Madhankumar S, Chuy DS, Hillman I, Thimirisetty S, Amara A, Tadros M. Portal hypertension in the era of endo-hepatology: Emerging diagnostic and therapeutic roles of endoscopy and endoscopic ultrasound. World J Gastrointest Endosc 2026; 18(7): 122980 [DOI: 10.4253/wjge.122980]
Corresponding Author of This Article
Savita Madhankumar, BA, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, United States. madhans@amc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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Madhankumar S, Chuy DS, Hillman I, Thimirisetty S, Amara A, Tadros M. Portal hypertension in the era of endo-hepatology: Emerging diagnostic and therapeutic roles of endoscopy and endoscopic ultrasound. World J Gastrointest Endosc 2026; 18(7): 122980 [DOI: 10.4253/wjge.122980]
Savita Madhankumar, Isabella Hillman, Saikalyan Thimirisetty, Anokhi Amara, Albany Medical College, Albany, NY 12208, United States
Dareen S Chuy, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Micheal Tadros, Department of Gastroenterology and Hepatology, Albany Medical Center, Albany, NY 12208, United States
Co-corresponding authors: Savita Madhankumar and Micheal Tadros.
Author contributions: Tadros M and Madhankumar S designed the research study and led the project; Madhankumar S, Chuy DS, Hillman I, Thimirisetty S and Amara A analyzed and interpreted the data; Madhankumar S, Chuy DS, Hillman I, Thimirisetty S and Amara A drafted the manuscript; Tadros M and Madhankumar S performed critical revision of the manuscript for important intellectual content; Madhankumar S, Chuy DS, Hillman I, Thimirisetty S and Amara A performed substantive revisions and editing of the manuscript; Madhankumar S and Tadros M supervised the study; and all authors have made significant contributions to this study and have approved the final manuscript.
AI contribution statement: AI-assisted tools (ChatGPT) were used only for minor editorial revisions, including grammar and language refinement. All scientific content, interpretation, and final approval were performed by the authors.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Savita Madhankumar, BA, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, United States. madhans@amc.edu
Received: May 7, 2026 Revised: June 29, 2026 Accepted: July 8, 2026 Published online: July 16, 2026 Processing time: 73 Days and 2.4 Hours
Abstract
Portal hypertension is a major complication of chronic liver disease and cirrhosis, causing significant morbidity and mortality through gastroesophageal varices, portal hypertensive gastropathy (PHG), and variceal hemorrhage. Although endoscopy has long been central to diagnosing and treating these complications, advances in endoscopic ultrasound (EUS) have expanded its role and given rise to the novel field of endo-hepatology, an evolving paradigm in which advanced EUS techniques transform endoscopy from a primarily therapeutic tool for variceal hemorrhage into an integrated platform for hemodynamic assessment, tissue characterization, and targeted intervention within a single session. A comprehensive narrative review of the literature was conducted to summarize both established and novel endoscopic approaches to portal hypertension management, including their indications, advantages, limitations, and integration with risk stratification tools, pharmacologic therapies, and multidisciplinary care pathways. Conventional modalities, including endoscopic variceal ligation, sclerotherapy, cyanoacrylate injection, and argon plasma coagulation, remain essential for managing esophageal and gastric varices and PHG. Newer EUS-based techniques, including EUS-guided coil and glue therapy, portal pressure gradient measurement, and liver biopsy, provide complementary approaches that enable more precise hemodynamic assessment and targeted intervention. These advances illustrate the transition from conventional bleeding-focused endoscopic management to an integrated endo-hepatology platform that supports personalized management of portal hypertension. Further studies are needed to define optimal patient selection, comparative effectiveness, and long-term outcomes.
Core Tip: Endoscopy is expanding beyond its traditional hemostatic role in portal hypertension into an integrated tool that expands its clinical potential. Advances in endoscopic ultrasound-based procedures allow for a comprehensive single-session evaluation of disease severity and bleeding risk. This endo-hepatology approach facilitates risk stratification and more informed clinical decision-making and a shift toward more personalized care in patients with chronic liver disease.
