Endoscopic ultrasound in the management of complications related to cirrhosis- recent evidence

Abstract

Advanced endoscopic methods like endoscopic ultrasound (EUS) have recently been applied for the management of complications related to cirrhosis. This includes novel techniques to measure portal pressure gradients, esophageal, gastric, and ectopic varices management, and EUS-assisted treatment of liver tumors. Management of liver tumors has seen significant changes in recent years, and many minimally invasive procedures have been approved, especially in the management of liver cell carcinoma. These are specialized procedures and are performed only in patients with cirrhosis in specialized centers. There are concerns for complications in patients with cirrhosis due to their increased risk of bleeding and the altered hemostatic milieu. This minireview summarizes the recent evidence on using EUS in the management of cirrhosis-related complications.

Keywords: Endoscopic ultrasound; Cirrhosis; Endohepatology; Gastric varices; Portal hypertension; Liver biopsy; Liver tumor

Core Tip: This minireview discusses various applications of endoscopic ultrasound (EUS)-guided interventions in managing cirrhosis and its complications. We describe updates on the EUS-guided diagnosis and treatment of conditions such as portal hypertension, esophageal and gastric varices, liver biopsy, antitumoral interventions, caudate lobe ablation and sampling, and other indications of EUS-guided procedures, and compare them to the current standards of care. Additionally, we discuss the potential future uses of EUS-guided management, which is currently in its infancy, including antitumoral interventions and the application of artificial intelligence.