Gastroenterology · 4 h ago
ESGE review outlines selective use of EUS techniques in hepatology
A European Society of Gastrointestinal Endoscopy technical review assessed evidence for endoscopic ultrasound (EUS)-guided procedures in liver disease and portal hypertension. Eight statements support selected uses in expert settings, while portal vein sampling remains investigational; the evidence is limited by small studies and heterogeneous methods.
- Eight ESGE statements address EUS techniques in hepatology.
- Several techniques are positioned as adjunctive or complementary.
- Gastric varix treatment may be an alternative in expert hands.
- Portal vein sampling remains investigational.
The European Society of Gastrointestinal Endoscopy (ESGE) reviewed evidence on EUS-guided techniques in hepatology and portal hypertension, based on a structured literature search through April 2026. The review covered liver stiffness assessment, focal liver lesion characterization and sampling, liver biopsy, portal pressure gradient measurement, gastric variceal therapy, and portal vein sampling for liquid biopsy. Eight statements were developed using the GRADE framework.
The review supports selected use of EUS-guided shear wave elastography and contrast-enhanced EUS as adjunctive techniques. EUS-guided liver biopsy and portal pressure gradient measurement may complement other approaches in selected patients and expert centers. EUS-guided treatment of gastric varices is described as a valid alternative to direct endoscopic injection when appropriate expertise is available. Portal vein sampling remains investigational.
The authors note that the evidence is limited by small studies, heterogeneous techniques and outcome definitions, and a lack of prospective comparative data. The review calls for standardized techniques, structured training, and further comparative studies. Its statements provide a framework for selective use, not support for routine adoption across settings.
In practice
For clinicians managing liver disease or portal hypertension, the review supports considering selected EUS-guided approaches as adjunctive or complementary options, including elastography, contrast-enhanced assessment, liver biopsy, and portal pressure measurement. EUS-guided gastric varix treatment may be an alternative to direct endoscopic injection where expertise is available. These statements do not establish routine use: evidence is limited by small studies, technical and outcome heterogeneity, and limited prospective comparisons. Portal vein sampling remains investigational, and use should be selective and expertise-dependent.
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Endoscopy: Endoscopic ultrasound in hepatology: A European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.