ASGE Therapeutic EUS for Advanced Endosonographers (Live and Virtual) | September 2022-6_Diehl

6_Diehl_EUS guided vascular therapy

Pdf Summary

The document discusses EUS guided vascular therapy, focusing on EUS-guided liver biopsy (EUS-LB), EUS-guided portal pressure measurement (EUS-PPG), EUS-guided gastric varix management, and EUS arterial bleeding management. EUS-LB has evolved over time and is now comparable to or better than percutaneous or transjugular liver biopsy. It offers advantages such as the ability to perform other procedures simultaneously, increased sample yields, bilobar sampling, improved patient experience, and safety. Techniques for EUS-LB include wet suction, 19 G FNB, and 1 pass with 3 actuations. EUS-PPG, using the EchoTip InsightTM Portosystemic Pressure Gradient Measurement System, has potential indications such as clarifying the cause of portal HTN, earlier diagnosis, and preoperative assessment for high-risk surgeries. Benefits of EUS-PPG include unifying patient care within the GI department, the ability to perform other procedures simultaneously, and a more acceptable approach for patients compared to transjugular measurement. EUS-guided gastric varix management can be accomplished using glue or glue and coil injections, while EUS-guided hemostasis is effective for refractory bleeding. It involves injecting ethanol or cyanoacrylate into the bleeding site to decrease Doppler signal. The document concludes with the take-home messages that EUS-LB is a reliable method for liver biopsies, caution should be taken to avoid splenic biopsies, and EUS-PPG may be preferred over transjugular measurement in many cases, allowing for a comprehensive evaluation of liver disease.

Keywords

EUS guided vascular therapy

EUS-LB

EUS-guided liver biopsy

EUS-PPG

EUS-guided portal pressure measurement

EUS-guided gastric varix management

EUS arterial bleeding management

wet suction

19 G FNB

EchoTip InsightTM Portosystemic Pressure Gradient Measurement System