Role of endoscopic ultrasound in the field of hepatology: Recent advances and future trends

Table 1 Technique of endoscopic ultrasound guided paracentesis[1-3,9-11]

Pre-procedure requirements

(1) No recommendations exist for EUS-P, although most studies have been performed under the cover of pre/peri-procedural antibiotics; and (2) Patient is usually fasted for 4-6 h before the procedure

Technical aspects

(1) EUS-P is usually performed using a 22 G/25 G FNA needle. A specialized spring-loaded 22 G FNA needle can also be used for the same; (2) The approach can be transgastric or transduodenal. The tip of the needle is visualized under EUS guidance in the ascites; (3) At the time of puncture, care is taken to avoid a trajectory involving any tumor/vessels to avoid peritoneal seeding or bleeding; (4) For therapeutic paracentesis, a suction tube attached to a vacuum canister can be used; (5) Repositioning of the needle is carried out in case it gets blocked by the tumor or omentum; (6) Two and fro motion is usually not needed; (7) CE-EUS followed by FNA of the peritoneal/omental nodules can also be done for added diagnostic value; and (8) The sample aspirated is sent for routine cytological assessment and for any additional tests that might be needed

Post procedure

The administration of albumin post 5 L of paracentesis and post procedure observation are carried out as per standard recommendations (EASL, AASLD)

EUS: Endoscopic ultrasound; EUS-FNA: Endoscopic ultrasound guided fine needle aspiration; EUS-P: Endoscopic ultrasound guided paracentesis; G: Gauge; CE-EUS: Contrast enhanced endoscopic ultrasound; EASL: European Association for the Study of Liver; AASLD: American Association for the Study of Liver Diseases.