Endoscopic ultrasound-guided vascular intervention for portal hypertension

ABSTRACT

As endoscopic ultrasound (EUS) equipment improves, the diagnostic and therapeutic applications of EUS in patients with portal hypertension (pHTN) have been increasingly explored. Various EUS-guided vascular interventions for pHTN have been evaluated in human or animal studies. EUS has been shown to be useful in variceal and perforating feeding veins identification, prediction of variceal recurrence/rebleeding, and assessment of response to pharmacological therapy for pHTN. When compared to conventional endoscopic therapies, EUS-guided therapy for varices and/or perforating feeding veins can ensure intra-variceal delivery of injection therapy, allow real-time monitoring of variceal obliteration, and provide injection therapy under pure EUS guidance when the target varix is endoscopically obscured. While the feasibility of EUS-guided assessment of portal hemodynamics and creation of intrahepatic portosystemic shunt has been evaluated, further studies would be needed to assess the long term outcomes before routine application.