Managing Liver Cirrhosis: a Multidisciplinary Approach

Abstract

Aim . Analysis of the experience of managing patients with liver cirrhosis (LC) at the Regional Clinical Hospital No. 2 of the Ministry of Health of Krasnodar Krai. Materials and methods . In this retrospective study, we assessed data on routine outpatient monitoring of 832 patients with LC and oesophageal varices by the outpatient and inpatient services of the Regional Clinical Hospital No. 2 during 2009-2019. Results . Endoscopic oesophageal variceal ligation was performed in 832 patients, with total 1149 surgeries and 1 to 8 banding repeats per individual. Transjugular intrahepatic portosystemic shunting (TIPS) was implemented in 2014 and performed 51 times in 5 years, coupled in 20 patients with simultaneous gastric variceal embolisation. Oesophageal variceal ligation preceded TIPS in 34 (66.7 %) patients; 62 patients were included in the liver transplant waiting list. Among 17 liver transplant patients, 6 had oesophageal variceal bleeding in history. Endoscopic ligation was performed in 5, and TIPS — in 3 patients awaiting a transplant. Successful adoption of health telecom technologies in Krasnodar Krai renders high-quality specialised medical aid publically accessible, also in remote regions. Conclusion . A model is presented for providing high-tech specialised assistance to LC patients, which engages a surgeon, a gastroenterologist, an endoscopist, an X-ray physician, an endovascular surgeon and an infectionist. A resident physician should coordinate the multidisciplinary team at the outpatient stage, and a surgeon — upon the patient's admission in case of surgical LC complications.