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Liver Update: WGO recommendations about chronic liver disease (CLD) patients during COVID-19

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eMediNexus    16 June 2021

Patients with stable, compensated liver diseases should postpone medical visits and routine labs or should be encouraged for telemedicine or phone visits.

  • Telemedicine or phone visits are not feasible in low-income countries. Outpatient visits may be used to distinguish patients with compensated and decompensated liver disease. 
  • Outpatient visits should be restricted to those with high MELD scores.
  • In persons with decompensated cirrhosis who have, complications such as ascites management may need laboratory monitoring.
  • Telemedicine approaches should consider patients with alcohol use disorder and such patients should be approached. 
  • Routine prescriptions should be sent by mail and should be given to cover extended durations. 
  • Treatment of severe alcoholic hepatitis with corticosteroids should be customized, liberal use of high dose steroids should be avoided, and whenever possible patients should be hospitalized. 
  • Liver biopsies should be restricted in unavoidable cases to make a conclusive diagnosis.
  • Hospitalizations should be as short as possible, preferably in private rooms. Keep doors closed and windows open and limit medical and nursing staff.
  • Phone communication and tele-medicine is encouraged; restrict imaging exams to cases where it can change management.
  • SARS-CoV-2 testing should be done in patients with acute decompensation of CLD, or acute on chronic liver failure.
  • WGO recommendations about performing procedures during COVID 19
  • Interventional procedures, such as endoscopy and endoscopic retrograde cholangiopancreatography (ERCP), should not be performed in patients with CLD unless in  cases with high risk varices or cholangitis. 
  • Pure screening of gastric and esophageal varices in patients with stable cirrhosis should be rescheduled. 
  • Endoscopy should always be done using appropriate personal protective equipment (PPE). 
  • Equipment and the endoscopy room should be properly disinfected, minimize exposure in waiting and recovery areas and triage patients at entry, using well-trained staff. 
  • Doctors should screen all patients undergoing endoscopy using a rapid COVID-19 test prior to the procedure.
  • Transjugular intrahepatic portosystemic shunt (TIPS) insertion should only be performed in life-threatening cases of refractory variceal bleeding.

Source: WGO GUIDANCE FOR PATIENTS WITH COVID-19 and LIVER DISEASE. Available at: https://www.worldgastroenterology.org/UserFiles/file/COVID19/WGO_200601_DACYKBNRDVLBMMCleanCOVID19andLiverDisease.pdf?utm_source=WGO%20Website&utm_medium=Website&utm_campaign=COVID19Informationwebpage_COVID19_Management_LiverDisease

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