Hepatic applications of endoscopic ultrasound: Current status and future directions

Abstract

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 as a Diagnostic Tool in a Case of Obscure Hemobilia

“…Angiographic coil embolization via interventional radiology has become the treatment of choice and was successful in our patient. This case adds to the existing literature to suggest a role for EUS in the evaluation of hemobilia, especially in cases where other testing modalities such as cross-sectional imaging, ERCP, and even angiography have been unsuccessful or unrevealing 10-11. As illustrated in this case, EUS can serve as an important diagnostic tool in the evaluation of obscure hemobilia.…”

Autosomal Dominant Polycystic Kidney Disease with Hepatic Cysts Complications in a Hemodialysis Patient: A Case Report

“…The majority of the hepatic cysts are asymptomatic. When the symptomatology occurs, can be due to mass effect, hemorrhage, rupture or infection of the cysts (10) and can include abdominal pain, vomiting, nausea, early satiety, hepatomegaly and obstructive jaundice (10,11). The management of the hepatic cyst formations has varied over the years.…”

“…The management of the hepatic cyst formations has varied over the years. The therapeutic options include the surgical approach (such as open or laparoscopic deroofing, complete resection of the cysts and hepatectomy), sclerotherapy and percutaneous aspiration (10,11,(12)(13)(14)(15). Previous reports have shown that percutaneous aspiration is associated with a very high recurrence rate (nearly to 100%) observed earlier than 2 weeks (13,15).…”

Role of endoscopic ultrasound in liver disease: Where do we stand in 2017?

“…Focal hepatic lesions are divided into benign lesions (such as hepatic cysts, focal nodular hyperplasia, regenerative nodular hyperplasia, abscess, adenoma or hemangioma) and malignant lesions (such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, biliary cystadenoma and metastatic liver disease)[ 4 ]. Those lesions were classically diagnosed with combination of conventional imaging such CT and transabdominal ultrasound and percutaneous liver.…”

“…EUS, especially when combined by cytology, has been used not for evaluating intra-abdominal masses only, but also for staging purposes[ 6 - 9 ]. In recent review by Srinivasan et al[ 4 ], EUS has shown superiority in detecting focal hepatic lesions compared with conventional CT and trans-abdominal ultrasound, especially for small lesions. A recent study comparing the diagnostic sensitivity of EUS and CT scan showed that of 574 patients, 14 had liver lesions that were visualized by EUS, however, only 3 of those 14 patients had their lesions visualized by CT scan prior to the use of EUS[ 10 ].…”