Lesmana Cosmas Rinaldi Adithya, Paramitha Maria Satya, Gani Rino A, Lesmana Laurentius A
Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
J Med Ultrason (2001). 2022 Jul;49(3):359-370. doi: 10.1007/s10396-021-01165-4. Epub 2021 Nov 19.
Chronic liver disease is still a major problem because disease progression will ultimately lead to liver cirrhosis. Portal hypertension is the hallmark in advanced liver disease management. By establishing portal vein access, endoscopic ultrasound (EUS) has been utilized in various clinical applications. In comparison to standard upper gastrointestinal endoscopy, EUS-Doppler has been shown to be a better modality for detecting esophageal and gastric varices along with peri-esophageal collateral veins, para-esophageal collateral veins, and perforating veins, and may be used to objectively predict the recurrence of bleeding. EUS-guided portal vein catheterization has also been proposed to overcome the limitations of trans-jugular approaches. The combination of EUS-elastography and azygos vein evaluation can also enhance the diagnostic accuracy of each modality. Another well-known implementation of EUS-guided procedures is in the management of ascites; particularly in paracentesis and ascitic fluid analysis. In addition, the most common clinical application of EUS in the treatment of portal hypertension is through vascular therapy or creation of intrahepatic portosystemic shunts. Major drawbacks of EUS mainly revolve around technical difficulties, the high cost of the procedure, as well as the requirement of more studies in humans to evaluate EUS-guided advanced therapeutic modalities in portal hypertension.
慢性肝病仍然是一个主要问题，因为疾病进展最终会导致肝硬化。门静脉高压是晚期肝病管理的标志。通过建立门静脉通路，内镜超声（EUS）已被应用于各种临床领域。与标准上消化道内镜检查相比，EUS-多普勒已被证明是检测食管和胃静脉曲张以及食管周围侧支静脉、食管旁侧支静脉和穿支静脉的更好方法，并且可用于客观预测出血复发。EUS引导的门静脉插管也被提出来克服经颈静脉途径的局限性。EUS弹性成像和奇静脉评估的结合也可以提高每种方法的诊断准确性。EUS引导程序的另一个众所周知的应用是在腹水管理中；特别是在腹腔穿刺术和腹水分析方面。此外，EUS在门静脉高压治疗中最常见的临床应用是通过血管治疗或创建肝内门体分流术。EUS的主要缺点主要围绕技术困难、手术成本高，以及需要更多人体研究来评估EUS引导的门静脉高压先进治疗方法。
