Endoscopic ultrasound in the diagnosis and treatment of upper digestive bleeding: a useful tool

The use of endoscopic ultrasound (EUS) in identifying the causes of upper digestive bleeding is less individualised. EUS can find the small vessel responsible for intermittent active bleeding in case of Dieulafoy ulcer or for discriminating it from vascular abnormalities. The EUS diagnosis of portal hypertension has to describe esophageal and gastric varices, perforant and paraesophageal veins, dilatations of the azygos, portal, superior mesenteric vein and splenic vein. Few studies have involved EUS in the prediction of variceal bleeding and variceal bleeding recurrence, and in the guided therapy of gastric varices or submucosal gastric neoplasms. The EUS aspect of hemobilia is that of an enlarged inhomogeneous common bile duct, without a Doppler signal, and the origin of the bleeding can be identified as a biliary tumor, bile duct stone or vascular abnormality. The EUS image of the pseudoaneurysm responsible for hemosuccus pancreaticus is that of a cystic lesion with Doppler signal; sometimes, a pseudoaneurysm can be found to communicate with a blood vessel and EUS-guided therapies have been reported. Despite the limitations of the current devices and accessories, EUS has established its place among the endoscopic and radiologic tools. However, rational patient selection is mandatory.