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

Table 1 Characteristics of the included studies on endoscopic ultrasound-guided portal pressure measurement

Ref.	Type of study	Number of studies included in manuscript	Country	Number of patients	Mean age (years)	Male/female	Comments/major findings
Laleman et al[2]	Review	20	United States	N/A	N/A	N/A	EUS-guided portal pressure measurement viable alternative for HVPG
Kolb et al[4]	Retrospective	1	United States	385	57.23	188/197 (51.2)	First multicenter study evaluating EUS-guided portal pressure measurement
Huang et al[5]	Prospective	1	United States	28	63	18/10 (36)	EUS-portal pressure gradient measurement showing 100% success and no adverse events
Laleman et al[6]	Review	135	United States	N/A	N/A	N/A	Suggests EUS-guided portal pressure gradient measurement is adequate alternative to hepatic vein catheterization
Choi et al[7]	Retrospective	1	United States	64	57.5	40/25 (37.5)	EUS-guided portal pressure gradient measurements have excellent correlation with histological hepatic fibrosis stage
Hajifathalian et al[8]	Prospective	1	United States	24	53	5/19 (79)	EUS-guided portosystemic pressure gradient combined with EUS-guided liver biopsy feasible, safe, accurate
Choi et al[9]	Retrospective	1	United States	83	59.4	51/32 (39)	Larger retrospective study showing EUS-guided portal pressure gradient measurement showing gradient was higher in patients with cirrhotic features
Zhang et al[10]	Prospective	1	China	12	63	9/3 (25)	EUS-guided portal pressure gradient measurement using 22-gauge fine-needle aspiration safe and accurate
Gadour et al[11]	Systematic review and meta-analysis	45	10 countries worldwide	N/A	N/A	N/A	Meta-analysis showing success rate of over 95% of EUS-guided portal pressure gradient measurement
Vanderschueren et al[12]	Prospective	Recruiting	Pending	Recruiting	Pending	Pending	Active study to evaluating head-to-head comparison of HVPG and EUS-guided portal pressure measurement

EUS: Endoscopic ultrasound; HVPG: Hepatic venous pressure gradient; N/A: Not available.

Table 2 Summarized version of the endoscopic ultrasound-guided portal pressure gradient measurement technique proposed by Laleman et al[2]

General technical steps in performing EUS-guided portal pressure gradient measurement
Survey liver on EUS for potential focal lesions and blunting of liver edge, liver echotexture, gastric varices, and flow in portal and splenic veins
EUS-shear wave elastography then used over left lobe of liver, spleen and then right lobe of liver from duodenum
Best vessel chosen and pulse wave doppler used to confirm. Listen for continuous hum of the portal vein
Typically, middle hepatic vein and left portal vein chosen
Pressure gauge and 25-gauge needle device primed with saline or heparinized saline, manometer placed at phlebostatic axis (4th intercostal space, approximately at level of R atrium)
Needle is then guided through parenchyma to vessel. Enter hepatic vein 2 cm from inferior vena cava convergence
Flush needle with saline, then watch pressure gauge rise until reaches steady state for 1 minute
Measurement repeated until 3 consecutive pressures are close together
Average is the mean hepatic vein pressure
Withdraw needle and apply doppler to ensure there is no hemorrhage
Repeat for portal vein

EUS: Endoscopic ultrasound.

Table 3 Characteristics of the included studies on endoscopic ultrasound management of gastric, gastroesophageal and ectopic varices

Ref.	Type of study	Number of studies included in manuscript	Country	Number of patients	Mean age (years)	Male/female	Comments/major findings
Dragomir et al[14]	Systematic review	23	N/A	N/A	N/A	N/A	EUS more reliable than conventional endoscopy for treatment of GV
Yang et al[15]	Systematic review	23	China	N/A	N/A	N/A	Outlines and recommends different EUS-guided variceal management techniques
Bahdi et al[16]	Prospective	1	United States	1	41	1/0 (0)	Successful outcome in EUS-guided coiling and cyanoacrylate injection of ectopic duodenal varices
Huang et al[5]	Prospective	1	United States	28	63	28/10 (36)	Data regarding EUS diagnosis of varices
Rudnick et al[17]	Systematic review	32	United States	N/A	N/A	N/A	Overall clinical success of EUS-guided GV therapies 100%, adverse event rated of 14%
Sarin et al[18]	Prospective	1	India	37	34.5, 36.1	37/10 (27.1)	EUS-guided cyanoacrylate is more effective for treatment of GV than sclerotherapy with alcohol
O’Rourke et al[20]	Retrospective	1	United Kingdom	20	59	20/9 (55)	EUS-guided GV obliteration with coil placement and thrombin is safe with acceptable medium-term efficacy
Liu et al[19]	Prospective	3	China	3	49.3	2/1 (33.3)	Three cases with successful outcomes of endoscopic sclerotherapy for jejunal ectopic varices
Robles-Medranda et al[21]	Prospective	1	Equador	60	61.8, 61.6	16/14 (46.7), 19/11 (36.7)	EUS-guided coil embolization with cyanoacrylate injection superior to coil treatment alone

EUS: Endoscopic ultrasound; GV: Gastric varices; N/A: Not available.

Table 4 Characteristics of the included studies on endoscopic ultrasound-assisted liver biopsy and treatment of liver tumors

Ref.	Type of study	Number of studies included in manuscript	Number of patients	Mean age (years)	Male/female	Comments/ major findings
Rudnick et al[17]	Systematic review	32	N/A	N/A	N/A	EUS-guided liver biopsy is a good alternative to percutaneous or transjugular biopsy, allows for biopsies of both lobes
Arruda do Espirito Santo et al[24]	Systematic review and meta-analysis	4	258	N/A	N/A	EUS-guided liver biopsy is safe and effective as percutaneous liver biopsy and has lower post-procedure pain
McCarty et al[26]	Systematic review and meta-analysis	5	656	51.62	298/368 (56.1)	EUS-guided liver biopsy is comparable to percutaneous and transjugular liver biopsy in specimens obtained and safety

EUS: Endoscopic ultrasound; N/A: Not available.

Table 5 Characteristics of the included studies on endoscopic ultrasound-guided caudate lobe ablation and sampling

Ref.	Type of study	Study setting	Country	Number of patients	Mean age (years)	Male/female	Comments/major findings
De et al[27]	Prospective	Single center	India	1	64	1/0 (0)	Complete ablation of small caudate lobe tumor using EUS-guided radiofrequency ablation
Attili et al[28]	Prospective	Single center	Italy	1	75	1/0 (0)	First documented case of EUS-guided caudate lobe tumor ablation
Katrevula et al[29]	Prospective	Single center	India	1	48	1/0 (0)	Successful ablation of caudate lobe tumor using EUS-guided radiofrequency ablation
de Nucci et al[30]	Prospective	Single center	Italy	10	78.6	5/5 (50)	Case series detailing EUS-guided caudate lobe tumor ablation of larger tumor

EUS: Endoscopic ultrasound.

Table 6 Characteristics of the included studies on other endoscopic ultrasound-guided procedures and indications

Ref.	Topic	Type of study	Number of studies included in manuscript	Country	Number of patients	Mean age (years)	Male/female	Comments/major findings
Nimri et al[33]	EUS-LAMS	Retrospective	1	International	43	58.4	22/21 (49)	EUS-LAMS deployment resulted in mainly mild adverse events
Wilson et al[34]	EUS-guided cholecystojejunostomy	Prospective	1	United States	1	Unknown	0/1 (100)	Suggests that EUS-guided placement of chlecystojejunostomy LAMS may offer effective management of acute cholecystitis
Garg et al[35]	EUS-guided gallbladder drainage	Retrospective	1	United States, Spain	170	66.5 (cirrhosis), 71.3 (no cirrhosis)	29/18 (38.3) (cirrhosis), 68/55 (44.7) (no cirrhosis)	EUS-guided gallbladder drainage is effective in cirrhotic patients with a similar adverse event profile to non-cirrhotic patients
Lisotti et al[36]	EUS-guided elastography	Systematic review	14	N/A	52	Unknown	Unknown	Reviews and highlights potential benefits of EUS-guided elastography
AbiMansour et al[37]	EUS-guided shear wave elastography	Prospective	1	United States	256	54.5	144/112 (43.8)	EUS-guided shear wave elastography shows reliability in detecting liver stiffness
Wang et al[38]	EUS-guided shear wave elastography	Cross-sectional	1	United States	62	49.2	20/42 (66.7)	EUS-guided shear wave elastography is superior to Fibrosis-4 Index and vibration-controlled transient elastography
Diehl et al[39]	EUS-guided shear wave elastography	Prospective	1	United States	52	48.4	20/32 (61.5)	EUS-guided shear wave elastography is less accurate in the left lobe and overall comparable to vibration-controlled transient elastography
Fujii-Lau et al[40]	EUS-derived criteria for benign vs malignant hepatic masses	Retrospective	1	United States	332	64	199/133 (40)	Introduces EUS scoring system to distinguish benign from malignant hepatic masses
Nakai et al[41]	EUS-guided liver biopsy	Prospective	1	Japan	17	64	12/5 (29)	EUS-guided liver biopsy is safe and feasible
Laleman et al[42]	EUS-guided shunt obliteration and EUS-guided intrahepatic portosystemic shunt	Review	45	Unknown	N/A	N/A	N/A	Details future potential for intrahepatic portosystemic shunt
Rathi et al[43]	EUS-guided shunt obliteration	Prospective	1	India	7	54.3	Unknown	Shows technical success in EUS-guided transgastric shunt obliteration
Buscaglia et al[44]	EUS-guided intrahepatic portosystemic shunt	Prospective	1	United States	Pigs	N/A	N/A	EUS-guided intrahepatic portosystemic shunt is feasible and an alternative to transjugular intrahepatic portosystemic shunt

EUS: Endoscopic ultrasound; LAMS: Lumen-apposing metal stent; N/A: Not available.

Table 7 Characteristics of the included studies on safety profiles of endoscopic ultrasound procedures in cirrhosis

Ref.	Topic	Type of study	Number of studies included in manuscript	Country	Number of patients	Mean age (years)	Male/female	Comments/major findings
Facciorusso et al[45]	Safety of EUS-guided fine needle aspiration	Retrospective	1	Italy	190	64	114/76 (40)	The rate of adverse events of EUS-guided fine needle aspiration is higher in cirrhotic patients
Garg et al[35]	Safety of EUS-guided gallbladder drainage	Retrospective	1	United States, Spain	170	66.5 (cirrhosis), 71.3 (no cirrhosis)	29/18 (38.3) (cirrhosis), 68/55 (44.7) (no cirrhosis)	Similar adverse events were seen in cirrhotic patients vs non-cirrhotic patients in EUS-guided gallbladder drainage
Gadour et al[11]	Safety of EUS-guided liver abscess drainage and GV management	Systematic review and meta-analysis	45	10 countries worldwide	N/A	N/A	N/A	EUS-guided GV management and liver biopsy have low complication rates
Choi et al[9]	Safety of EUS-guided portal pressure gradient measurement and liver biopsy	Retrospective	1	United States	83	59.4	51/32 (39)	Demonstrated no adverse events in EUS-guided portal pressure gradient measurement and liver biopsy

EUS: Endoscopic ultrasound; GV: Gastric varices.