Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications: What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging?

Figure 1 Diagnostic algorithm discussing role of endoscopic ultrasonography (EUS), and potential merits. Potential advantages of EUS in the management algorithm (1) Stratification of indeterminate nodules, especially in high-risk patients, with negative imaging characteristics, which may eventually change the management[14]; (2) In detection and characterization of smaller lesions < 2 cm[14,19,113]; (3) If a lesion is found by EUS, cytology / histology can be obtained in the same session rather than performing another procedure at later time[19]; (4) Assessment of portal vein invasion, spread to other vasculature and lymph nodes[26,118]; (5) The ability to sample enlarged regional lymph nodes for preoperative staging[118]; (6) Therapeutic roles: tumor ablation by intra-tumoral injection of absolute alcohol, radiofrequency probes, fiducial placement for stereotactic radiotherapy, brachytherapy using radioactive seeds and EUS guided biliary drainage[121]. EUS: Endoscopic ultrasonography.