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In addition to the management of patients with cirrhosis, alcohol-related liver diseases, fatty liver, autoimmune conditions, biliary conditions, metabolic liver disease and cancers of the liver, gallbladder or pancreas there are areas of additional expertise in the following:
We are a major centre for treatment for primary liver cancer offering a range of non-surgical treatments including transarterial chemoembolization (TACE), microwave ablation, immunotherapy and chemotherapy. We have a weekly upper gastrointestinal cancer and monthly specialist liver cancer multidisciplinary meeting in which patients are discussed in depth. We also have strong links with King’s College Hospital for consideration of liver radiotherapy and liver surgery including resection and transplantation.
We are regional hub treating patients with viral hepatitis B and C infections, including providing highly effective direct acting antiviral medication for hepatitis C. The service is consultant-led in conjunction with clinical nurse specialists and specialist senior pharmacists. There are weekly multidisciplinary meetings to optimise treatment plans for patients. There is an active community screening programme.
Local Alcohol Prevention Service
We have a team of alcohol nurses, an alcohol clinical specialist nurse and lead consultant who work together to help patients who want to reduce their alcohol intake and support those that have given up entirely. This work involves work within the hospital and community alcohol services.
Cirrhosis Multidisciplinary Meeting
We conduct a monthly meeting involving liver consultants, a palliative care consultant, specialist nurses and pharmacists in which we discuss the care of patients with advanced cirrhosis (extensive scarring of the liver) including medical treatment, interventional treatment options, transplant candidacy and advanced care planning. Cases are selected by consultants and we do also discuss patients being treated in other South West London hospitals on the request of their treating physician.
Management of Portal Hypertension
We offer a range of service for patients with varices related to portal hypertension including a dedicated variceal screening and treatment endoscopy list, radiological portal pressure measurement and expertise in transjugular intrahepatic portosystemic shunts (TIPSS). For patients with ascites (abdominal fluid) related to portal hypertension, we offer an abdominal paracentesis (drainage) service, and can offer TIPSS or long-term abdominal drains in selected cases.
The endoscopy unit at St George’s Hospital offers both endoscopic ultrasound scanning (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) to aid in the diagnosis, management and treatment of patients with pancreatic and hepatobiliary disease. There is a very close working relationship with the radiology department and our interventional radiology consultant colleagues with two weekly meetings being held to discuss patients with both cancer and non-cancer related illnesses.