Endoscopic Ultrasonography In Portal Hypertension

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. I N T R O D U C T I O N Over the past two decades, endoscopic ultrasonography (EUS) has undergone a transition from being a novel imaging technique to becoming a clinical diagnostic test that is necessary for the optimal management of gastrointestinal diseases. Along with established clinical indications, such as gastrointestinal and pancreatic tumor staging, differential diagnosis of submucosal lesions, evaluation of solid and cystic pancreatic masses, detection of lymph nodes and fine needle aspiration (FNA), new applications have been suggested. Of great interest has been the effort of endosonographers to define a clinical role for EUS in portal hypertension. Since its first use in the assessment of patients with portal hypertension in the mid-1980s [1], many conflicting studies have been published. Nowadays, EUS has an established role in diagnosing varices and portal hypertension, and assessing the risk of recurrent varices and variceal hemorrhage as well as in evaluating the success of pharmacologic, endoscopic and shunt therapy for portal hypertension. REVIEW Institut Paoli-Calmettes, Marseille, France, 2 Department of Gastroenterology, Åvangelismos Hospital, Athens, Greece HOSPITAL CHRONICLES 2006, 1(1): 36–41 Address for correspondence: Christina Bergele, MD, Gastroenterologist, 5, Nafpaktias Str., Agia Paraskevi 153 41, Tel. (Mobile): 6944 961836 e-mail: [email protected]