Recent Development of Endo-hepatology

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy
• Medical Imaging

Background:

• Endo-hepatology, emerging in 2012, utilizes endoscopic ultrasound (EUS) for diagnosing and treating hepatobiliary diseases.
• Advances in interventional EUS have significantly expanded the field's capabilities.
• A 2024 review broadened the scope to include advanced imaging and endoscopic retrograde cholangiopancreatography.

Purpose of the Study:

• To review the diagnostic and therapeutic applications of endo-hepatology in managing portal hypertension (PH).
• To highlight the role of EUS-guided porto-systemic pressure gradient measurement (EUS-PPGM) in assessing portal pressure.
• To discuss the integration of diagnostic and therapeutic procedures for comprehensive patient management.

Main Methods:

• Diagnostic applications include EUS-based hemodynamic assessment, elastography, EUS-PPGM, EUS-guided liver biopsy (EUS-LB), and portal vein sampling.
• Therapeutic applications involve EUS-guided embolization, shunt obliteration, radiofrequency ablation, and novel procedures like shunt creation and stenting.
• EUS-PPGM is presented as a direct, minimally invasive method for portal pressure measurement.

Main Results:

• EUS-PPGM shows strong correlation with hepatic venous pressure gradient (HVPG) and may be advantageous in specific PH types.
• EUS-guided interventions, like coil plus cyanoacrylate injection for gastric varices, demonstrate efficacy and safety.
• EUS-LB offers diagnostic accuracy comparable to percutaneous biopsy with reduced pain.

Conclusions:

• Endo-hepatology integrates endoscopy and hepatology, providing comprehensive, minimally invasive management for PH and chronic liver disease.
• The "one-stop" concept allows for simultaneous assessment and treatment within a single endoscopic session.
• EUS-PPGM and other EUS-guided techniques offer personalized treatment strategies for liver conditions.