Budd-Chiari syndrome is defined as hepatic venous outflow obstruction or stenosis, resulting in portal hypertension from congestive liver failure. We present our original surgical procedures and results in 71 consecutive Budd-Chiari syndrome patients treated at our institution. Operative procedures: The patients were placed in the left lateral position under unilateral ventilation and then the lateral site of the hepatic inferior vena cava and the right atrium were exposed by dividing the 1/3 lateral site of diaphragm circularly via right 6th intercostal thoracotomy and upper median laparotomy. After partial cardiopulmonary bypass via the right femoral artery and venous cannulation, the hepatic inferior vena cava was clamped and incised longitudinally. Our procedure involves autologous pericardium patch augmentation of the stenosed or obstructed hepatic inferior vena cava and re-open as many occluded hepatic veins as possible by a resecting venous wall including liver parenchyma, resulting in normal hepatic circulation. There are two (2.8%) perioperative death from liver failure and arrhythmia. During mean follow up period of 9.7 (0.04-29.8) years, 1-, 5- and 10-year mortality were 95.6%, 88.3% and 71.7%, respectively. Our corrective procedures for Budd-Chiari syndrome might have long-term survival and recovery in hepatic functions.

Aim: To clarify the significance of nutrition therapy in patients with chronic liver diseases based on the relation between the extent of sarcopenia and daily protein intakes.

Methods: Subjects were 122 Japanese patients with chronic liver diseases consisting of 37 patients with sarcopenia and 85 patients without sarcopenia. Percentages of patients taking foods containing protein of the recommended amount or more were compared between those with and without sarcopenia.

Results: Daily volume of protein intakes (mean ± SD) were 47.4 ± 13.0 g and 54.4 ± 16.2 g in patients with sarcopenia and in those without sarcopenia, respectively. Daily protein intakes of the recommended amounts or more were achieved in 10 patients with sarcopenia, while in 47 patients without sarcopenia. Thus, percentages of patients taking foods containing sufficient protein were significantly lower in the former patients than in the latter patients (27.0% vs. 47.1%, P＝0.0386).

Conclusions: Nutrition therapy is required for patients with chronic liver diseases manifesting sarcopenia, since daily protein intakes were insufficient in these patients.

Balloon occluded retrograde transvenous obliteration (BRTO) is effective for porto-systemic shunt hepatic encephalopathy (PSHE), although some patients have refractory to BRTO. We investigate the usefulness of BRTO for patients with PSHE. Nineteen patients with liver cirrhotic and PSHE were divided in two groups, group NE (recurred PSHE within 12 weeks after BRTO: n＝6) and group E (did not recur PSHE within 12 weeks: n＝13). We analyzed Child-Pugh score (CPS), serum ammonia (NH₃), hepatic venous pressure gradient (HVPG) and skeletal muscle index (SMI). In group NE, HVPG was higher and SMI was lower significantly than group E. The patients HVPG over 12 mmHg tended early recur of PSHE compared with less 12 mmHg. The diagnostic capability for predicting therapeutic effectiveness of HVPG and SMI were satisfactory with area under the receiver operating characteristic curve (AUROC) of 0.91 (p＜0.001, 95%CI＝0.77-1.04), 0.84 (p＜0.001, 95%CI＝0.65-1.03). HVPG and SMI before BRTO might be useful factor for prediction of therapeutic effect.

Long-term outcome of patients receiving endoscopic injection sclerotherapy combined with ligation (EISL) for esophageal varices was evaluated. One hundred three patients receiving EISL monotherapy were enrolled, and endoscopic recurrence rates defined as positive red-color sign (RCS) and/or large varices formation, hemorrhage recurrence rate, complications and hospital stay duration were compared between patients aged 65 years old or more and the remaining patients. Factors contributing both endoscopic and hemorrhage recurrence were also examined. The endoscopic recurrence rates define as positive RCS and large varices formation were 62% and 26%, respectively, and the hemorrhagic recurrence rate was 19.2%. Baseline positive RCS was a factor contributing endoscopic recurrence defined as positive RCS following EISL therapy. Female was a factor associated with the endoscopic recurrence defined as large varices formation. Factors contributing hemorrhagic recurrence were female and RCS recurrence. No serious adverse events were observed, and the average hospital stay duration (±SD) was 16.3 days (±6). No difference was observed between the elderly and non-elderly patients in each evaluation. Although endoscopic and hemorrhage recurrence occurred frequently after EISL monotherapy, EISL monotherapy merits consideration especially for patients with esophageal varices negative for RCS at baseline.