ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand) | September 2022-6_Diehl

6_Diehl_EUS guided vascular therapy

Pdf Summary

The document discusses EUS guided vascular therapy, specifically focusing on EUS-guided liver biopsy, EUS-guided portal pressure measurement (EUS-PPG), EUS-guided gastric varix management, and EUS arterial bleeding management. The author highlights the potential for "One Stop Shop" evaluation of liver disease using EGD to rule out varices and EUS to evaluate the common bile duct, gallbladder, liver, and assess liver stiffness. The document also presents changing trends in liver biopsy volume and technique at Geisinger, showing an increase in EUS-guided liver biopsies over the years.<br /><br />Advantages of EUS-guided liver biopsy mentioned in the document include the ability to perform other procedures like EGD, EUS, and colonoscopy during the same session, excellent sample yields, the possibility of bilobar sampling to decrease sampling error, improved patient experience, and a good safety profile if inadvertent splenic biopsy is avoided. The document also provides techniques for refining the EUS-guided liver biopsy procedure.<br /><br />EUS-guided portal pressure measurement is discussed as an alternative to transjugular measurement, allowing for earlier diagnosis and intervention in portal hypertension. The document presents indications for EUS-guided PPG measurement, advantages including keeping patient care within the GI department and the ability to perform EGD, EUS, liver biopsy, and PPG simultaneously, and the technique for performing EUS-PPG.<br /><br />The document briefly mentions EUS-guided gastric varix management, including injection of glue or a combination of glue and coil to treat gastric varices, and limitations such as the need for an experienced endosonographer and the availability and cost of glue and coils.<br /><br />Lastly, the document mentions EUS-guided hemostasis for non-variceal bleeding, specifically mentioning cases of refractory bleeding in patients with GIST, Dieulafoy, duodenal ulcer, and hemosuccus. The document provides examples of the use of ethanol or cyanoacrylate injection into the bleeding lesion to achieve hemostasis.<br /><br />In conclusion, the document highlights the advantages and techniques of EUS-guided vascular therapy, including liver biopsy, portal pressure measurement, gastric varix management, and arterial bleeding management, emphasizing the potential for comprehensive evaluation and treatment of liver disease using EUS-guided procedures.

Keywords

EUS guided vascular therapy

EUS-guided liver biopsy

EUS-guided portal pressure measurement

EUS-guided gastric varix management

EUS arterial bleeding management

One Stop Shop evaluation of liver disease

EGD

Common bile duct evaluation

Liver stiffness assessment

Changing trends in liver biopsy volume