The term acute liver failure (ALF) refers to the acute (<26 weeks) and severe worsening in liver function associated with encephalopathy in a person with no underlying chronic liver disease. ALF constitutes a critical clinical syndrome that is potentially reversible but has a very variable prognosis. No specific treatment is available, and liver transplantation (LT) is the treatment of choice in many cases. However, the challenge remains of identifying those patients with a poor likelihood of spontaneous recovery of liver function and for whom the indication and time of LT in order to guarantee survival (based on identification of prognostic factors) need to be established. In Europe, 8% of LT are due to ALF. Although the results of LT due to ALF have improved over recent years, they are still far from those seen after elective LT.
Part of the book: Liver Research and Clinical Management
Postsurgical benign colorectal strictures occur in up to 20% of patients who undergo colon or rectal resection. Traditionally, treatment has been surgical, but recent decades have seen the growing importance of an endoscopic approach, particularly balloon dilatation, which is now considered the first-line treatment for these benign strictures. However, balloon dilatation is associated with a recurrence of the stricture in up to 25% of cases. When this arises, one can opt for surgery aimed at performing a reanastomosis; a new intestinal anastomosis may be technically complex or even impossible, which would result in the patient requiring a permanent colostomy, with its consequent negative impact on quality of life. Accordingly, different endoscopic approaches have been evaluated for strictures refractory to balloon dilatation, such as the implant of self-expanding metallic stents, biodegradable stents, or incisional therapy, with variable results in efficacy.
Part of the book: Endoscopy