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World J Gastroenterol. Oct 21, 2014; 20(39): 14230-14236
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14230
Utility of endoscopic ultrasound in patients with portal hypertension
Ghassan M Hammoud, Jamal A Ibdah
Ghassan M Hammoud, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
Author contributions: Hammoud GM wrote the manuscript; Ibdah JA edited the manuscript.
Correspondence to: Jamal A Ibdah, MD, PhD, Professor, Director, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, One Hospital Drive, CE 405, Columbia, MO 65212, United States. ibdahj@health.missouri.edu
Telephone: +1-573-8827349  Fax: +1-573-8844595
Received: November 28, 2013
Revised: March 22, 2014
Accepted: June 14, 2014
Published online: October 21, 2014
Abstract

Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt.

Keywords: Endoscopic ultrasound, Cirrhosis, Portal hypertension, Gastroesophageal varices, Cyanoacrylate, Hepatocellular carcinoma, Fine needle aspiration

Core tip: This review provides an up-to-date summary of published studies and case reports on the utilization of endoscopic ultrasound in patients with advanced liver disease and portal hypertension. We highlight the significance of portal hypertension and the potential application of endoscopic ultrasound, endoscopic ultrasound (EUS)-guided fine needle aspiration, and EUS-guided injection in the management of portal hypertension. In addition, we highlight the utilization of EUS in the diagnosis and management of gastroesophageal varices. This review also provides insights on the limitation of endoscopic ultrasound in patients with portal hypertension.