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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2018; 10(2): 56-68
Published online Feb 16, 2018. doi: 10.4253/wjge.v10.i2.56
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?
Mohit Girotra, Kaartik Soota, Amaninder S Dhaliwal, Rtika R Abraham, Mauricio Garcia-Saenz-de-Sicilia, Benjamin Tharian
Mohit Girotra, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Kaartik Soota, Division of Gastroenterology and Hepatology, University of Iowa School of Medicine, Iowa City, IA 52242, United States
Amaninder S Dhaliwal, Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198, United States
Rtika R Abraham, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Mauricio Garcia-Saenz-de-Sicilia, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United State
Benjamin Tharian, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Soota K, Dhaliwal AS and Abraham RR contributed towards literature search, manuscript preparation and revisions; Girotra M, Garcia-Saenz-de-Sicilia M and Tharian B contributed towards manuscript preparation, revision, editing with final appraisal and approval; Girotra M and Tharian B also contributed the endoscopic ultrasound and pathology images from their personal cases.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: 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/
Correspondence to: Mohit Girotra, MD, Assistant Professor, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, 1120 NW 14th Street, (D-49) 1111 CRB, Miami, FL 33136, United States. mgirotra@med.miami.edu
Telephone: +1-305-2438040 Fax: +1-305-2433762
Received: October 15, 2017
Peer-review started: October 16, 2017
First decision: November 7, 2017
Revised: December 28, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: February 16, 2018
Processing time: 115 Days and 16.7 Hours
Abstract

Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process. In the last few years, there has been evolution of utility of endoscopy, specifically endoscopic ultrasonography along with Fine needle aspiration, for this purpose, which we comprehensively review in this article.

Keywords: Hepatocellular carcinoma; Liver; Cancer; Fine needle aspiration; Endoscopy; Endoscopic ultrasound; Endoscopic ultrasonography; Staging; Management; Treatment

Core tip: Hepatocellular carcinoma (HCC) constitutes the commonest primary liver cancer, and if diagnosed at an early stage, has better prognosis. Of late, there has been evolution of utility of endoscopic techniques, specifically endoscopic ultrasonography (EUS) with fine needle aspiration, for this purpose. EUS is superior over computed tomography in detecting hepatic lesions smaller than 1cm, and also allows FNA for accurate histopathological diagnosis. This strategy is particularly useful for indeterminate nodules, with non-specific imaging characteristics. Role of EUS in diagnosis and management of HCC are the focus of this article. In addition, other endoscopic techniques, including esophagogastroduodenoscopy and endoscopic retrograde cholangio-pancreatography, are of immense use in management of complications of HCC, which are also briefly discussed in this review.