The Role of Endoscopic Ultrasound in Assessing Portal Hypertension: A State‐of‐the‐Art Literature Review and Evolving Perspectives

TL;DR

Endoscopic ultrasound is a promising tool for assessing portal hypertension in liver disease patients, offering detailed imaging and less invasive methods.

Contribution

This paper reviews the evolving role of endoscopic ultrasound in evaluating portal hypertension, highlighting its advantages and limitations.

Findings

EUS provides high-resolution imaging and advanced tools like contrast enhancement and shear-wave elastography for assessing liver stiffness and PH severity.

EUS-guided portal pressure gradient measurement offers a less invasive alternative to conventional PH evaluation methods.

Despite its benefits, EUS faces limitations such as invasiveness, variability due to sedation, and limited availability.

Abstract

Portal hypertension (PH) is a critical complication in patients with hepatic diseases. Its accurate evaluation is essential for early diagnosis, risk stratification, and management. Endoscopic ultrasound (EUS) has emerged as a promising diagnostic tool, offering high‐resolution imaging of the portal venous system, hepatic vasculature, and surrounding structures.

This review aims at providing an overview of the evolving role of EUS in PH evaluation in patients with liver disease.

A systematic search was conducted in PubMed and Google Scholar until 31 May 2024. Relevant studies were identified using keywords related to EUS and PH. Additional references were included based on expert knowledge and citation analysis. Only full‐length papers and abstracts in English were considered. Results: EUS demonstrates significant utility in PH assessment, offering high‐resolution imaging and advanced tools like contrast enhancement (CE) and shear‐wave elastography (SWE) for evaluating liver stiffness and correlating it with PH severity. EUS‐guided portal pressure gradient (PPG) measurement provides a less invasive method for evaluating PH, potentially offering a safer alternative to conventional techniques.

EUS offers unique advantages in PH assessment, enabling comprehensive evaluation in a single session. Despite its potential, limitations such as invasiveness, sedation‐related variability, and restricted availability persist. Emerging techniques require further validation in larger cohorts and standardised training.

EUS is a valuable diagnostic tool for PH evaluation, with the potential to improve outcomes through earlier diagnosis and better stratification. Addressing its limitations through further research and standardised protocols is critical to optimize its clinical utility.

Trial Registration: NCT04115046, NCT05728697, NCT05097963 and NCT03155282

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