Usefulness of endoscopic ultrasonography in hepatology

Abstract

Endoscopic ultrasonography (EUS) is used to evaluate patients with hepatobiliary diseases. The technique is useful for the diagnosis of esogastric varices in selected cases of portal hypertension, and to evaluate the pathogenic role and prognostic value of the collateral circulation in patients with this condition. When coupled with the Doppler technique, EUS can be used to guide injection sclerotherapy and to verify the obliteration of varices (particularly fundal varices) after endoscopic treatment. Hemodynamic changes induced in the collateral circulation by vasoactive drugs can also be measured with Doppler-EUS. Fine-needle aspiration under EUS guidance is useful in the diagnosis of focal liver lesions and perihepatic adenopathy, and in the evaluation of biliary tract diseases. New indications can be developed in the future after adequate experimental validation.

Figure 1

Endoscopic image of gastric varices (GV)

Figure 2

Left panel Perigastric portal hypertension. Endoscopic ultrasound with Doppler array showing a paragastric collateral vein (A), perigastric collateral vein (B) and gastric varices (C). The gastric varices are located in the submucosa, which corresponds to the hyperechoic layer surrounded by adjacent hypoechoic layers (mucosa and muscularis propria [MP]). Right panel Perforating vein. Endoscopic ultrasound with Doppler array showing a large perigastric collateral vein perforating (thick arrow) the MP of the gastric wall (thin arrows), leading to a significant submucosal varix

Figure 3

Evaluation of portal vein patency. Endoscopic ultrasound with Doppler array showing a subtotal portal vein (PV) obstruction, with minimal peripheral intravascular flow (thin arrows). There are concomitant periduodenal collateral veins (thick arrows)