Rudnick SR, Conway JD, Russo MW. Current state of endohepatology: Diagnosis and treatment of portal hypertension and its complications with endoscopic ultrasound. World J Hepatol 2021; 13(8): 887-895 [PMID: 34552695 DOI: 10.4254/wjh.v13.i8.887]
Corresponding Author of This Article
Sean R Rudnick, MD, Assistant Professor, Section on Gastroenterology & Hepatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States. srudnick@wakehealth.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2021; 13(8): 887-895 Published online Aug 27, 2021. doi: 10.4254/wjh.v13.i8.887
Current state of endohepatology: Diagnosis and treatment of portal hypertension and its complications with endoscopic ultrasound
Sean R Rudnick, Jason D Conway, Mark W Russo
Sean R Rudnick, Jason D Conway, Section on Gastroenterology & Hepatology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Mark W Russo, Department of Hepatology, Atrium Health, Carolinas Medical Center, Charlotte, NC 28204, United States
Author contributions: Rudnick SR wrote the manuscript; Conway JD and Russo MW assisted in the editing the manuscript for content and accuracy.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sean R Rudnick, MD, Assistant Professor, Section on Gastroenterology & Hepatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States. srudnick@wakehealth.edu
Received: March 5, 2021 Peer-review started: March 5, 2021 First decision: April 6, 2021 Revised: May 18, 2021 Accepted: August 4, 2021 Article in press: August 4, 2021 Published online: August 27, 2021 Processing time: 168 Days and 8 Hours
Abstract
The diagnosis and management of cirrhosis and portal hypertension (PH) with its complications including variceal hemorrhage, ascites, and hepatic encephalopathy continues to evolve. Although there are established “standards of care” in liver biopsy and measurement of PH, gastric varices remain an area without a universally accepted therapeutic approach. The concept of “Endo Hepatology” has been used to describe of the applications of endoscopic ultrasound (EUS) to these challenges. EUS-liver biopsy (EUS-LB) offers an alternative to percutaneous and transjuglar liver biopsy without compromising safety or efficacy, and with added advantages including the potential to reduce sampling error by allowing biopsies in both hepatic lobes. Furthermore, EUS-LB can be performed during the same procedure as EUS-guided portal pressure gradient (PPG) measurements, allowing for the collection of valuable diagnostic and prognostic data. EUS-guided PPG measurements provide an appealing alternative to the transjugular approach, with proposed advantages including the ability to directly measure portal vein pressure. In addition, EUS-guided treatment of gastric varices (GV) offers several possible advantages to current therapies. EUS-guided treatment of GV allows detailed assessment of the vascular anatomy, similar efficacy and safety to current therapies, and allows the evaluation of treatment effect through doppler ultrasound visualization. The appropriate selection of patients for these procedures is paramount to ensuring generation of useful clinical data and patient safety.
Core Tip: In this review we familiarize the reader to salient aspects of endoscopic ultrasound (EUS)-guided hepatic interventions including liver biopsy, portal pressure measurements, and treatment of gastric varices, and outline the data supporting their use. We highlight the potential advantages and disadvantages of EUS guided interventions compared to the current standards of care, and propose clinical scenarios in which EUS guided interventions may be favored over the current standard of care.
