Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 28 A promising new paradigm “Endo-Hepatology” intersects and integrates endoscopy in the diagnosis and treatment of liver disease. This includes: evaluation of the liver surface [by endoscopic ultrasound (EUS)], elastography to determine liver stiffness and fibrosis, contrast enhanced harmonic EUS to detect focal lesions, EUS-guided intrahepatic porto-systemic shunt, EUS-guided liver biopsy, endoscopic variceal band ligation and intra-variceal injection with glue +/- coil (by EUS), evaluation of the portal circulation and EUS-guided portosystemic pressure gradient, and detection of ascites with EUS-guided paracentesis. EUS: Endoscopic ultrasound; PPG: Portosystemic pressure gradient; IPSS: Intrahepatic porto-systemic shunt.