BackgroundPortal hypertension (PH) is a critical complication in patients with hepatic diseases. Its accurate evaluation is essential for early diagnosis, risk stratification, and management. Endoscopic ultrasound (EUS) has emerged as a promising diagnostic tool, offering high‐resolution imaging of the portal venous system, hepatic vasculature, and surrounding structures.AimsThis review aims at providing an overview of the evolving role of EUS in PH evaluation in patients with liver disease.Materials and MethodsA systematic search was conducted in PubMed and Google Scholar until 31 May 2024. Relevant studies were identified using keywords related to EUS and PH. Additional references were included based on expert knowledge and citation analysis. Only full‐length papers and abstracts in English were considered. Results: EUS demonstrates significant utility in PH assessment, offering high‐resolution imaging and advanced tools like contrast enhancement (CE) and shear‐wave elastography (SWE) for evaluating liver stiffness and correlating it with PH severity. EUS‐guided portal pressure gradient (PPG) measurement provides a less invasive method for evaluating PH, potentially offering a safer alternative to conventional techniques.DiscussionEUS offers unique advantages in PH assessment, enabling comprehensive evaluation in a single session. Despite its potential, limitations such as invasiveness, sedation‐related variability, and restricted availability persist. Emerging techniques require further validation in larger cohorts and standardised training.ConclusionEUS is a valuable diagnostic tool for PH evaluation, with the potential to improve outcomes through earlier diagnosis and better stratification. Addressing its limitations through further research and standardised protocols is critical to optimize its clinical utility.Trial Registration: NCT04115046, NCT05728697, NCT05097963 and NCT03155282
