ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy

12_Diehl_Endohepatology

Pdf Summary

In this state-of-the-art lecture, Dr. David L. Diehl discusses the emerging field of endohepatology, which involves the use of endoscopic techniques for the diagnosis and treatment of liver diseases. He highlights common applications of endohepatology, including esophageal variceal diagnosis and management, evaluation of the gallbladder and biliary tree, and liver biopsy guided by endoscopic ultrasound (EUS). Dr. Diehl also mentions emerging applications such as EUS shear wave elastography and EUS-guided treatments for gastric varices and gallbladder drainage.<br /><br />He emphasizes the advantages of EUS-guided liver biopsy, including the ability to perform multiple procedures (EGD, EUS, and COLO) in a single sedation, improved safety and specimen yield, and the possibility of bilobar sampling to reduce sampling errors. Dr. Diehl also discusses refinements to the technique of EUS-guided liver biopsy, such as using wet suction and larger FNB needles.<br /><br />Furthermore, he introduces EUS-portal pressure gradient assessment as an alternative to transjugular measurement, highlighting its advantages in patient acceptance and unifying patient care within the GI department. He describes the indications for EUS-guided portal pressure measurement and presents a video demonstrating the technique.<br /><br />Dr. Diehl also discusses the management of gastric varices using EUS-guided glue injection and coil placement, noting the limitations and potential complications of this approach. He then explores EUS-guided gallbladder drainage as an alternative to percutaneous cholecystostomy for unfit surgical candidates and outlines some unanswered questions regarding the procedure.<br /><br />In conclusion, Dr. Diehl emphasizes the promising future of endohepatology and its potential for a comprehensive approach to liver disease evaluation. He mentions the increasing number of referrals for EUS-guided gallbladder drainage and encourages further research and innovation in the field.

Keywords

endohepatology

endoscopic techniques

liver diseases

esophageal variceal diagnosis

gallbladder

liver biopsy

endoscopic ultrasound (EUS)

EUS-guided treatments

gastric varices

gallbladder drainage