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Surgical resection is considered as the gold standard treatment of hepatic malignancy. The majority of primary and metastatic tumors of the liver are not treated by surgical excision in the case of poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been used to treat liver tumors. Radiofrequency ablation has recently been accepted as a new modality for local tumor destruction, especially for tumor larger than 3 cm. The biliary system related complications after radiofrequency ablation is rarely reported. Recently, we experienced a case of biliary fistula developed after radiofrequency ablation therapy for a hepatocellular carcinoma. The case was treated by endoscopic retrograde biliary stent insertion. We report the case of biliary fistula developed after radiofrequency ablation therapy with a brief review of related literature.
Nonalcoholic fatty liver disease (NAFLD) is an increasingly common cause of chronic liver disease in Korea and it is associated with increased liver-related mortality and hepatocellular carcinoma. But the natural history of NAFLD remains unclear. The prognosis of NAFLD depends on the histological subtype. The more than 60% patients had disease remission or remained the same. The weight reduction was a predictor. Diet and lifestyle modification remain the mainstay of treatment. At present there are no approved therapies. For patients with NASH(Nonalcoholic steatohepatitis) and advanced fibrosis, current liver-directed pharmacotherapy with vitamin E and pioglitazone offer some benefits in selected cases. However, the beneficial effects of these therapies must be balanced with the potential adverse effects, limiting their widespread use. Coexisting comorbidity must be diagnosed and treated because cardiovascular disease remains primary cause of death in these patients. The new agents currently in trial provide the first hope of effective, targeted pharmacotherapy in this field.