Termite Fabrizio, Borrelli de Andreis Federica, Liguori Antonio, Gasbarrini Antonio, Attili Fabia, Spada Cristiano, Miele Luca
Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome Italy, Università Cattolica del Sacro Cuore, Rome, Italy.
Liver Int. 2025 Apr;45(4):e16176. doi: 10.1111/liv.16176. Epub 2024 Nov 27.
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.
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.
NCT04115046, NCT05728697, NCT05097963 and NCT03155282.
门静脉高压（PH）是肝脏疾病患者的一种关键并发症。其准确评估对于早期诊断、风险分层及管理至关重要。内镜超声（EUS）已成为一种有前景的诊断工具，可对门静脉系统、肝血管系统及周围结构进行高分辨率成像。
本综述旨在概述EUS在肝病患者PH评估中不断演变的作用。
截至2024年5月31日，在PubMed和谷歌学术上进行了系统检索。使用与EUS和PH相关的关键词来识别相关研究。基于专家知识和引文分析纳入了其他参考文献。仅考虑英文的全文论文和摘要。
EUS在PH评估中显示出显著效用，提供高分辨率成像以及诸如对比增强（CE）和剪切波弹性成像（SWE）等先进工具，用于评估肝脏硬度并将其与PH严重程度相关联。EUS引导下的门静脉压力梯度（PPG）测量为评估PH提供了一种侵入性较小的方法，可能是传统技术的更安全替代方案。
EUS在PH评估中具有独特优势，能够在一次检查中进行全面评估。尽管有其潜力，但诸如侵入性、与镇静相关的变异性以及可用性受限等局限性仍然存在。新兴技术需要在更大队列中进行进一步验证并进行标准化培训。
EUS是用于PH评估的有价值诊断工具，有可能通过早期诊断和更好的分层来改善治疗结果。通过进一步研究和标准化方案解决其局限性对于优化其临床效用至关重要。
NCT04115046、NCT05728697、NCT05097963和NCT03155282。
