EUS in portal hypertension

Authors Christine Bergele, A. Avgerinos.


Endoscopic ultrasonography (EUS) has recently emerged
as a most accurate, less invasive and easily repeatable alternative
means of providing data on patients with portal
hypertension. 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 has
allowed sonographic visualization of the vessels, playing
an important role in cirrhotic patients, together with the
performance of hemodynamic studies. It has thus become
feasible, not only to assess the vascular blood flow, but also
to evaluate possible morphologic and hemodynamic changes
in the vessels after endoscopic or pharmacologic therapy.
It is obvious nowadays that EUS is an exciting technological
advance that has established its position in the diagnosis
of varices and cirrhosis; what lies ahead is for EUS to find
a definite application in predicting the risk of variceal
bleeding and in the management of portal hypertension.
Key words: EUS, portal hypertension, gastroesophageal
varices, variceal reccurence, rebleeding, venous blood flow