Endoscopic Treatment of Portal Hypertension and Its Complications

Bazerbachi, Fateh; Levy, Michael J.; Song, Louis M. Wong Kee

doi:10.1016/j.tige.2021.11.001

Cited by 1 publication

(1 citation statement)

References 70 publications

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“…Conventional endoscopic treatment of gastric varices (GV) typically involves the injection of cyano-acrylate glue via a sclerotherapy needle. EUS-guided angiotherapy improves the treatment of GV by enabling direct visualization of the network of varices, controlled and targeted delivery of therapeutic agents (liquid and nonliquid), along with real-time Doppler monitoring of response [28,29]. Cyanoac-rylate (CYA) with and without coil embolization has been demonstrated to be successful in achieving hemostasis during active bleeding and for secondary prophylaxis [30][31][32] and in a single-center study was shown to be effective for primary prophylaxis of high-risk GV [32].…”

Section: Eus-guided Angiotherapymentioning

confidence: 99%

Endohepatology – current status

Edelson

Mitchell

Rockey

2022

Current Opinion in Gastroenterology

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Purpose of reviewThis article discusses the most recent studies regarding the emerging field of endohepatology – the use of diagnostic and therapeutic endoscopic tools for the management of patients with liver disease and portal hypertension.Recent findingsNew research has shown that liver biopsy specimens obtained by each Endoscopic ultrasound (EUS)-guidance, the percutaneous approach, and the transjugular approach contained sufficient portal triads to adequately analyzed by experienced pathologists – suggesting that any of these routes of liver biopsy is clinically acceptable; further, all had similar rates of adverse events. An initial prospective study showed that EUS guided portal pressure measurement was safe, effective, and accurate. A recent metanalysis showed that EUS-guided cyanoacrylate injection and coil embolization was statistically more efficacious and with less complications than EUS guided cyanoacrylate injection and EUS guided coil injection alone, suggesting that combination therapy appears to be the preferred approach for gastric varices (GV) bleeding. A prospective study evaluating focal liver lesions showed that the use of artificial intelligence had up to 100% sensitivity and 81% specificity for identifying malignant focal liver lesions.SummaryEUS guided liver biopsy is safe and enables accurate diagnosis of underlying liver disease. EUS guided portal pressure measurement is also safe and is accurate. Combination therapy of EUS guided cyanoacrylate injection and coil embolization is more efficacious and has less complications than injection or coil therapy alone when used for GV bleeding. Artificial intelligence is highly sensitive and specific when used in conjunction with EUS in the diagnosis of malignant focal liver lesions. Endohepatology is a rapidly expanding field with great potential.

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