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Minerva Gastroenterologica e Dietologica 2008 June;54(2):131-9

language: English

Endoscopic ultrasonography in hepatology: focus on portal hypertension

De Angelis C. 1, Pellicano R. 1, Carucci P. 1, Bruno M. 1, Repici A. 2, Goss M. 1, Fagoonee S. 3, Saracco G. 1, Rizzetto M. 1

1 Department of Gastro-Epatology San Giovanni Battista (Molinette) Hospital, Turin, Italy
2 Department of Gastroenterology Humanitas Hospital, Rozzano, Milan, Italy
3 Department of Biology, Biochemistry and Genetics and Molecular Biotechnology Center University of Turin, Turin, Italy


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Portal hypertension (PHT) is more frequently caused by cirrhosis. Increase in portal pressure induces development of collateral circulation with shunting resulting in disturbances such as gastroesophageal varices (GEV). Prevention and therapy of bleeding from GEV are mandatory. Therefore, the diagnosis of PHT represents a crucial step. Endoscopic ultrasound (EUS), with its combination of endoscopic imaging and ultrasonic capabilities, can offer an almost comprehensive evaluation of portal venous system and porto-systemic collateral circulation. The improved endoscopic view of several video-echoendoscopes has filled the gap between EUS and standard video-endoscopy in diagnosing GEV and in assessing endoscopic criteria of bleeding risk. EUS combined with Color-Doppler capabilities are able to provide hemodynamic information. Furthermore, EUS data allow to stratify patients on the basis of PHT severity and first bleeding risk, monitor the results of pharmacologic and/or endoscopic therapy, predict the response to treatment, quantify the risk of variceal recurrence and recurrent bleeding after GEV obliteration and guide or assist EGD therapy. Despite having this amount of information, there is lack of scientific evidence that EUS imaging and EUS-assisted therapy can have a clear-cut clinical impact and affect patients outcome.

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