Skip to main content
SpringerLink
Log in
Book cover

Diagnostic Methods for Cirrhosis and Portal Hypertension pp 169–182Cite as

Endoscopic Ultrasound and Portal Hypertension

  • Chapter
  • First Online:

  • 1001 Accesses

Abstract

Endoscopic ultrasound (EUS) is a valuable diagnostic and therapeutic tool in many gastrointestinal disorders. It is a useful technique to assess vascular abnormalities in patients with chronic liver disease and portal hypertension and allows for a noninvasive evaluation of the hemodynamic changes linked to this condition. EUS improves the detection of gastric varices and collateral veins and provides assessment of variceal recurrence, risk of rebleeding and response to therapy. Furthermore EUS may be of help in guiding endoscopic therapy of varices, such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided glue injection or coiling of gastric varices. In addition, the ability of EUS to access the portal vein (PV) enables a broad spectrum of diagnostic and therapeutic interventions in patients with portal hypertension which have been shown to be feasible in animal models and in small, preliminary human studies.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kitano S, Terblanche J, Kahn D, et al. Venous anatomy of the lower oesophagus in portal hypertension: practical implications. Br J Surg. 1986;73:525–31.

    Article  CAS  PubMed  Google Scholar 

  2. Hashizume M, Kitano S, Sugimachi K, et al. Threedimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology. 1988;8:1482–7.

    Article  CAS  PubMed  Google Scholar 

  3. Irisawa A, Obara K, Sato Y, et al. EUS analysis of collateral veins inside and outside the esophageal wall in portal hypertension. Gastrointest Endosc. 1999;50:374–80.

    Article  CAS  PubMed  Google Scholar 

  4. Parasher VK, Meroni E, Malesci A, et al. Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound. Gastrointest Endosc. 1998;48:588–92.

    Article  CAS  PubMed  Google Scholar 

  5. Wiersema MJ, Chak A, Kopecky KK, et al. Duplex Doppler endosonography in the diagnosis of splenic vein, portal vein, and portosystemic shunt thrombosis. Gastrointest Endosc. 1995;42:19–26.

    Article  CAS  PubMed  Google Scholar 

  6. Kakutani H, Hino S, Ikeda K, et al. Use of the curved linear-array echo endoscope to identify gastrorenal shunts in patients with gastric fundal varices. Endoscopy. 2004;36:710–4.

    Article  CAS  PubMed  Google Scholar 

  7. Avunduk C, Hampf F. Endoscopic ultrasound in the diagnosis of watermelon stomach. J Clin Gastroenterol. 1996;22:104–6.

    Article  CAS  PubMed  Google Scholar 

  8. Kassem AM, Salama ZA, Zakaria MS, et al. Endoscopic ultrasonography study of the azygos vein before and after endoscopic obliteration of esophagogastric varices by injection sclerotherapy. Endoscopy. 2000;32:630–4.

    Article  CAS  PubMed  Google Scholar 

  9. Nishida H, Giostra E, Spahr L, et al. Validation of color Doppler EUS for azygos blood flow measurement in patients with cirrhosis: application to the acute hemodynamic effects of somatostatin, octreotide, or placebo. Gastrointest Endosc. 2001;54:24–30.

    Article  CAS  PubMed  Google Scholar 

  10. Lee YT, Sung JJY, Yung MY, et al. Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension. Gastrointest Endosc. 1999;50:47–52.

    Article  CAS  PubMed  Google Scholar 

  11. Faigel DO, Rosen HR, Sasaki A, et al. EUS in cirrhotic patients with and without prior variceal hemorrhage in comparison with noncirrhotic control subjects. Gastrointest Endosc. 2000;52:455–62.

    Article  CAS  PubMed  Google Scholar 

  12. McKiernan PJ, Sharif K, Gupte GL. The role of endoscopic ultrasound for evaluating portal hypertension in children being assessed for intestinal transplantation. Transplantation. 2008;86:1470–3.

    Article  PubMed  Google Scholar 

  13. Caletti G, Brocchi E, Baraldini M, et al. Assessment of portal hypertension by endoscopic ultrasonography. Gastrointest Endosc. 1990;36:S21–7.

    Article  CAS  PubMed  Google Scholar 

  14. Burtin P, Calès P, Oberti F, et al. Endoscopic ultrasonographic signs of portal hypertension in cirrhosis. Gastrointest Endosc. 1996;44:257–61.

    Article  CAS  PubMed  Google Scholar 

  15. Boustiere C, Dumas O, Jouffre C, et al. Gastric endoscopic ultrasonography: a new approach to the diagnosis of portal hypertension in cirrhotic patients. Hepatology. 1991;14:85.

    Google Scholar 

  16. Liu JB, Miller LS, Feld RI, et al. Gastric and esophageal varices: 20-MHz transnasal endoluminal US. Radiology. 1993;187:363–6.

    Article  CAS  PubMed  Google Scholar 

  17. Suzuki T, Matsutani S, Umebara K, et al. EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy. Gastrointest Endosc. 2000;52:611–7.

    Article  CAS  PubMed  Google Scholar 

  18. Choudhuri G, Dhiman RK, Agarwal DK. Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertension. Hepato-Gastroenterology. 1996;43:1250–5.

    CAS  PubMed  Google Scholar 

  19. Lee YT, Chan FK, Ching JY, et al. Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients. Endoscopy. 2002;34:391–8.

    Article  CAS  PubMed  Google Scholar 

  20. Konishi Y, Nakamura T, Kida H, et al. Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointest Endosc. 2002;55:197–203.

    Article  PubMed  Google Scholar 

  21. Lo GH, Lai KH, Cheng JS, et al. Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc. 1999;49:428–36.

    Article  CAS  PubMed  Google Scholar 

  22. Pontes JM, Leitao MC, Portela FA, et al. Endoscopic ultrasonography in the treatment of esophageal varices by endoscopic sclerotherapy and band ligation: do we need it. Eur J Gastroenterol Hepatol. 1995;7:41–6.

    CAS  PubMed  Google Scholar 

  23. Goenka MK, Kochhar R, Nagi B, et al. Rectosigmoid varices and other mucosal changes in patients with portal hypertension. Am J Gastroenterol. 1991;86:1185–9.

    CAS  PubMed  Google Scholar 

  24. Wu CS, Chen CM, Chang KY. Endoscopic injection sclerotherapy of bleeding duodenal varices. J Gastroenterol Hepatol. 1995;19:481–3.

    Article  Google Scholar 

  25. Palazzo L, Hochain P, Helmer C, et al. Biliary varices on endoscopic ultrasonography: clinical presentation and outcome. Endoscopy. 2000;32:520–4.

    Article  CAS  PubMed  Google Scholar 

  26. Irisawa A, Saito A, Obara K, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe periesophageal collateral veins and large perforating veins. Gastrointest Endosc. 2001;53:77–84.

    Article  CAS  PubMed  Google Scholar 

  27. Sato T, Yamazaki K, Toyota J, et al. Endoscopic ultrasonographic evaluation of hemodynamics related to variceal relapse in esophageal variceal patients. Hepatol Res. 2009;39:126–33.

    Article  PubMed  Google Scholar 

  28. Dhiman RK, Choudhuri G, Saraswat VA, et al. Role of paraesophageal collateral and perforating veins on outcome of endoscopic sclerotherapy for esophageal varices: an endosonographic study. Gut. 1996;38:759–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Leung VK, Sung JJ, Ahuja AT, et al. Large paraesophageal varices on endosonography predict recurrence of esophageal varices rebleeding. Gastroenterology. 1997;112(6):1811.

    Article  CAS  PubMed  Google Scholar 

  30. Hino S, Kakutani H, Ikeda K, et al. Hemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography to predict recurrence after endoscopic treatment. Endoscopy. 2001;33:869–72.

    Article  CAS  PubMed  Google Scholar 

  31. Kuramochi A, Imazu H, Kakutani H, et al. Color Doppler endoscopic ultrasonography in identifying groups at high-risk of recurrence of esophageal varices after endoscopic treatment. J Gastroenterol. 2007;42:219–24.

    Article  PubMed  Google Scholar 

  32. Lee YT, Chan FK, Ng EK, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52:168–74.

    Article  CAS  PubMed  Google Scholar 

  33. Iwase H, Suga S, Morise K. Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and endoscopic obliteration with cyanoacrylate glue. Gastrointest Endosc. 1995;41:150–4.

    Article  CAS  PubMed  Google Scholar 

  34. Lahoti S, Catalano M, Alcocer E, et al. Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler. Gastrointest Endosc. 2000;51(3):331.

    Article  CAS  PubMed  Google Scholar 

  35. De Paulo GA, Ardengh JC, Nakao FS, et al. Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUSguided sclerotherapy of esophageal collateral veins. Gastrointest Endosc. 2006;63:396–402.

    Article  PubMed  Google Scholar 

  36. Romero-Castro R, Pellicer-Bautista FJ, Jiménez-Saenz M, et al. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66:402–7.

    Article  PubMed  Google Scholar 

  37. Levy M, Wong Kee Song L, Kendrick M. EUS-guided coil embolization for refractory ectopic variceal bleeding. Gastrointest Endosc. 2008;67:572–4.

    Article  PubMed  Google Scholar 

  38. Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013;78:711–21.

    Article  PubMed  Google Scholar 

  39. Bhat YM, Weilert F, Fredrick RT, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video). Gastrointest Endosc. 2016;83(6):1164–72.

    Article  PubMed  Google Scholar 

  40. So H, Park do H, Jung K, Ko HK. Successful endoscopic ultrasound-guided coil embolization for severe duodenal bleeding. Am J Gastroenterol. 2016;111:925.

    Article  PubMed  Google Scholar 

  41. Sharma M, Somasundaram A. Massive lower GI bleed from an endoscopically inevident rectal varices: diagnosis and management by EUS (with videos). Gastrointest Endosc. 2010;72:1106–8.

    Article  PubMed  Google Scholar 

  42. Weilert F, Shah JN, Marson FP, et al. EUS-guided coil and glue for bleeding rectal varix. Gastrointest Endosc. 2012;76:915–6.

    Article  PubMed  Google Scholar 

  43. Tsynman DN, DeCross AJ, Maliakkal B, et al. Novel use of EUS to successfully treat bleeding parastomal varices with N-butyl-2-cyanoacrylate. Gastrointest Endosc. 2014;79:1007–8. discussion 1008

    Article  PubMed  Google Scholar 

  44. Lai L, Poneros J, Santilli J. EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility. Gastrointest Endosc. 2004;59:280–3.

    Article  PubMed  Google Scholar 

  45. Giday S, Clarke J, Buscaglia J, et al. EUS-guided portal vein catheterization: a promising novel approach for portal angiography and portal vein pressure measurements. Gastrointest Endosc. 2008;67:338–42.

    Article  PubMed  Google Scholar 

  46. Schulman AR, Thompson CC, Ryou M. EUS-guided portal pressure measurement using a digital pressure wire with real-time remote display: a novel, minimally invasive technique for direct measurement in an animal model. Gastrointest Endosc. 2016;83:817–20.

    Article  PubMed  Google Scholar 

  47. Huang JY, Samarasena JB, Tsujino T, et al. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus standard transjugular approach: a comparison animal study. Gastrointest Endosc. 2016;84:358–62.

    Article  PubMed  Google Scholar 

  48. Fujii-Lau LL, Leise MD, Kamath PS, et al. Endoscopic ultrasonography-guided portal-systemic pressure gradient measurement. Endoscopy 2014;46(S01):E654–E656.

    Google Scholar 

  49. Huang JY, Samarasena JB, Tsujino T, et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc.Epub 2016 Sep 29

    Google Scholar 

  50. Buscaglia JM, Dray X, Shin EJ, et al. A new alternative for a transjugular intrahepatic portosystemic shunt: EUS-guided creation of an intrahepatic portosystemic shunt (with video). Gastrointest Endosc. 2009;69:941–7.

    Article  PubMed  Google Scholar 

  51. Schulman AR, Ryou M, Aihara H, et al. EUS-guided intrahepatic portosystemic shunt with direct portal pressure measurements: a novel alternative to transjugular intrahepatic portosystemic shunting. Gastrointest Endosc. 2017;85:243–7.

    Article  PubMed  Google Scholar 

  52. Binmoeller KF, Shah JN. EUS-guided transgastric intrahepatic portosystemic shunt using the axios stent [abstract]. Gastrointest Endosc. 2011;73:AB167.

    Google Scholar 

  53. Lai R, Stephens V, Bardales R. Diagnosis and staging of hepatocellular carcinoma by EUS-FNA of a portal vein thrombus. Gastrointest Endosc. 2004;59:574–7.

    Article  PubMed  Google Scholar 

  54. Michael H, Lenza C, Gupta M, et al. Endoscopic ultrasound-guided fineneedle aspiration of a portal vein thrombus to aid in the diagnosis and staging of hepatocellular carcinoma. Gastroenterol Hepatol. 2011;7:124–9.

    Google Scholar 

  55. Storch I, Gomez C, Contreras F, et al. Hepatocellular carcinoma (HCC) with portal vein invasion, masquerading as pancreatic mass, diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Dig Dis Sci. 2007;52:789–91.

    Article  PubMed  Google Scholar 

  56. Kayar Y, Turkdogan KA, Baysal B, Unver N, et al. EUS-guided FNA of a portal vein thrombus in hepatocellular carcinoma. Pan Afr Med J. 2015;21:86.

    PubMed  PubMed Central  Google Scholar 

  57. Vazquez-Sequeiros E, Olcina JRF. Endoscopic ultrasound guided vascular access and therapy: a promising indication. World J Gastrointest Endosc. 2010;2:198–202.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Matthes K, Sahani D, Holalkere NS, et al. Feasibility of endoscopic ultrasound-guided portal vein embolization with Enteryx. Acta Gastroenterol Belg. 2005;68:412–5.

    CAS  PubMed  Google Scholar 

  59. Faigel D, Lake D, Landreth T, et al. Endoscopic ultrasonography-guided portal injection chemotherapy for hepatic metastases. Endosc Ultrasound. 2014;3(Supp 1):S1.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Catenacci DVT, Chapman CG, Xu P, et al. Acquisition of portal venous circulating tumor cells from patients with pancreaticobiliary cancers by endoscopic ultrasound. Gastroenterology. 2015;149:1794–803.e4.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endoscopy Unit, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain

    Oriol Sendino M.D., Ph.D. & Angels Ginès M.D., Ph.D., M.M.Sc.

Authors
  1. Oriol Sendino M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angels Ginès M.D., Ph.D., M.M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angels Ginès M.D., Ph.D., M.M.Sc. .

Editor information

Editors and Affiliations

  1. Inselspital, University of Bern, UVCM, DMLL, Hepatology Inselspital, University of Bern, Berne, Switzerland

    Annalisa Berzigotti

  2. Hospital Clinic, Hepatic Hemodynamic Laboratory Hospital Clinic, Barcelona, Spain

    Jaime Bosch

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sendino, O., Ginès, A. (2018). Endoscopic Ultrasound and Portal Hypertension. In: Berzigotti, A., Bosch, J. (eds) Diagnostic Methods for Cirrhosis and Portal Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-72628-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72628-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72627-4

  • Online ISBN: 978-3-319-72628-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation