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. 2025 Apr;45(4):e16176.
doi: 10.1111/liv.16176. Epub 2024 Nov 27.

The Role of Endoscopic Ultrasound in Assessing Portal Hypertension: A State-of-the-Art Literature Review and Evolving Perspectives

Fabrizio Termite  1 , Federica Borrelli de Andreis  1   2   3 , Antonio Liguori  1 , Antonio Gasbarrini  1   4 , Fabia Attili  1   2 , Cristiano Spada  1   2 , Luca Miele  1   4
Affiliations

The Role of Endoscopic Ultrasound in Assessing Portal Hypertension: A State-of-the-Art Literature Review and Evolving Perspectives

Fabrizio Termite et al. Liver Int. 2025 Apr.

Abstract

Background: Portal hypertension (PH) is a critical complication in patients with hepatic diseases. Its accurate evaluation is essential for early diagnosis, risk stratification, and management. Endoscopic ultrasound (EUS) has emerged as a promising diagnostic tool, offering high-resolution imaging of the portal venous system, hepatic vasculature, and surrounding structures.

Aims: This review aims at providing an overview of the evolving role of EUS in PH evaluation in patients with liver disease.

Materials and methods: A systematic search was conducted in PubMed and Google Scholar until 31 May 2024. Relevant studies were identified using keywords related to EUS and PH. Additional references were included based on expert knowledge and citation analysis. Only full-length papers and abstracts in English were considered.

Results: EUS demonstrates significant utility in PH assessment, offering high-resolution imaging and advanced tools like contrast enhancement (CE) and shear-wave elastography (SWE) for evaluating liver stiffness and correlating it with PH severity. EUS-guided portal pressure gradient (PPG) measurement provides a less invasive method for evaluating PH, potentially offering a safer alternative to conventional techniques.

Discussion: EUS offers unique advantages in PH assessment, enabling comprehensive evaluation in a single session. Despite its potential, limitations such as invasiveness, sedation-related variability, and restricted availability persist. Emerging techniques require further validation in larger cohorts and standardised training.

Conclusion: EUS is a valuable diagnostic tool for PH evaluation, with the potential to improve outcomes through earlier diagnosis and better stratification. Addressing its limitations through further research and standardised protocols is critical to optimize its clinical utility.

Trial registration: NCT04115046, NCT05728697, NCT05097963 and NCT03155282.

Keywords: chronic liver disease; endoscopic ultrasound; portal hypertension.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Graphical abstract on the role of endoscopic ultrasound in the assessment of portal hypertension. PH, portal hypertension; PPG, portal pressure gradient.
FIGURE 2
FIGURE 2
Evaluation of perforating vessels of the gastric wall on colour Doppler during endoscopic ultrasound in a patient with liver cirrhosis and portal hypertension.
FIGURE 3
FIGURE 3
Endoscopic ultrasound image of the hepatic left lobe in liver cirrhosis. The image is obtained from the cardial region.
See this image and copyright information in PMC

References

    1. Mendes F. D., Suzuki A., Sanderson S. O., Lindor K. D., and Angulo P., “Prevalence and Indicators of Portal Hypertension in Patients With Nonalcoholic Fatty Liver Disease,” Clinical Gastroenterology and Hepatology 10 (2012): 1028–1033.e2. - PMC - PubMed
    1. Rinella M. E., Lazarus J. V., Ratziu V., et al., “A Multi‐Society Delphi Consensus Statement on New Fatty Liver Disease Nomenclature,” Annals of Hepatology 101133 (2023): E93–E94. - PubMed
    1. Targher G., Bertolini L., Poli F., et al., “Nonalcoholic Fatty Liver Disease and Risk of Future Cardiovascular Events Among Type 2 Diabetic Patients,” Diabetes 54 (2005): 3541–3546. - PubMed
    1. Sauerbruch T., Schierwagen R., and Trebicka J., “Managing Portal Hypertension in Patients With Liver Cirrhosis,” F1000Res 7 (2018): F1000 Faculty Rev‐533. - PMC - PubMed
    1. de Franchis R., Bosch J., Garcia‐Tsao G., et al., “Baveno VII—Renewing Consensus in Portal Hypertension,” Journal of Hepatology 76 (2022): 959–974. - PMC - PubMed

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