Role of endoscopic ultrasound in vascular interventions: Where are we now?

Abstract

From a mere diagnostic tool to an imperative treatment modality, endoscopic ultrasound (EUS) has evolved and revolutionized safer efficient options for vascular interventions. Currently it is an alternative treatment option in the management of gastrointestinal bleeding, primarily variceal type bleeding. Conventional treatment option prior to EUS incorporation had limited efficiency and high adverse events. The characterization and detail provided by EUS gives a cutting edge towards a holistically successful management choice. Data indicates that EUS-guided combination therapy of coil embolization and glue injection has the higher efficacy for the treatment of varices. Conversely, similar treatment options that exist for esophageal and other ectopic variceal bleeding was also outlined. In conclusion, many studies refer that a combination therapy of coil and glue injection under EUS guidance provides higher technical success with fewer recurrence and adverse events, making its adaptation in the guideline extremely favorable. Endo-hepatology is a novel disciple with a promising future outlook, we reviewed topics regarding portal vein access, pressure gradient measurement, and thrombus biopsy that are crucial interventions as alternative of radiological procedures. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the role of EUS in vascular interventions. We reviewed the role of EUS in variceal bleeding in recent studies, especially gastric varices and novel approaches aimed at the portal vein.

Keywords: Endoscopic ultrasound; Cyanoacrylate; Coil injection; Gastric varices; Gastrointestinal bleeding; Vascular endoscopic treatments

Core Tip: Currently endoscopic ultrasound (EUS) is an alternative treatment option in the management of gastrointestinal bleeding, primarily variceal type bleeding. This manuscript tackles a comprehensive review for the uses of EUS in the majority of vascular interventions with regard to gastrointestinal bleeding and offers a directive for the technical aspects in carrying out a procedural treatment of combination coil and glue therapy for gastric varices.