ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand) | October 2022-12 Diehl ASGE Course at ACG-Endohepatology

12 Diehl ASGE Course at ACG-Endohepatology

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Dr. David L. Diehl gave a state-of-the-art lecture on the emerging field of Endohepatology. This field involves using endoscopic techniques for the diagnosis and treatment of liver diseases. Some common applications include esophageal variceal diagnosis and management, evaluation of the gallbladder and biliary tree, and EUS-guided liver biopsy.<br /><br />In terms of emerging applications, Dr. Diehl discussed EUS shear wave elastography (EUS-SWE), EUS-portal pressure gradient assessment (EUS-PPG), EUS-assisted gastric variceal treatment, and EUS-guided gallbladder drainage. The goal of these techniques is to provide a comprehensive evaluation of liver disease in a single procedure.<br /><br />Dr. Diehl highlighted the advantages of EUS-guided liver biopsy, stating that it is comparable or better than percutaneous or transjugular liver biopsy. It allows for multiple samples to be taken, improves patient experience, and keeps patient care within the GI department.<br /><br />EUS-guided portal pressure measurement was also discussed as an alternative to the transjugular approach. It has advantages such as being more acceptable for patients, allowing for multiple procedures to be done at the same time, and having rare adverse effects.<br /><br />The management of gastric varices with EUS-guided glue injection or coiling was another topic covered. The use of glue and coils can help decrease the incidence of glue embolization.<br /><br />Lastly, Dr. Diehl discussed EUS-guided gallbladder drainage, which is often performed using cautery enhanced lumen apposing metal stents. It is a viable option for surgically unfit patients or those with cirrhosis.<br /><br />In conclusion, the field of Endohepatology is expanding and becoming more widely used. It offers a comprehensive approach to the diagnosis and treatment of liver diseases. The techniques discussed by Dr. Diehl show promising results and offer potential advancements in the field.

Keywords

Endohepatology

endoscopic techniques

liver diseases

esophageal variceal diagnosis

gallbladder and biliary tree evaluation

EUS-guided liver biopsy

EUS shear wave elastography

EUS-portal pressure gradient assessment

EUS-assisted gastric variceal treatment

EUS-guided gallbladder drainage