLD. Indeed, although workplace exposure has been associated with virtually the entire spectrum of acute and chronic liver diseases, data on the epidemiology of OLD are scarce. These diseases may be a result of high‐level accidental exposure or prolonged lower level exposure to a variety of chemicals including solvents, pesticides, metals and other agents. While acute liver diseases related to OLD are uncommon and easily recognized, chronic liver diseases are relatively more frequent but often overlooked because of their asymptomatic course and an insidious onset which is often accompanied by comorbidities. Because of the absence of data in observational studies and meta‐analyses or systematic reviews, the evidence and recommendations in these guidelines have been graded according to the Oxford Centre for Evidence‐based Medicine, which assesses evidence according to diagnostic, prevalence, aetiological, prognostic or preventive categories. They can still generate grades of recommendation even when the evidence is inconclusive.

Change in the Recurrence Pattern and Predictors over Time after Complete Cure of Hepatocellular Carcinoma

“… 1 In patients with Barcelona Clinic Liver Cancer (BCLC) stage A HCC, surgical resection or radiofrequency ablation (RFA) are usually recommended. 2 - 4 Though median survival reaches 50% to 70% at 5 years after curative treatment, recurrence rate is still high. 5 - 7 Because recurrence is the main cause of mortality in HCC patients, 8 , 9 identification of recurrence patterns and predictive factors is crucial.…”

An Optimal Ablative Margin of Small Single Hepatocellular Carcinoma Treated with Image-Guided Percutaneous Thermal Ablation and Local Recurrence Prediction Base on the Ablative Margin: A Multicenter Study

“…HCC was diagnosed by either imaging or histological evaluation based on the European Association of the Study of the Liver (EASL) and the American Association for the Study of Liver Disease (AASLD) guidelines. 22,23 Details of patient recruitment and grouping method are outlined in Supplementary Methods 1.1. (sFigure 1) shows the patient enrollment pathway.…”

Detection of hepatocellular carcinoma in a population at risk: iodine-enhanced multidetector CT and/or gadoxetic acid-enhanced 3.0 T MRI

“…3 The current guidelines are recommending contrast-enhanced CT and/or contrast-enhanced MRI for the detection of hepatocellular carcinoma. [4][5][6][7][8][9][10] These guidelines are also recommending fetoprotein measurements and ultrasound diagnosis every 6 months in high-risk patients. 11 However, diagnosis of hepatocellular carcinoma according to these guidelines may possess false-negative and false-positive results, 12 which are overcome by alternative imaging methods using contrast agents 13 and/or biopsies.…”

“… 11 However, diagnosis of hepatocellular carcinoma according to these guidelines may possess false-negative and false-positive results, 12 which are overcome by alternative imaging methods using contrast agents 13 and/or biopsies. 4 5 9 CT and MRI methods of diagnosis of hepatocellular carcinoma are costly. 12 In contrast, contrast-enhanced ultrasound is cost-effective.…”

“…MRI facilitates the decision of treatment in hepatocellular carcinoma 3. The current guidelines are recommending contrast-enhanced CT and/or contrast-enhanced MRI for the detection of hepatocellular carcinoma 4–10. These guidelines are also recommending fetoprotein measurements and ultrasound diagnosis every 6 months in high-risk patients 11.…”