Endoscopic Ultrasonography In Portal Hypertension

Abstract

Endoscopic ultrasonography (EUS) has recently emerged as an alternative means of providing data for patients with portal hypertension that is more accurate, less invasive and reproducible. It is well established that video-echo endoscopy, with combined endoscopic and sonographic examination, is comparable to endoscopy in diagnosing esophageal varices, but is more sensitive in diagnosing the presence of gastric varices. Dilated venous abnormalities outside the gastroesophageal lumen, which cannot be diagnosed by endoscopy, are readily visible by means of EUS or miniature probes. In the clinical setting of portal hypertension, endoscopic ultrasonography is also useful to predict the risk of variceal recurrence or rebleeding, which cannot be reliably predicted using endoscopy alone. The introduction of echo endoscopes equipped with Doppler facilities together with the performance of haemodynamic studies has allowed sonographic visualization of the vessels, playing thus an important role in the management of cirrhotic patients. It has thus become feasible not only to assess the vascular blood flow but also to evaluate possible morphologic and haemodynamic changes of the vessels after endoscopic or pharmacologic therapy. It is, nowadays, obvious that EUS is an exciting technological advance that has established its position in the diagnosis of varices and cirrhosis; what lies ahead for EUS is to positively find application in predicting the risk of variceal bleeding and in managing portal hypertension.