Bio

Clinical Focus


  • Acute Pancreatitis
  • Cancer > GI Oncology
  • Early Detection of Pancreatic Cancer
  • Pancreatic Cyst
  • Chronic Pancreatitis
  • Gastroenterology

Academic Appointments


Administrative Appointments


  • Medical Director, Pancreas Clinic, Stanford Hospital & Clinics (2012 - Present)

Boards, Advisory Committees, Professional Organizations


  • Member, Health & Public Policy Committee, American Society for Gastrointestinal Endoscopy (2009 - Present)
  • Member, Quality Assurance Committee, American Society for Gastrointestinal Endoscopy (2009 - Present)
  • Member, American Society for Gastrointestinal Endoscopy (2006 - Present)
  • Member, American Gastroenterological Association (2006 - Present)
  • Member, American College of Gastroenterology (2006 - Present)
  • Member, American Pancreatic Association (2008 - Present)

Professional Education


  • Residency:Stanford University Hospital -Internal Medicine Residency Training Program (2006) CA
  • Fellowship:Stanford Hospital and Clinics (2009) CA
  • Board Certification: Gastroenterology, American Board of Internal Medicine (2009)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2006)
  • Medical Education:Johns Hopkins University School of Medicine (2003) MD

Research & Scholarship

Current Research and Scholarly Interests


Dr. Park's research interests are in the diagnosis and management of pancreatic cysts, acute and chronic pancreatitis. His approach incorporates methods in health services research including the use of observational datasets, cost-effectiveness studies, and the development of clinical cohorts.

Publications

Journal Articles


  • Gastrointestinal stromal tumor: an unusual cause of gastrointestinal bleeding. Digestive diseases and sciences Wong, R. J., Longacre, T. A., Poultsides, G., Park, W., Rothenberg, M. E. 2013; 58 (11): 3112-3116

    View details for DOI 10.1007/s10620-013-2678-x

    View details for PubMedID 23633157

  • Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: glucose and kynurenine GASTROINTESTINAL ENDOSCOPY Park, W. G., Wu, M., Bowen, R., Zheng, M., Fitch, W. L., Pai, R. K., Wodziak, D., Visser, B. C., Poultsides, G. A., Norton, J. A., Banerjee, S., Chen, A. M., Friedland, S., Scott, B. A., Pasricha, P. J., Lowe, A. W., Peltz, G. 2013; 78 (2): 295-?

    Abstract

    BACKGROUND: Better pancreatic cyst fluid biomarkers are needed. OBJECTIVE: To determine whether metabolomic profiling of pancreatic cyst fluid would yield clinically useful cyst fluid biomarkers. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: Two independent cohorts of patients (n = 26 and n = 19) with histologically defined pancreatic cysts. INTERVENTION: Exploratory analysis for differentially expressed metabolites between (1) nonmucinous and mucinous cysts and (2) malignant and premalignant cysts was performed in the first cohort. With the second cohort, a validation analysis of promising identified metabolites was performed. MAIN OUTCOME MEASUREMENTS: Identification of differentially expressed metabolites between clinically relevant cyst categories and their diagnostic performance (receiver operating characteristic [ROC] curve). RESULTS: Two metabolites had diagnostic significance-glucose and kynurenine. Metabolomic abundances for both were significantly lower in mucinous cysts compared with nonmucinous cysts in both cohorts (glucose first cohort P = .002, validation P = .006; and kynurenine first cohort P = .002, validation P = .002). The ROC curve for glucose was 0.92 (95% confidence interval [CI], 0.81-1.00) and 0.88 (95% CI, 0.72-1.00) in the first and validation cohorts, respectively. The ROC for kynurenine was 0.94 (95% CI, 0.81-1.00) and 0.92 (95% CI, 0.76-1.00) in the first and validation cohorts, respectively. Neither could differentiate premalignant from malignant cysts. Glucose and kynurenine levels were significantly elevated for serous cystadenomas in both cohorts. LIMITATIONS: Small sample sizes. CONCLUSION: Metabolomic profiling identified glucose and kynurenine to have potential clinical utility for differentiating mucinous from nonmucinous pancreatic cysts. These markers also may diagnose serous cystadenomas.

    View details for DOI 10.1016/j.gie.2013.02.037

    View details for Web of Science ID 000321825200015

    View details for PubMedID 23566642

  • The Epidemiology of Idiopathic Acute Pancreatitis, Analysis of the Nationwide Inpatient Sample From 1998 to 2007 PANCREAS Chen, Y., Zak, Y., Hernandez-Boussard, T., Park, W., Visser, B. C. 2013; 42 (1): 1-5

    Abstract

    The study aimed to better define the epidemiology of idiopathic acute pancreatitis (IAP).We identified admissions with primary diagnosis of acute pancreatitis (AP) in Nationwide Inpatient Sample between 1998 and 2007. Idiopathic AP was defined as all cases after excluding International Classification of Diseases, Ninth Revision, codes for other causes of AP (including biliary, alcoholic, trauma, iatrogenic, hyperparathyroidism, hyperlipidemia, etc).Among the primary admissions for AP, 26.9% had biliary pancreatitis, 25.1% alcoholic, and 36.5% idiopathic. Idiopathic AP had estimated 81,8025 admissions with a mean hospitalization of 5.6 days. Patients with IAP accounted for almost half of the fatalities among the cases of AP (48.2%) and had a higher mortality rate than both patients with biliary pancreatitis and patients with alcoholic pancreatitis (1.9%, 1.5%, and 1.0%, respectively, P < 0.01). Forty-six percent of patients with biliary pancreatitis underwent cholecystectomy during the index hospitalization, compared with 0.42% of patients with IAP. Patients with IAP had a demographic distribution similar to that of patients with biliary AP (female predominant and older), which was distinct from patients with alcoholic pancreatitis (male predominant and younger). There was a gradual but steady decrease in the incidence of IAP, from 41% in 1998 to 30% in 2007.Despite improving diagnostics, IAP remains a common clinical problem with a significant mortality. Standardization of the clinical management of these patients warrants further investigation.

    View details for DOI 10.1097/MPA.0b013e3182572d3a

    View details for Web of Science ID 000312560200001

    View details for PubMedID 22750972

  • How to Value Technological Innovation: A Proposal for Determining Relative Clinical Value GASTROENTEROLOGY Ladabaum, U., Brill, J. V., Sonnenberg, A., Shaheen, N. J., Inadomi, J., Wilcox, C. M., Park, W. G., Hur, C., Pasricha, P. J. 2013; 144 (1): 5-8

    View details for DOI 10.1053/j.gastro.2012.11.006

    View details for Web of Science ID 000312965100010

    View details for PubMedID 23153872

  • Pancreatic Neuroendocrine Tumors: Radiographic Calcifications Correlate with Grade and Metastasis ANNALS OF SURGICAL ONCOLOGY Poultsides, G. A., Huang, L. C., Chen, Y., Visser, B. C., Pai, R. K., Jeffrey, R. B., Park, W. G., Chen, A. M., Kunz, P. L., Fisher, G. A., Norton, J. A. 2012; 19 (7): 2295-2303

    Abstract

    Studies to identify preoperative prognostic variables for pancreatic neuroendocrine tumor (PNET) have been inconclusive. Specifically, the prevalence and prognostic significance of radiographic calcifications in these tumors remains unclear.From 1998 to 2009, a total of 110 patients with well-differentiated PNET underwent surgical resection at our institution. Synchronous liver metastases present in 31 patients (28%) were addressed surgically with curative intent. Patients with high-grade PNET were excluded. The presence of calcifications in the primary tumor on preoperative computed tomography was recorded and correlated with clinicopathologic variables and overall survival.Calcifications were present in 16% of patients and were more common in gastrinomas and glucagonomas (50%), but never encountered in insulinomas. Calcified tumors were larger (median size 4.5 vs. 2.3 cm, P=0.04) and more commonly associated with lymph node metastasis (75 vs. 35%, P=0.01), synchronous liver metastasis (62 vs. 21%, P<0.01), and intermediate tumor grade (80 vs. 31%, P<0.01). On multivariate analysis of factors available preoperatively, calcifications (P=0.01) and size (P<0.01) remained independent predictors of lymph node metastasis. Overall survival after resection was significantly worse in the presence of synchronous liver metastasis (5-year, 64 vs. 86%, P=0.04), but not in the presence of radiographic calcifications.Calcifications on preoperative computed tomography correlate with intermediate grade and lymph node metastasis in well-differentiated PNET. This information is available preoperatively and supports the routine dissection of regional lymph nodes through formal pancreatectomy rather than enucleation in calcified PNET.

    View details for DOI 10.1245/s10434-012-2305-7

    View details for Web of Science ID 000305558000030

    View details for PubMedID 22396008

  • Endoscopic mucosal resection with an over-the-counter hyaluronate preparation GASTROINTESTINAL ENDOSCOPY Friedland, S., Kothari, S., Chen, A., Park, W., Banerjee, S. 2012; 75 (5): 1040-1044

    Abstract

    Hyaluronic acid (HA) provides a long-lasting and distinct mucosal elevation for EMR, but expense and inconvenience have limited its adoption.To evaluate the safety and efficacy of an over-the-counter 0.15% HA preparation for EMR.Retrospective study.Veterans Administration Hospital and university hospital.30 patients with a total of 32 colonic lesions and 1 duodenal lesion.EMR by using HA.En bloc resection rate and complications.EMR was successful in all cases. En bloc resection was achieved in 26 of the 28 lesions up to 25 mm in diameter. Two lesions, both with fibrosis from prior attempted resection, had trace residual tissue necessitating cauterization with argon plasma. Five lesions measuring 30 mm to 60 mm all required piecemeal resection. There was one complication, a postpolypectomy bleed.Small number of patients and retrospective design.EMR may be performed safely and effectively by using an inexpensive, over-the-counter 0.15% HA preparation. Further studies are needed to verify the results of this study and to compare the safety and efficacy of this HA preparation with saline solution.

    View details for DOI 10.1016/j.gie.2012.01.010

    View details for Web of Science ID 000303277400016

    View details for PubMedID 22381528

  • Diagnostic accuracy of cyst fluid amphiregulin in pancreatic cysts BMC GASTROENTEROLOGY Tun, M. T., Pai, R. K., Kwok, S., Dong, A., Gupta, A., Visser, B. C., Norton, J. A., Poultsides, G. A., Banerjee, S., Van Dam, J., Chen, A. M., Friedland, S., Scott, B. A., Verma, R., Lowe, A. W., Park, W. G. 2012; 12

    Abstract

    Accurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. This study evaluated the diagnostic utility of amphiregulin (AREG) as a pancreatic cyst fluid biomarker to differentiate non-mucinous, benign mucinous, and malignant mucinous cysts.A single-center retrospective study to evaluate AREG levels in pancreatic cyst fluid by ELISA from 33 patients with a histological gold standard was performed.Among the cyst fluid samples, the median (IQR) AREG levels for non-mucinous (n = 6), benign mucinous (n = 15), and cancerous cysts (n = 15) were 85 pg/ml (47-168), 63 pg/ml (30-847), and 986 pg/ml (417-3160), respectively. A significant difference between benign mucinous and malignant mucinous cysts was observed (p = 0.025). AREG levels greater than 300 pg/ml possessed a diagnostic accuracy for cancer or high-grade dysplasia of 78% (sensitivity 83%, specificity 73%).Cyst fluid AREG levels are significantly higher in cancerous and high-grade dysplastic cysts compared to benign mucinous cysts. Thus AREG exhibits potential clinical utility in the evaluation of pancreatic cysts.

    View details for DOI 10.1186/1471-230X-12-15

    View details for Web of Science ID 000301923400002

    View details for PubMedID 22333441

  • Adult Intestinal Malrotation: When Things Turn the Wrong Way DIGESTIVE DISEASES AND SCIENCES Palmer, O. P., Rhee, H. H., Park, W. G., Visser, B. C. 2012; 57 (2): 284-287

    View details for DOI 10.1007/s10620-011-1818-4

    View details for Web of Science ID 000299487500005

    View details for PubMedID 21805171

  • Colloid Carcinoma of the Pancreas DIGESTIVE DISEASES AND SCIENCES Plerhoples, T. A., Ahdoot, M., DiMaio, M. A., Pai, R. K., Park, W. G., Poultsides, G. A. 2011; 56 (5): 1295-1298

    View details for DOI 10.1007/s10620-011-1573-6

    View details for Web of Science ID 000289899200008

    View details for PubMedID 21253833

  • Screening for pancreatic cancer: what can cyst fluid analysis tell us? F1000 medicine reports Park, W. G. 2011; 3: 3-?

    Abstract

    Pancreatic cysts are increasingly recognized as a dilemma in clinical practice because of their uncertain risk of malignancy. Because diagnosis by cytology is insensitive, current guidelines suggest using radiographic and clinical criteria to determine the appropriateness of surgery or surveillance, although this is far from perfect. Several cyst fluid biomarkers have been reported to aid diagnosis, and to date, carcinoembryonic antigen is the most accurate in detecting potentially cancerous mucinous cysts, but not in detecting malignant cysts. Recent studies have highlighted novel cyst fluid biomarkers based on DNA analysis, protein expression profiling, and secreted proteins that, if validated, may improve diagnosis and management.

    View details for DOI 10.3410/M3-3

    View details for PubMedID 21399760

  • Diagnostic Performance of Cyst Fluid Carcinoembryonic Antigen and Amylase in Histologically Confirmed Pancreatic Cysts PANCREAS Park, W. G., Mascarenhas, R., Palaez-Luna, M., Smyrk, T. C., O'Kane, D., Clain, J. E., Levy, M. J., Pearson, R. K., Petersen, B. T., Topazian, M. D., Vege, S. S., Chari, S. T. 2011; 40 (1): 42-45

    Abstract

    The objective of this study was to evaluate and validate cyst fluid carcinoembyronic antigen (CEA) and amylase in differentiating (1) nonmucinous from mucinous pancreatic cystic lesions (PCLs), (2) benign mucinous from malignant mucinous PCLs, and (3) pseudocysts from nonpseudocysts (amylase only).A retrospective analysis of patients with histologically confirmed PCLs from February 1996 to April 2007 was performed. Cyst fluid CEA (n=124) and/or amylase (n=91) were measured and correlated to cyst type.Carcinoembyronic antigen levels (P=0.0001), but not amylase, were higher in mucinous versus nonmucinous cysts. The sensitivity, specificity, and diagnostic accuracy of CEA 200 ng/mL or greater for the diagnosis of mucinous PCLs were 60%, 93%, and 72%, respectively. Carcinoembyronic antigen levels did not differentiate benign from malignant mucinous cysts. Whereas amylase levels were higher in pseudocysts than nonpseudocysts (P=0.009), 54% of noninflammatory PCLs had a level greater than 250 IU/L, including mucinous cystic neoplasms (median, 6800 IU/L; interquartile range, 70-25,295 IU/L). Malignant mucinous cysts had lower amylase levels than benign mucinous cysts (P=0.0008).Cyst fluid CEA and amylase levels are suggestive but not diagnostic in differentiating PCLs. Unlike CEA, amylase may help differentiate benign from malignant mucinous cysts. Novel biomarkers are needed.

    View details for DOI 10.1097/MPA.0b013e3181f69f36

    View details for Web of Science ID 000285375900009

    View details for PubMedID 20966811

  • EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy GASTROINTESTINAL ENDOSCOPY Park, W. G., Yan, B. M., Schellenberg, D., Kim, J., Chang, D. T., Koong, A., Patalano, C., Van Dam, J. 2010; 71 (3): 513-518

    Abstract

    Image-guided radiation therapy (IGRT) accurately delivers a high dose of potentially tumoricidal radiation to its target while sparing adjacent healthy tissue. Application of IGRT to unresectable pancreatic cancer requires the use of fiducials to track the precise location of the tumor. Fiducial markers have been successfully placed endoscopically.To determine the feasibility of EUS-guided gold fiducial placement for IGRT.Prospective case series.Tertiary medical center.Consecutively referred patients with locally advanced unresectable pancreatic adenocarcinoma for EUS-guided insertion of gold fiducials from December 2006 to February 2009.Under only EUS guidance, fiducial markers were deployed into or near the tumor by using a 19-gauge needle. In most cases, a sterile water injection technique was used to insert the fiducials. Fluoroscopy was not used in any case.Successful placement of an adequate number of fiducials to proceed with IGRT as determined by CT.Fifty-seven consecutive patients were included. Fifty cases (88%) were successful. Of the cases in which fiducial placement was attempted and follow-up was adequate, 94% (50 of 53) of cases were successful.Single-center, nonrandomized study.EUS-guided fine-needle insertion was safe and effective in delivering gold fiducial markers for image-guided radiation therapy. Fluoroscopy was not required for successful fiducial placement.

    View details for DOI 10.1016/j.gie.2009.10.030

    View details for Web of Science ID 000275897900012

    View details for PubMedID 20189509

  • Management of Pancreatic Cystic Neoplasms: Decision-Making with Limited Information PANCREATOLOGY Park, W. G., Chari, S. T. 2010; 10 (2-3): 142-143

    View details for DOI 10.1159/000276894

    View details for Web of Science ID 000279583200006

    View details for PubMedID 20460945

  • Election year fever? Voting on EUS criteria for chronic pancreatitis GASTROINTESTINAL ENDOSCOPY Park, W. G., Van Dam, J. 2009; 69 (7): 1262-1263

    View details for DOI 10.1016/j.gie.2008.09.024

    View details for Web of Science ID 000266800000009

    View details for PubMedID 19481648

  • Painless Jaundice and Bilaterally Enlarged Sub-mandibular Glands in an Elderly Man DIGESTIVE DISEASES AND SCIENCES Park, W. G., Pai, R., Ro, K., Lowe, A. W. 2009; 54 (3): 488-490

    View details for DOI 10.1007/s10620-008-0627-x

    View details for Web of Science ID 000262970400005

    View details for PubMedID 19034648

  • Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Soetikno, R. M., Kaltenbach, T., Rouse, R. V., Park, W., Maheshwari, A., Sato, T., Matsui, S., Friedland, S. 2008; 299 (9): 1027-1035

    Abstract

    Colorectal cancer is the second leading cause of cancer death in the United States. Prevention has focused on the detection and removal of polypoid neoplasms. Data are limited on the significance of nonpolypoid colorectal neoplasms (NP-CRNs).To determine the prevalence of NP-CRNs in a veterans hospital population and to characterize their association with colorectal cancer.Cross-sectional study at a veterans hospital in California with 1819 patients undergoing elective colonoscopy from July 2003 to June 2004.Endoscopic appearance, location, size, histology, and depth of invasion of neoplasms.The overall prevalence of NP-CRNs was 9.35% (95% confidence interval [95% CI], 8.05%-10.78%; n = 170). The prevalence of NP-CRNs in the subpopulations for screening, surveillance, and symptoms was 5.84% (95% CI, 4.13%-8.00%; n = 36), 15.44% (95% CI, 12.76%-18.44%; n = 101), and 6.01% (95% CI, 4.17%-8.34%; n = 33), respectively. The overall prevalence of NP-CRNs with in situ or submucosal invasive carcinoma was 0.82% (95% CI, 0.46%-1.36%; n = 15); in the screening population, the prevalence was 0.32% (95% CI, 0.04%-1.17%; n = 2). Overall, NP-CRNs were more likely to contain carcinoma (odds ratio, 9.78; 95% CI, 3.93-24.4) than polypoid lesions, irrespective of the size. The positive size-adjusted association of NP-CRNs with in situ or submucosal invasive carcinoma was also observed in subpopulations for screening (odds ratio, 2.01; 95% CI, 0.27-15.3) and surveillance (odds ratio, 63.7; 95% CI, 9.41-431). The depressed type had the highest risk (33%). Nonpolypoid colorectal neoplasms containing carcinoma were smaller in diameter as compared with the polypoid ones (mean [SD] diameter, 15.9 [10.2] mm vs 19.2 [9.6] mm, respectively). The procedure times did not change appreciably as compared with historical controls.In this group of veteran patients, NP-CRNs were relatively common lesions diagnosed during routine colonoscopy and had a greater association with carcinoma compared with polypoid neoplasms, irrespective of size.

    View details for Web of Science ID 000253644800020

    View details for PubMedID 18319413

  • Injection therapies for variceal bleeding disorders of the GI tract GASTROINTESTINAL ENDOSCOPY Park, W. G., Yeh, R. W., Triadafilopoulos, G. 2008; 67 (2): 313-323

    View details for DOI 10.1016/j.gie.2007.09.052

    View details for Web of Science ID 000253368100023

    View details for PubMedID 18226695

  • Injection therapies for nonvariceal bleeding disorders of the GI tract GASTROINTESTINAL ENDOSCOPY Park, W. G., Neh, R. W., Triadafilopoulos, G. 2007; 66 (2): 343-354

    View details for DOI 10.1016/j.gie.2006.11.019

    View details for Web of Science ID 000248678700024

    View details for PubMedID 17643711

  • Diagnosis and treatment of chronic hepatitis B: an update. Minerva gastroenterologica e dietologica Morgan, M., Park, W., Keeffe, E. B. 2007; 53 (1): 25-41

    Abstract

    The diagnosis of chronic hepatitis B virus (HBV) infection is made using a combination of serological, virologic, biochemical, and histologic markers. The natural history of HBV infection can be divided into four phases: immune tolerance, immune clearance (HBeAg-positive chronic hepatitis B), inactive HBsAg carrier, and reactivation (HBeAg-negative chronic hepatitis B). Patients in the immune clearance and reactivation phases, with elevated alanine aminotransferase (ALT) and HBV DNA levels, are candidates for antiviral therapy. The primary goal of therapy for chronic hepatitis B is suppression of viral replication, which has been shown to reduce hepatic necroinflammation and retard progression of hepatic fibrosis. Long-term suppression of serum HBV DNA is likely to reduce progression to cirrhosis and hepatic decompensation and decrease the risk of hepatocellular carcinoma. Current antiviral therapy for chronic hepatitis B includes interferon alfa, peginterferon alfa-2a, lamivudine, adefovir, entecavir, and telbivudine. In patients with HBeAg-positive chronic hepatitis B, antiviral treatment is indicated when the serum HBV DNA level is = or > 10(5) copies/mL (20,000 IU/mL) and the ALT level is elevated. For HBeAg-negative patients, the threshold for initiation of therapy is lower, i.e., a serum HBV DNA level = or > 10(4) copies/mL (2,000 IU/mL) in association with an elevated ALT level. The presence of at least moderate necroinflammation and the presence of fibrosis on liver biopsy, which is optional and not mandatory before therapy, may be useful in supporting the decision to initiate therapy, particularly in patients with normal ALT levels. While undergoing therapy, patients require monitoring every 3 to 6 months to ensure compliance and to test for the development of resistance if an oral agent is used. Issues that remain controversial or need to be studied further are the necessity of a baseline liver biopsy, the HBV DNA and ALT thresholds for initiation of therapy, the optimal duration of antiviral therapy, selection of one agent over another, and the role of combination therapy.

    View details for PubMedID 17415343

  • Giant gastric ulcers in chronic spinal cord injury patients DIGESTIVE ENDOSCOPY Park, W. G., Rouse, R. V., Kahng, L. S., Bastidas, J. A., Meinke, L., Soetikno, R. M. 2007; 19 (1): 36-39
  • Diagnosis and treatment of chronic hepatitis B. Minerva gastroenterologica e dietologica Park, W., Keeffe, E. B. 2004; 50 (4): 289-303

    Abstract

    The diagnosis of chronic hepatitis B virus (HBV) infection is made using a combination of serological, virological, biochemical, and histological markers. The natural history of HBV infection can be divided into 3 phases: immune tolerant, immune active with chronic hepatitis B, and inactive carrier; patients in the immune active phase are candidates for antiviral therapy. The primary goal of therapy for chronic hepatitis B is suppression of viral replication, which has been shown to reduce hepatic necroinflammation and retard progression of hepatic fibrosis. Long-term suppression of serum HBV DNA is likely to reduce progression to cirrhosis and hepatic decompensation and may also decrease the risk of hepatocellular carcinoma. Current antiviral therapy for chronic hepatitis B includes interferon alpha, lamivudine and adefovir, with recent studies demonstrating good safety and efficacy of peginterferon and other nucleoside analogues that will soon become additional treatment options. In patients with HBeAg-positive chronic hepatitis B, antiviral treatment is indicated when the serum HBV DNA level is = or >10(5) copies/mL and the alanine aminotransferase (ALT) level is elevated, particularly greater than 2 times the upper limits of normal. For HBeAg-negative patients, the threshold for initiation of therapy is a HBV DNA level = or >10(4) in association with an elevated ALT level. The presence of at least moderate necroinflammation and the presence of fibrosis on liver biopsy, which is optional and not mandatory before therapy, may be useful in supporting the decision to initiate therapy. While undergoing therapy, patients require monitoring every 3 to 6 months to ensure compliance and to test for the development of resistance if an oral agent is used. Issues that remain controversial or need to be studied further are the necessity of a baseline liver biopsy, the HBV DNA and ALT thresholds for initiation of therapy, the optimal duration of antiviral therapy, selection of one agent over another, and the role of combination therapy.

    View details for PubMedID 15788985

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