Endo‐hepatology: The changing paradigm of endoscopic ultrasound in cirrhosis

Cirrhosis and portal hypertension encompass a broad spectrum of diseases associated with a myriad of manifestations and complications. The present clinical management of patients with advanced liver disease and portal hypertension, including diagnosis, surveillance, and management, relies on a multidisciplinary approach, including specialists in hepatology, interventional radiology, surgery, pathology, and interventional endoscopy. Recent innovations in EUS have expanded the role of endoscopy in diagnosis and management of patients with liver disease. Endoscopic hepatology, or “endohepatology,” is an emerging field comprising innovative EUSguided modalities aimed at providing diagnostic and/or therapeutic interventions for patients with cirrhosis and other diseases of the liver.1 For example, a patient undergoing an upper endoscopy for variceal screening can be simultaneously offered EUSguided LB and EUSguided portal pressure measurements. This concept of a “onestopshop” can potentially simplify health care delivery, improve accessibility, and enhance patient satisfaction and followup. Endohepatology plays an important role in the clinical management of patients with cirrhosis, those with precirrhotic diseases of the liver, and patients with portal hypertension. The present realm of EUSguided interventions in liver disease encompasses the diagnosis of liver pathology and fibrosis/cirrhosis via liver biopsy (LB), measurement of portal pressure gradient (PPG), and management of gastric varices (GVs).2 Understanding the role of these innovative modalities, as well as the limitations in the current literature, will facilitate the appropriate adoption of these practices and stimulate further research in the field. In this article, we elucidate the present knowledge on the role of EUS in the diagnosis and management of patients with advanced liver disease and portal hypertension.