Lesmana Cosmas Rinaldi A, Paramitha Maria Satya, Gani Rino A
Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.
Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
Can J Gastroenterol Hepatol. 2021 Jun 28;2021:9948979. doi: 10.1155/2021/9948979. eCollection 2021.
Chronic liver disease (CLD) is still a major problem, where the disease progression will lead to liver cirrhosis (LC) or hepatocellular carcinoma (HCC). Portal hypertension (PH) management and loco-regional therapy for HCC have become the cornerstones in advanced liver disease management. Recently, there are studies looking at the potential role of interventional endoscopic ultrasound (EUS) in liver diseases. EUS may be useful in vascular changes of the digestive wall evaluation, performing dynamic assessment of hemodynamic changes, predicting variceal bleeding and rebleeding risk, and assessing the pharmacological effects. In PH management, EUS-guided vascular therapy-which revolves around glue injection, endovascular coil placement/embolization, and combination of both-has shown promising results. As a diagnostic modality for liver cancer, the implementation of EUS in liver diseases is currently not only limited to liver biopsy (EUS-LB) but also in shear-wave elastography (SWE) and portal pressure gradient measurement, as well as portal vein sampling. The application of EUS-guided radiofrequency ablation (EUS-RFA) and tumor injection can also overcome the limitations shown by both modalities without EUS. Nevertheless, establishing EUS as a firm diagnostic and therapeutic modality is still challenging since the performance of interventional EUS requires high expertise and adequate facilities.
慢性肝病（CLD）仍然是一个主要问题，疾病进展会导致肝硬化（LC）或肝细胞癌（HCC）。门静脉高压（PH）的管理和肝癌的局部区域治疗已成为晚期肝病管理的基石。最近，有研究探讨了介入性内镜超声（EUS）在肝病中的潜在作用。EUS可能有助于评估消化壁的血管变化、动态评估血流动力学变化、预测静脉曲张出血和再出血风险以及评估药物疗效。在PH管理中，以胶水注射、血管内线圈放置/栓塞以及两者结合为核心的EUS引导下的血管治疗已显示出有前景的结果。作为肝癌的一种诊断方式，EUS在肝病中的应用目前不仅限于肝活检（EUS-LB），还包括剪切波弹性成像（SWE）和门静脉压力梯度测量以及门静脉采样。EUS引导下的射频消融（EUS-RFA）和肿瘤注射的应用也可以克服无EUS时两种方式所显示的局限性。然而，将EUS确立为一种可靠的诊断和治疗方式仍然具有挑战性，因为介入性EUS的操作需要高专业水平和足够的设备。
