Hepatology (Liver Medicine)

Aintree University Hospital hosts the regional medical hepatobiliary service. As a part of this, we have an established hepatobiliary endoscopy service comprising endoscopic ultrasound (EUS), endoscopic retrograde cholangiography and pancreatography (ERCP) and complex ERCP.

The tertiary (specialist) ERCP performed at Aintree includes all treatments for proximal or peri-hilar disease (often cholangiocarcinoma) as well as a well-established cholangioscopy service using SpyGlass cholangioscopy for both evaluation and diagnosis of strictures, and management of complex biliary stones (gallstones) unable to be removed using conventional techniques.

We can combine EUS guided bile duct punctures for biliary access where conventional cannulation is not possible, and with interventional radiology supported techniques in combination with our experienced and expert interventional radiologists.

If a patient is jaundiced with a proximal obstruction, we will arrange to bring the patient over to Aintree as an inpatient for the appropriate care, whilst also planning their forward management within the wider primary liver multi-disciplinary team. Tertiary ERCPs are either performed following transfer of patients or as a ‘treat and transfer’ case on a given day.

Aintree hepatology hosts the regional Hepatocellular Carcinoma (HCC) service for Cheshire, Merseyside, North Wales and the Isle of Man as well as parts of Lancashire. 

We have a weekly multi-disciplinary team (MDT) meeting, and will see new referrals the following week to discuss treatment options. 

We can offer all available treatments for HCC within Liverpool other than liver transplant, but link in with the transplant unit at Birmingham to include liver transplantation. As a regional cancer service, the MDT includes colleagues from across the Trust, as well as the Clatterbridge Cancer Centre.

The HCC treatments available in Liverpool include:

• Liver resection for HCC
• Percutaneous ablation (microwave, radiofrequency or ethanol injection)
• Trans-Arterial ChemoEmbolization (TACE)
• Stereotactic Ablative Body Radiotherapy (SABR)
• Selective Internal Radiation Therapy (SIRT)
• Systemic therapies (including Immunotherapies)

We have a very close working relationship with the liver transplant unit in Birmingham, and have a dedicated liver transplant clinic run by our transplant trained hepatologists to support patients in the lead up to a liver transplant, and for follow up post liver transplant.

We oversee the medications required for anti-rejection purposes and blood monitoring, as well as looking out for complications of the transplant.

Patients can be referred to Hepatology via:

• Primary care (GPs) 
• Following a hospital admission
• From other specialist doctors within the hospital.

In addition to this, we receive referrals from other NHS services around the region, as we are a core part of the liver cancer service for Cheshire and Merseyside (including North Wales and the Isle of Man).

• British Liver Trust - Pioneering Liver Health
• Haemochromatosis UK
• Hepatitis C Trust
• Liver Cancer UK
• AIH Support (Autoimmune hepatitis)
• PBC Foundation (Primary Biliary Cholangitis)
• PSC Support (Primary Sclerosing Cholangitis)

The Aintree hepatology service has an active research portfolio. We are currently, or have recently, recruited to clinical trials for several liver diseases including: 

• Non-alcoholic fatty liver disease 
• Hepatocellular Carcinoma 
• Cholangiocarcinoma 
• Alcoholic liver disease 
• Alcoholic hepatitis 
• Primary Sclerosing Cholangitis 
• Primary Biliary Cholangitis 
• Decompensated Cirrhosis.

Non-Alcoholic Fatty Liver Disease (NAFLD) Research / Services

Dr Theresa Hydes and Prof Daniel Cuthbertson are leading on several original research studies for NAFLD based between the University of Liverpool (Department of Cardiovascular and Metabolic Medicine) and Aintree University Hospital. 

We have an active Patient and Public Involvement and Engagement (PPIE) group for NAFLD research. This group has help informed research priorities and advised on research design. If you would like to be involved, please email liverppi@liverpoolft.nhs.uk.

Active studies

• Patient Preferences for NAFLD care: Recruiting people with NAFLD, or at risk of NAFLD to undertake in-depth discussions regarding preferences for NAFLD care. For more information, click here or email: nafldpp@liverpool.ac.uk
• CALIBRATE (MetaboliC, multi-orgAn and microvascular effects of a Low-calorIe diet in younger oBese with pRediabetEs and/or metabolic syndrome): Recruiting people 18-55 years, with obesity plus pre-diabetes / NAFLD / metabolic syndrome to receive a low-calorie diet or standard care. For more information, email: calibr8@liverpool.ac.uk 
• Kirkby Metabolic Liver Clinic: In partnership with Millbrook Medical Centre, we have established a community based metabolic liver clinic where patients can undergo screening for NAFLD and received a management for cardiometabolic multimorbidity.