EUS for portal hypertension: a comprehensive and critical appraisal of clinical and experimental indications

Abstract

Endoscopic ultrasonography (EUS) has significantly improved our understanding of the complex vascular structural changes that occur in portal hypertension and their clinical and prognostic significance. EUS in combination with color Doppler technique enables us to study the hemodynamic changes in the portal venous system noninvasively, and to determine objectively the effect of different pharmacological agents on portal hypertension. EUS has also found some role in the treatment and follow up of esophageal and gastric varices. It may play a clinical role in the diagnosis of gastric, duodenal, and rectal varices. Recently reported EUS-based devices that measure variceal wall tension and intravariceal pressure noninvasively could have an impact on the identification of patients at high risk of variceal bleeding with the aim of initiating prophylactic treatment, and in the assessment of patients' responses to drug therapy of portal hypertension. EUS is occasionally very helpful in the clinical management of portal hypertension. It is an interesting and important research tool for many experimental indications that are not routinely applied in clinical practice at this time.

High-frequency ultrasonographic imaging of the gastrointestinal wall

“…Doppler US may provide important information on tissue vascularization and help to differentiate between cystic and vascular structures [48]. Doppler US can also be helpful in the diagnosis and evaluation after endoscopic treatment of varices and vascular malformations in the GI wall [49,50].…”

Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound—A Case Series [with video]

“…38,39 EUS is useful for noninvasive HDA of the portal venous system. 40 EUS has demonstrated perforators in esophageal, gastric, rectal and CBD wall. 16,17,34,41 Although angiography has demonstrated paraduodenal varices in portal hypertension, duodenal perforators have not been demonstrated so far.…”

Endoscopic Management of Portal Hypertension

“…Vascular changes within the esophagus, gastric or rectal walls can be accurately confirmed with EUS [14], but currently this modality has a limited role in clinical practice. EUS appears to perform as well as EGD for detection of clinically significant EVs [15], but is superior to EGD for detection of GV [16].…”