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

12_Diehl_Endohepatology

Pdf Summary

In this state-of-the-art lecture, Dr. David L. Diehl discusses the emerging field of Endohepatology, which involves using endoscopic techniques for the diagnosis and treatment of liver diseases. He begins by mentioning his disclosures of various medical companies he has relationships with. Dr. Diehl highlights the increasing prevalence of chronic liver diseases, such as NASH, Hepatitis C, and alcohol-related liver disease, and the need for effective diagnostic and treatment approaches.<br /><br />He then discusses the current and emerging applications of Endohepatology, including esophageal variceal diagnosis and management, EUS evaluation of the gallbladder and biliary tree, EUS-guided liver biopsy, and various emerging techniques such as EUS shear wave elastography, EUS-portal pressure gradient assessment, EUS-assisted gastric variceal treatment, and EUS-guided gallbladder drainage. The goal is to provide a comprehensive evaluation of liver disease in a single procedure.<br /><br />Dr. Diehl emphasizes the advantages of EUS-guided liver biopsy over percutaneous or transjugular liver biopsy, including excellent sample yields, improved patient experience, and cost-saving benefits. He also discusses techniques to refine the procedure and improve its effectiveness.<br /><br />He then explains the technique and advantages of EUS-guided portal pressure gradient measurement, which can provide information about portal hypertension without the need for a transjugular approach. This allows for unified patient care within the GI department. Dr. Diehl also mentions various indications for this procedure and its rare adverse events.<br /><br />Next, he discusses the management of gastric varices using EUS-guided glue injection and possibly coiling, highlighting the benefits of using coils in addition to glue to decrease the incidence of glue embolization.<br /><br />Lastly, Dr. Diehl explores the use of EUS-guided gallbladder drainage as an alternative to surgical options in certain patient populations. He mentions the technical and clinical success rates as well as potential adverse effects.<br /><br />Dr. Diehl concludes by emphasizing the bright future of Endohepatology and its potential to revolutionize the diagnosis and treatment of liver diseases.

Keywords

Endohepatology

liver diseases

endoscopic techniques

diagnosis

treatment

chronic liver diseases

EUS-guided liver biopsy

EUS-portal pressure gradient assessment

EUS-assisted gastric variceal treatment

EUS-guided gallbladder drainage