Endoscopic ultrasonography (EUS) in portal hypertension

Although the first studies on EUS in portal hypertension are by now dated approximately 20 years ago, this method still has not become a routine examination among the diagnostic and therapeutic examinations in this field. EUS has an important role in the following applications: early diagnosis of esophageal and gastric varices and of hypertensive gastropathy, screening of subjects to treat medically, endoscopically or surgically, and their follow-up, EUS-guided injection therapy of varices. Several papers have confirmed and/or added important clinical applications to the EUS use in such patients. In fact, if at the beginnig the studies were concentrated on the best way to show varices compared to the endoscopic examination, or on aspects still unknown such as the presence of periesophageal veins and collaterals increased in number and diameter, at present sophisticated instruments with several types of Doppler and therapeutic possibilities are available. The observation of perforating veins under the esophagogastric junction seems to have a particular clinical interest having a predictive value on the effectiveness of the sclerotherapy and therefore on the final eradication. Also the several instrumentations used can modify the

Using the high frequencies EUS miniprobes, the sensibility in identifying even the minimal or initial varices increases. In the evaluation of the pharmacological therapy, EUS with the new instruments equipped with color Doppler can be very useful and can replace other diagnostic methods very invasive and dangerous and thus used only in highly specialized centers. As to the nursing aspect of EUS in portal hypertension, it must be underlined that such pathology is often the consequence of viral hepatitis infection. Therefore, beside a correct clinical evaluationl before endoscopic ultrasound examination, all devices, drugs and anything else could be be necessary to complete with success an intervention, e.g. sclerotherapy in emergency, should be prepared in advance.