• Endoscopic ultrasound
• Gastric varices
• Gastrointestinal bleeding
• Interventional endoscopy
• Interventional radiolog
• Portal pressure gradient
• Pseudoaneurysms
• Vascular access

• Humans
• Aneurysm, False/therapy
• Aneurysm, False/diagnostic imaging
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/diagnostic imaging
• Embolization, Therapeutic/methods
• Endosonography/methods
• Esophageal and Gastric Varices/therapy
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/etiology
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/etiology
• Liver Neoplasms/therapy
• Neoplastic Cells, Circulating
• Portal Vein/diagnostic imaging
• Ultrasonography, Interventional/methods

• cirrhosis
• endoscopic ultrasound
• esophageal varices
• gastric varices
• gastrointestinal hemorrhage
• portal hypertension
• portal pressure gradient

• endohepatology
• endosonography
• eus
• eus coil embolization
• eus liver biopsy
• eus portal vein sampling

• Humans
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/surgery
• Gastroenterologists
• Gastrointestinal Hemorrhage/therapy
• Endoscopy
• Liver Diseases/diagnostic imaging
• Liver Diseases/surgery

• Gastric varices
• Gastrointestinal bleeding
• Portal pressure gradient measurement
• Portal vein
• Pseudoaneurysm
• Vascular intervention

• Endoscopic ultrasound
• Liver diseases
• Portal hypertension

Gastric varices (GV) represent a common and severe complication in patients with portal hypertension, commonly seen in patients with cirrhosis and severe pancreatic disease. Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa, portal vein and its tributaries, and collateral circulations during direct endoscopic observation. Recently, various studies have been published about endoscopic ultrasound (EUS)-guided management of GV, mainly including diagnosis, treatment, and prognostic analysis. This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.

• Endoscopic ultrasound
• Diagnosis
• Treatment
• Gastric varices

The role of endoscopic ultrasound (EUS) as a diagnostic and therapeutic modality for the management of various gastrointestinal diseases has been expanding. The imaging or intervention for various liver diseases has primarily been the domain of radiologists. With the advances in EUS, the domain of endosonologists is rapidly expanding in the field of hepatology. The ability to combine endoscopy and sonography in one hybrid device is a unique property of EUS, together with the ability to bring its probe/transducer near the liver, the area of interest. Its excellent spatial resolution and ability to provide real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS, have facilitated the growth of EUS. The concept of “Endo-hepatology” encompasses the wide range of diagnostic and therapeutic procedures that are now gradually becoming feasible for managing various liver diseases. Diagnostic advancements can enable a wide array of techniques from elastography and liver biopsy for liver parenchymal diseases, to CE-EUS for focal liver lesions to portal pressure measurements for managing various liver conditions. Similarly, therapeutic advancements range from EUS-guided eradication of varices, drainage of bilomas and abscesses to various EUS-guided modalities of liver tumor management. We provide a comprehensive review of all the different diagnostic and therapeutic EUS modalities available for the management of various liver diseases. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.

• Endoscopic ultrasound
• Liver disease
• Elastography
• Varices
• Liver tumor
• Liver biopsy

• Endoscopic ultrasound
• Liver cirrhosis
• Portal hypertension

• EUS
• chronic liver disease
• endoscopic ultrasound
• hepatology

• BRTO
• Cirrhosis
• Early TIPS
• Endoscopy
• Esophageal varices
• Gastric varices
• Gastrointestinal bleeding
• Portal hypertension
• Primary prophylaxis
• Secondary prophylaxis

EUS has become a substantial diagnostic and therapeutic modality for digestive tract conditions. The extent of endosonographic assessment is wide, and, among others, it allows for the evaluation of liver anatomy and related pathologies. Moreover, EUS assessment has proved more accurate in detecting small focal liver lesions missed by standard imaging examinations such as computed tomography or magnetic resonance. Endosonographically, various liver segments can be visualized by transgastric and transduodenal scanning following anatomical landmarks, thus providing arranged systematic examination. In addition, knowledge considering the correct position during examination is crucial for EUS-guided procedures such as hepaticogastrostomy, ablation of tumors, and measurement of portal pressure gradient. The evolution of EUS-guided intervention has contributed to the increasing importance of understanding the hepatic segmental anatomy during the EUS examination.

• EUS
• anatomy
• linear
• liver segments

Endoscopic ultrasound (EUS) is a minimally invasive diagnostic and therapeutic modality with a number of established as well as evolving uses in patients with chronic liver disease. Compared to other diagnostic tools such as cross-sectional imaging or conventional endoscopy, EUS has been shown to increase diagnostic sensitivity and therapeutic success for many clinical scenarios and applications with a low rate of adverse events. In this review, we discuss and focus on the current and growing role of EUS in the evaluation and/or treatment of hepatobiliary masses, hepatic parenchymal disease, portal hypertension, esophageal and other varices, and indeterminate biliary strictures.

• Endoscopy
• Cirrhosis
• Liver mass
• Liver biopsy
• Variceal bleeding

Gastroesophageal variceal bleeding is a life-threatening complication in patients with liver cirrhosis and portal hypertension. The endoscopic injection of cyanoacrylate is considered as the first-line alternative for gastric varices treatment; however, the incidence of adverse events supports the endoscopic ultrasound–guided approach. Endoscopic ultrasound–guided interventions are a safe and feasible technique for the injection of sclerosants, cyanoacrylate, thrombin, and the deployment of coils into targeted vessels. This review article aims to offer an overview of the role of endoscopic ultrasound–guided vascular therapy and present the available data regarding endoscopic ultrasound–guided management of gastrointestinal bleeding and other vascular therapies. The available data have shown the superiority of endoscopic ultrasound–guided endovascular therapy over the endoscopic technique, which supports the implementation of endoscopic ultrasound–guided therapy in therapeutical algorithms and guidelines. Regarding whether injecting cyanoacrylate, the deployment of coils, or combined therapy, we recommend the endoscopic ultrasound–guided combined therapy in patients with gastric varices due to the high eradication rate with lower rebleeding and reintervention rates. Multicenter worldwide studies are required to confirm the actual clinical applicability of endoscopic ultrasound–guided endovascular therapy and establish treatment algorithms. Endoscopic ultrasound offered a safe and effective alternative in the management of variceal and nonvariceal gastrointestinal bleeding, with the implementation of new diagnostic and treatment options for various gastrointestinal conditions, representing a new territory for research and development.

• endoscopic ultrasonography
• endosonography
• gastric variceal bleeding
• gastro-intestinal hemorrhage
• portal vein

Pancreatic cancer is a lethal cancer with an increasing incidence. Despite improvements in chemotherapy, patients with pancreatic cancer continue to face poor prognoses. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is the primary method for obtaining tissue samples of pancreatic cancer. Due to advancements in next-generation sequencing (NGS) technologies, multiple parallel sequencing can be applied to EUS-TA samples. Genomic biomarkers for therapeutic stratification in pancreatic cancer are still lacking, however, NGS can unveil potential predictive genomic biomarkers of treatment response. Thus, the importance of NGS using EUS-TA samples is becoming recognized. In this review, we discuss the recent advances in EUS-TA application for NGS of pancreatic cancer.

• biomarker
• endoscopic ultrasound-guided fine needle aspiration
• endoscopic ultrasound-guided fine needle biopsy
• endoscopic ultrasound-guided tissue acquisition
• genome sequencing
• next-generation sequencing
• pancreatic cancer
• precision medicine

To identify the usefulness of endoscopic ultrasonography with a mini-probe (EUM) and to create a predictive model for esophageal variceal (EV) recurrence and bleeding following esophageal variceal ligation (EVL).

A total of 144 patients who received EUM prior to prophylactic EVL and met the inclusion criteria were enrolled. EUM findings, EV diameter, paraesophageal vein diameter, and the number of perforating veins were assessed.

EV recurrence was observed in 42 patients (29.2%), 10 of whom experienced EV bleeding. Larger diameter of the paraesophageal vein (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.17 to 1.96; p=0.002) and perforating vein (OR, 3.27; 95% CI, 1.11 to 9.65; p=0.032) were significant predictive factors for EV recurrence. However, the diameter of the paraesophageal vein was the only significant risk factor for EV bleeding (adjusted OR, 1.51; 95% CI, 1.06 to 2.16; p=0.022). The areas under the curves of the predictive model for EV recurrence and bleeding were 0.872 (95% CI, 0.811 to 0.934) and 0.811 (95% CI, 0.630 to 0.992), respectively.

The diameter of the paraesophageal vein was a significant predictive factor for EV recurrence and bleeding. The predictive model constructed based on the significant EUM findings exhibited good performance.

• Endosonography
• Esophageal and gastric varices
• Hemorrhage
• Recurrence

• Hemostatic Powder
• Portal Hypertension
• Variceal Bleeding

• EUS-Guided Gallbladder Drainage (EUS-GBD)
• EUS-Guided Gastroenterostomy (EUS-GE)
• EUS-Guided Pancreatic Fluid Collection Drainage (EUS-PFC Drainage)

• EUS-guided hemostasis
• EUS-guided vascular access
• Endoscopic hemostasis
• Gastrointestinal bleeding

• Cyanoacrylates
• Endosonography/methods
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/methods
• Humans
• Stents
• Treatment Outcome
• Ultrasonography, Interventional/methods

Endoscopic ultrasound (EUS) was first introduced into medical practice in 1980s as a diagnostic imaging modality for pancreatic pathology. EUS has the unique advantage of combining ultrasound and endoscopy to obtain detailed information of the gastrointestinal tract. Over the past decade, the use of EUS in liver diseases has been increasing. EUS, which was initially used as a diagnostic tool, is now having increasing therapeutic role as well. We provide a review of the application of EUS in the diagnostic and therapeutic aspects of liver disease. We also look at the evolving future research on the role of EUS in liver diseases.

• Endoscopic ultrasound
• Liver disease
• Portal hypertension
• Liver lesions

The inspection of the liver is a valuable part of the upper endoscopic ultrasonography (EUS) studies, regardless of the primary indication for the examination. The detailed images of the liver segments provided by EUS allows the use of this technique in the study of parenchymal liver disease and even in the diagnosis and classification of focal liver lesions. EUS has also emerged as an important tool in understanding the complex collateral circulation in patients with portal hypertension and their clinical and prognostic value. Recently, EUS-guided portal vein catheterization has been performed for direct portal pressure measurement as an alternative method to evaluate portal hemodynamics. In this review, the authors summarize the available evidence regarding the application of EUS to patients with liver diseases and how we can apply it in our current clinical practice.

• Endoscopic ultrasonography
• Portal hypertension
• Gastroesophageal varices
• Focal liver lesions
• Liver biopsy

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

• Endosonography
• Esophageal and gastric varices
• Portal pressure

• endoscopic variceal sclerotherapy
• esophageal variceal bleeding
• irregular interval
• weekly interval

• Endoscopic Hemostasis
• Endoscopic Ultrasound
• Lower Intestinal Bleeding
• Upper Gastrointestinal Bleeding

Endoscopic ultrasound (EUS) has significantly improved our understanding of the complex vascular structural changes in patients with portal hypertension. At present, EUS is a useful diagnostic tool for the evaluation of esophagogastric varices (EGVs) and guidance of endoscopic therapy. Several studies have employed this new technique for the diagnosis and management of esophageal and gastric varices, respectively. In the present review, we have summarized the current status of EUS for the diagnosis and management of EGVs and clarified the clinical feasibility of this procedure. New indications for EUS can be developed in the future after adequate validation.

The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various studies have established its role in gastrointestinal malignancies and pancreatic conditions, its potential in the field of hepatic lesions still remains vastly untapped. In this paper the authors attempt to review important and landmark trials, case series and case studies involving hepatic applications of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role.

• Endoscopic ultrasound
• Drainage
• Liver
• Intrahepatic lesion

• Animals
• Bile Duct Diseases/diagnostic imaging
• Bile Duct Diseases/therapy
• Bile Ducts, Intrahepatic/diagnostic imaging
• Endosonography
• Humans
• Liver/diagnostic imaging
• Liver Diseases/diagnostic imaging
• Liver Diseases/therapy
• Predictive Value of Tests
• Prognosis
• Tomography, X-Ray Computed

• Coil Embolization
• Cyanoacrylate Injection
• Interventional Endoscopic Ultrasound
• Refractory GI Bleeding

• coil
• cyanoacrylate
• endoscopic ultrasonography (EUS)
• interventional EUS
• varix

• Cryotherapy
• EUS-guided angiotherapy
• Endoscopic suturing
• Hemostasis
• Hemostatic spray
• Nonvariceal upper gastrointestinal bleeding
• Over-the-scope clip
• Radiofrequency ablation

• Endoscopic ultrasound
• Gastrointestinal bleeding
• Vascular access

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.

• Endoscopic ultrasound
• Cirrhosis
• Portal hypertension
• Gastroesophageal varices
• Cyanoacrylate
• Hepatocellular carcinoma
• Fine needle aspiration

• Ascites/diagnostic imaging
• Ascites/etiology
• Cyanoacrylates/administration & dosage
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/diagnostic imaging
• Hypertension, Portal/physiopathology
• Hypertension, Portal/therapy
• Injections
• Portal Pressure
• Portal Vein/diagnostic imaging
• Portal Vein/physiopathology
• Portasystemic Shunt, Surgical/methods
• Predictive Value of Tests
• Recurrence
• Sclerosing Solutions/administration & dosage
• Sclerotherapy/methods
• Treatment Outcome
• Ultrasonography, Doppler
• Ultrasonography, Interventional/methods

Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.

• Endoscopic ultrasound-guided drainage
• Endoscopic ultrasound-guided intervention
• Endosonography
• Therapeutic endoscopy

Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or large-sized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers (NSBBs) or endoscopic variceal ligation (EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene (PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events.

• Esophageal varices
• Primary prophylaxis
• Variceal bleeding
• Secondary prophylaxis
• Cirrhosis
• Endoscopic treatment

• Adrenergic beta-Antagonists/therapeutic use
• Combined Modality Therapy
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/mortality
• Esophageal and Gastric Varices/therapy
• Esophagoscopy/adverse effects
• Esophagoscopy/mortality
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/methods
• Hemostasis, Endoscopic/mortality
• Humans
• Ligation
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/mortality
• Portasystemic Shunt, Transjugular Intrahepatic/instrumentation
• Recurrence
• Sclerotherapy
• Stents
• Treatment Outcome

• biliary drainage
• endoscopy
• endosonography
• pseudocyst
• therapeutic

• Histoacryl
• bleeding
• endoscopic ultrasonography
• gastric varices
• injection

• linear endosonography
• portal vein
• portal venous system
• splenic vein
• superior mesenteric vein

• linear endosonography
• portal vein
• portal venous system
• splenic vein
• superior mesenteric vein