Endo-Hepatology: Paradigm Shift in Endosonographic Diagnosis for Liver Disease to Digestive Endoscopy

Assessment of liver disease has traditionally relied on a fragmented approach involving cross-sectional imaging, noninvasive fibrosis assessment, liver biopsy, and endoscopy for complications of portal hypertension. Although effective, this strategy often requires multiple procedures and lacks integration. Advances in endoscopic ultrasound (EUS) have led to the emergence of endo-hepatology, an integrated model enabling comprehensive evaluation and management of liver disease within a single endoscopic platform. This review highlights recent advances in endo-hepatology and the expanding diagnostic and therapeutic roles of EUS. High-resolution EUS imaging, enhanced by contrast-enhanced harmonic techniques, improves detection and characterization of focal liver lesions, including early hepatocellular carcinoma and small metastases. EUS-guided liver biopsy is a safe and effective alternative to percutaneous and transjugular approaches, providing high-quality tissue acquisition from both hepatic lobes. EUS-guided shear wave elastography allows accurate fibrosis assessment in patients with obesity or ascites, overcoming limitations of transabdominal techniques. EUS-guided portal pressure gradient measurement offers direct assessment of portal hypertension without radiation or contrast exposure. Therapeutic EUS applications, including coil and glue therapy for gastric varices and emerging locoregional treatments for liver tumors, offer minimally invasive options in selected patients. Collectively, these advances support EUS as a potential "one-stop" modality for liver disease assessment and management. As evidence continues to accumulate, endo-hepatology is likely to assume an increasingly central role in modern hepatology practice.