Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Endoscopic ultrasound(EUS)has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal(GI)diseases.The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions.EUS provides important clinical and anatomical information related to the vessels'size,appearance and location.Its excellent spatial resolution,use of colour doppler with or without contrast enhancement and ability to provide images“real-time”helps in precision while intervening vascular structures.Additionally,structures such as venous collaterals or varices can be dealt with optimally using EUS.EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension.It also helps to avoid radiation exposure in addition to being minimally invasive.These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions.EUS-guided portal vein(PV)access and therapy is a new kid on the block.EUS-guided portal pressure gradient measurement,injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology.Lastly,EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus.Herein,we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding,portal vein access and its related therapeutic interventions,cardiac access,and therapy.A synopsis of all the technical details involving each procedure and the available data has been tabulated,and the future trends in this area have been highlighted.

Role of endoscopic ultrasound in the field of hepatology: Recent advances and future trends

The role of endoscopic ultrasound(EUS)as a diagnostic and therapeutic modality for the management of various gastrointestinal diseases has been expanding.The imaging or intervention for various liver diseases has primarily been the domain of radiologists.With the advances in EUS,the domain of endosonologists is rapidly expanding in the field of hepatology.The ability to combine endoscopy and sonography in one hybrid device is a unique property of EUS,together with the ability to bring its probe/transducer near the liver,the area of interest.Its excellent spatial resolution and ability to provide real-time images coupled with several enhancement techniques,such as contrast-enhanced(CE)EUS,have facilitated the growth of EUS.The concept of“Endo-hepatology”encompasses the wide range of diagnostic and therapeutic procedures that are now gradually becoming feasible for managing various liver diseases.Diagnostic advancements can enable a wide array of techniques from elastography and liver biopsy for liver parenchymal diseases,to CE-EUS for focal liver lesions to portal pressure measurements for managing various liver conditions.Similarly,therapeutic advancements range from EUS-guided eradication of varices,drainage of bilomas and abscesses to various EUS-guided modalities of liver tumor management.We provide a comprehensive review of all the different diagnostic and therapeutic EUS modalities available for the management of various liver diseases.A synopsis of all the technical details involving each procedure and the available data has been tabulated,and the future trends in this area have been highlighted.