Endohepatology – current status

Abstract

Purpose of reviewThis article discusses the most recent studies regarding the emerging field of endohepatology – the use of diagnostic and therapeutic endoscopic tools for the management of patients with liver disease and portal hypertension.Recent findingsNew research has shown that liver biopsy specimens obtained by each Endoscopic ultrasound (EUS)-guidance, the percutaneous approach, and the transjugular approach contained sufficient portal triads to adequately analyzed by experienced pathologists – suggesting that any of these routes of liver biopsy is clinically acceptable; further, all had similar rates of adverse events. An initial prospective study showed that EUS guided portal pressure measurement was safe, effective, and accurate. A recent metanalysis showed that EUS-guided cyanoacrylate injection and coil embolization was statistically more efficacious and with less complications than EUS guided cyanoacrylate injection and EUS guided coil injection alone, suggesting that combination therapy appears to be the preferred approach for gastric varices (GV) bleeding. A prospective study evaluating focal liver lesions showed that the use of artificial intelligence had up to 100% sensitivity and 81% specificity for identifying malignant focal liver lesions.SummaryEUS guided liver biopsy is safe and enables accurate diagnosis of underlying liver disease. EUS guided portal pressure measurement is also safe and is accurate. Combination therapy of EUS guided cyanoacrylate injection and coil embolization is more efficacious and has less complications than injection or coil therapy alone when used for GV bleeding. Artificial intelligence is highly sensitive and specific when used in conjunction with EUS in the diagnosis of malignant focal liver lesions. Endohepatology is a rapidly expanding field with great potential.

Endohepatology: More progress but not yet ready for prime time

“…This emerging field has been termed endohepatology. 3 The feasibility and accuracy of performing EUS-guided portal pressure gradient measurement (PPG) using a 25G needle and compact manometer was first evaluated in a porcine model and it demonstrated excellent correlation with the standard transjugular method. 4 The results of the first human pilot study with a cohort of 28 patients was published in 2017, with 100% technical success and no adverse events.…”

“…There is growing interest in the use of endoscopic ultrasound (EUS) for diagnostic and therapeutic interventions in patients with portal hypertension because both the liver parenchyma and portal system are well visualized by EUS. This emerging field has been termed endohepatology 3 …”

Endo-hepatology: Updates for the clinical hepatologist

“…Endo-hepatology is an emerging field in which diagnostic and therapeutic endoscopic ultrasound (EUS) techniques are used to assist in the diagnosis and management of acute or chronic liver diseases. [1][2][3] Endo-hepatology provides the opportunity to complete diagnostic and therapeutic procedures in one encounter for patients with liver disease. [2,4,5] As with any diagnostic and/or therapeutic intervention, the clinician should recognize the advantages and limitations of EUS-guided techniques and how they compare with, and potentially transform, the current standard of care.…”

“…[1][2][3] Endo-hepatology provides the opportunity to complete diagnostic and therapeutic procedures in one encounter for patients with liver disease. [2,4,5] As with any diagnostic and/or therapeutic intervention, the clinician should recognize the advantages and limitations of EUS-guided techniques and how they compare with, and potentially transform, the current standard of care. With increasing interest in endohepatology, hepatologists should be familiar with the many potential applications; 2 of which will be critically reviewed herein: EUS-portosystemic pressure gradient measurements and EUS-guided liver biopsies; and a brief mention of EUS-guided elastography.…”

Endoscopic Ultrasound-Guided Fine-Needle Biopsy versus Fine-Needle Aspiration in the Diagnosis of Focal Liver Lesions: Prospective Head-to-Head Comparison

“…Focal liver lesions require histological and immunohistochemical diagnosis for appropriate treatment, especially in the context of malignant disease. Endosonography (EUS) can visualize hepatic lesions <1 cm, which were not identified by cross-sectional imaging, especially during staging for digestive cancers, although it is limited to the left lobe and the proximal region of the right lobe [ 1 ].…”