Dhar Jahnvi, Samanta Jayanta
Gastroenterology, Sohana Multispeciality Hospital, Mohali 140308, India.
Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
World J Gastrointest Endosc. 2023 Apr 16;15(4):216-239. doi: 10.4253/wjge.v15.i4.216.
Endoscopic ultrasound (EUS) has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal (GI) diseases. The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions. EUS provides important clinical and anatomical information related to the vessels' size, appearance and location. Its excellent spatial resolution, use of colour doppler with or without contrast enhancement and ability to provide images "real-time" helps in precision while intervening vascular structures. Additionally, structures such as venous collaterals or varices can be dealt with optimally using EUS. EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension. It also helps to avoid radiation exposure in addition to being minimally invasive. These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions. EUS-guided portal vein (PV) access and therapy is a new kid on the block. EUS-guided portal pressure gradient measurement, injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology. Lastly, EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus. Herein, we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding, portal vein access and its related therapeutic interventions, cardiac access, and therapy. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.
内镜超声（EUS）已从单纯的诊断手段扩展为管理胃肠道（GI）疾病的重要治疗工具。胃肠道与纵隔和腹部血管结构的接近，促进了EUS在血管介入领域的发展。EUS提供与血管大小、外观和位置相关的重要临床和解剖学信息。其出色的空间分辨率、使用彩色多普勒（有无对比增强）以及提供“实时”图像的能力，有助于在介入血管结构时提高精准度。此外，诸如静脉侧支或静脉曲张等结构可以通过EUS得到最佳处理。EUS引导下使用线圈和胶水联合进行血管治疗，彻底改变了门静脉高压的管理方式。除了微创之外，它还有助于避免辐射暴露。这些优势使EUS成为血管介入领域中补充传统介入放射学的一种新兴手段。EUS引导下的门静脉（PV）穿刺和治疗是一个新领域。EUS引导下的门静脉压力梯度测量、向PV内注射化疗药物以及肝内门体分流术，拓展了内镜肝脏病学的视野。最后，EUS还涉足心脏介入领域，可进行心包积液抽吸和肿瘤活检，并有关于进入瓣膜装置的实验数据。在此，我们对EUS引导下在胃肠道出血、门静脉穿刺及其相关治疗干预、心脏穿刺和治疗方面不断扩展的血管介入模式进行全面综述。已将涉及每个程序的所有技术细节和现有数据制成表格，并突出了该领域的未来趋势。
