Start benzimidazole treatment with a low dose (albendazole 200 mg/day; mebendazole 500 mg/day) if suspected cACLD. Close monitoring for drug toxicity (liver function tests, full blood count, hair loss, drug levels). Stepwise (2–4 weeks) dose increase if feasible.

Monitor for development of cACLD by liver stiffness measurement with transient elastography (TE). Refer suspected cACLD patients (TE 10–15 kPa) to hepatologist for further workup.

Evaluate surgical treatment options to prevent long-term complications of vascular pathology even if R0 resection is not possible.

‘One-stop-shop MRI’ including general non-contrast sequence protocols, dynamic contrast-enhanced imaging and MR cholangiography balanced steady-state free-precession sequence protocol.

Consider contrast-enhanced CT in case of hilar infiltration and/or hepatic artery involvement.

Use structured reporting for assessment of vascular and biliary involvement.

Imaging guides determination of R0 resectability

Monitor hepatic vasculature and IVC by colour-coded duplex ultrasonography at 3–6 months intervals.

IVC or PV obstruction

Evaluate for oesophageal varices— set follow-up intervals

• No varices: screening at diagnosis and then yearly till 2 years after diagnosis.

• ≥Grade I: yearly follow-up.

• ≥Grade II

  • Primary prophylaxis of portal hypertension-related bleeding: NSBB for grade II and III varices.

  • Secondary prophylaxis of portal hypertension-related bleeding: NSBB and band ligation.

IVC or hepatic vein obstruction.

Evaluate for secondary Budd-Chiari-Syndrome.

Discuss indication for anticoagulation and weigh anticoagulation benefit against bleeding risk.