Hammoud Ghassan M, Ibdah Jamal A
Ghassan M Hammoud, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States.
World J Gastroenterol. 2014 Oct 21;20(39):14230-6. doi: 10.3748/wjg.v20.i39.14230.
Endoscopic ultrasound (EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate (Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors and analysis of free abdominal fluid. Using specialized EUS-guided needle biopsy, a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver disease. EUS-guided fine needle injection can be used to study portal vein pressure and hemodynamics, and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt.
内镜超声（EUS）彻底改变了胃肠道疾病患者的诊断和治疗方法。其在肝病和门静脉高压患者中的应用正在增加。慢性肝病患者有发生门静脉高压后遗症的风险，如腹水、自发性细菌性腹膜炎和胃食管静脉曲张。食管和胃静脉曲张出血是肝硬化患者最常见的死亡原因之一。因此，早期检测和治疗可改善该人群的预后。EUS可提高胃食管静脉曲张和侧支静脉的检测和诊断能力，并可提供胃食管静脉曲张的内镜治疗，如EUS引导下食管侧支血管硬化治疗和EUS引导下胃静脉曲张氰基丙烯酸酯（胶水）注射。EUS还可提供有关门静脉高压药物治疗疗效的知识。此外，EUS可提供内镜治疗后门静脉曲张复发的评估和预测，以及门静脉血流动力学评估，如奇静脉和门静脉的E-Flow和多普勒研究。此外，EUS引导下细针穿刺可提供局灶性肝肿瘤的细胞学诊断和游离腹腔积液分析。使用专门的EUS引导针活检，可获取肝组织样本以诊断和评估慢性肝病。EUS引导下细针注射可用于研究门静脉压力和血流动力学，并有可能用于协助精确测量门静脉压力和放置肝内门体分流术。
