ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual)

Video Transcription

Video Summary

In this video, Dr. Kenneth Chang introduces a technique for measuring portal pressure gradients (PPG) using endoscopic ultrasound (EUS). The procedure involves a transgastric puncture of the hepatic vein and portal vein, followed by flushing with heparinized saline. A multicenter study shows that patients with higher PPG measurements are at a higher risk of advanced fibrosis. EUS-guided injection therapies for treating bleeding gastric varices are also discussed. Coils, glue, and gel foam are shown to be effective in achieving hemostasis, with combination therapy being more effective than monotherapy. The adverse event rate for EUS-guided therapies is reported to be 10%. Dr. Kenneth Binmuller shares his technique for coil therapy, which involves injecting coils into the bleeding gastric varices followed by an adjunct. Overall, these techniques provide a less invasive approach for measuring portal pressures and treating bleeding gastric varices.<br /><br />The video also highlights the importance of collaboration and multidisciplinary approaches in managing liver diseases. The use of endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPG) is discussed and its benefits for patients with uncertain liver disease etiology and severity are emphasized. The establishment of successful endohepatology programs requires proper training and equipment. Endoscopic therapies for gastric varices, such as glue injection and coil use, are explored, with a focus on selecting appropriate coils based on varix size. Further research and collaboration are encouraged in the field of endohepatology. The video provides valuable insights into advances, challenges, and potential improvements in this field, emphasizing the goal of enhancing patient outcomes.

Keywords

Dr. Kenneth Chang

portal pressure gradients

endoscopic ultrasound

fibrosis

EUS-guided injection therapies

bleeding gastric varices

coils

glue

gel foam

coil therapy

less invasive approach

endohepatology programs