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World J Gastroenterol. Oct 28, 2021; 27(40): 6874-6887
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.6874
Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques
Rupinder Mann, Hemant Goyal, Abhilash Perisetti, Saurabh Chandan, Sumant Inamdar, Benjamin Tharian
Rupinder Mann, Department of Internal Medicine, Saint Agnes Medical Center, Fresno, CA 93730, United States
Hemant Goyal, Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18503, United States
Abhilash Perisetti, Department of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Saurabh Chandan, Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE 68107, United States
Sumant Inamdar, Benjamin Tharian, Department of Internal Medicine, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Perisetti A, Goyal H and Mann R concepted and designed the article, did a literature search; Mann R finished the first draft; all authors critically revised and edited manuscript.
Conflict-of-interest statement: Rupinder Mann, Hemant Goyal, Abhilash Perisetti, Saurabh Chandan, Sumant Inamdar has nothing to disclose; Benjamin Tharian acts as a consultant to Boston Scientific and Medtronic which are not relevant for this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Abhilash Perisetti, FACP, MBBS, MD, Academic Fellow, Department of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, United States. abhilash.perisetti@gmail.com
Received: March 16, 2021
Peer-review started: March 16, 2021
First decision: May 1, 2021
Revised: May 3, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 28, 2021
Processing time: 224 Days and 15.5 Hours
Abstract

Endoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool to a real-time therapeutic modality. The luminal gastrointestinal (GI) tract provides a unique opportunity to access multiple vascular structures, especially in the mediastinum and abdomen, thus permitting a variety of EUS-guided vascular interventions. The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract. EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy. EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity, thus, avoiding radiation exposure. EUS-guided techniques also allow real-time microscopic examination after target biopsy. Furthermore, many necessary interventions can be done during the same procedure after diagnosis. This article provides an overview of EUS-guided vascular interventions such as variceal, non-variceal bleeding interventions, EUSguided portal vein (PV) access with the formation of an intrahepatic portosystemic shunt, and techniques related to diagnosis of GI malignancies. Furthermore, we discuss current insights and future outlook of therapeutic modalities like PV embolization, PV sampling, angiography, drug administration, and portal pressure measurement.

Keywords: Endoscopic ultrasound; Vascular intervention; Esophageal varices; Gastric varices; Portal vein; Therapeutic endoscopy

Core Tip: Endoscopic ultrasound (EUS) technology has evolved rapidly in clinical practice, first as merely a diagnostic tool and now a therapeutic modality. EUS-guided interventions involve combining real-time imaging capability with invasive therapeutic interventions. The gastrointestinal (GI) tract has proximity to various vascular structures in the abdomen and mediastinum and thus provides a unique window to access these structures with EUS to render EUS-guided vascular interventions. Herein, this article provides an overview of EUS-guided vascular interventions for GI bleeding, portal vein access, and therapeutic implications, tumor diagnosis, and access to non-GI structures.