Endohepatology: Evolving Indications, Challenges, Unmet Needs and Opportunities

Endohepatology provides a unison of 2 rapidly developing fields of hepatology and advanced endoscopy. Conventionally, endoscopy in liver disease was restricted primarily to the management of varices. However, multiple new domains have emerged in advanced endoscopy, driven mainly by endoscopic ultrasound (EUS), and as such find several applications in clinical hepatology. Robust data have emerged regarding EUS liver biopsy and the management of gastric varices, and are becoming the first line of care at experienced centers. EUS-guided portal pressure gradient and direct measurements appear to be an exciting frontier for portal pressure assessment. EUS shear wave elastography holds promise but needs standardization and comparison to well-established noninvasive surrogates. Endobariatrics opens up new avenues in optimizing comprehensive obesity management. Interesting crossroads emerge in liver transplantation, where endohepatology may provide a unique single setting investigation and therapeutic solution. Several other potential uses are emerging but need to be replicated across settings. While the advancements usher in excitement, several gaps in knowledge and pragmatic concerns remain with the application of endohepatology, which need to be balanced against patient safety and in optimizing outcomes.