EUS in portal hypertension

Endoscopic ultrasonography (EUS) has recently emerged as a most accurate, less invasive and easily repeatable alternative means of providing data on patients with portal hypertension. It is well established that video-echo endoscopy, with combined endoscopic and sonographic examination is comparable to endoscopy in diagnosing esophageal varices, but is more sensitive in diagnosing the presence of gastric varices. Dilated venous abnormalities outside the gastroesophageal lumen, which cannot be diagnosed by endoscopy, are readily visible by means of EUS or miniature probes. In the clinical setting of portal hypertension, endoscopic ultrasonography is also useful to predict the risk of variceal recurrence or rebleeding, which cannot be reliably predicted using endoscopy alone. The introduction of echo endoscopes equipped with Doppler facilities has allowed sonographic visualization of the vessels, playing an important role in cirrhotic patients, together with the performance of hemodynamic studies. It has thus become feasible, not only to assess the vascular blood flow, but also to evaluate possible morphologic and hemodynamic changes in the vessels after endoscopic or pharmacologic therapy. It is obvious nowadays that EUS is an exciting technological advance that has established its position in the diagnosis of varices and cirrhosis; what lies ahead is for EUS to find a definite application in predicting the risk of variceal bleeding and in the management of portal hypertension.