Download PDF
Z Gastroenterol
DOI: 10.1055/a-2590-9998
Übersicht

Endo-Hepatologie: Neue endoskopische Lösungen für alte hepatologische Probleme

Endo-Hepatology: New Endoscopic Solutions for Old Hepatological Problems
Michael Praktiknjo 
1   Medizinische Klinik B, Universitätsklinikum Münster, Munster, Germany (Ringgold ID: RIN39069)
,
Matthias Dollinger
2   Medizinische Klinik I Gastroenterologie, Nephrologie und Diabetologie, Klinikum Landshut gGmbH, Landshut, Germany (Ringgold ID: RIN39831)
3   Innere Medizin I, University Hospital Ulm, Ulm, Germany (Ringgold ID: RIN27197)
,
Barbara Braden
1   Medizinische Klinik B, Universitätsklinikum Münster, Munster, Germany (Ringgold ID: RIN39069)
,
Wim Laleman
1   Medizinische Klinik B, Universitätsklinikum Münster, Munster, Germany (Ringgold ID: RIN39069)
4   Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, Leuven, Belgium (Ringgold ID: RIN60182)
,
Jonel Trebicka 
1   Medizinische Klinik B, Universitätsklinikum Münster, Munster, Germany (Ringgold ID: RIN39069)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Mit der rasanten Entwicklung des endoskopischen Ultraschalls (EUS) sind auch in der Hepatologie neuartige diagnostische und therapeutische Optionen hinzugekommen. Neue Anwendungen wie die EUS-gesteuerte Pfortaderdruckmessung (in Kombination mit der EUS-gesteuerten Leberbiopsie) oder die EUS-gesteuerte Varizenobliteration mittels Coils und Kleber bieten attraktive Verfahren, die potenziell auch Limitationen der bisherigen Goldstandards überwinden können. In diesem Übersichtsartikel geben wir einen Überblick über diese neuen Techniken der „Endo-Hepatologie“ und ordnen ihre aktuelle Rolle in der Behandlung von Lebererkrankungen ein.

Abstract

With the rapid development of endoscopic ultrasound (EUS), diagnostic and therapeutic platforms have emerged that are applicable in hepatology. New tools such as EUS-guided portal pressure measurement (in combination with EUS-guided liver biopsy) or EUS-guided variceal obliteration using coils and glue present attractive procedures that can potentially overcome the limitations of current gold standards. In this review article, we provide an overview of these new ‘endo-hepatology’ techniques and highlight their current role in the treatment of liver diseases.

Schlüsselwörter

Leber - Portale Hypertension - Endoskopie - Endoskopischer Ultraschall - EUS PPG - Endohepatologie - HVPG - Zirrhose - Varizen - Elastographie

Keywords

Liver - portal hypertension - endoscopy - endoscopic ultrasound - EUS PPG - endohepatology - HVPG - cirrhosis - varices - elastography


Publication History

Received: 02 December 2024

Accepted after revision: 10 April 2025

Article published online:
30 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Sun E, Hughes ML, Enslin S. et al. The Role of the Gastrointestinal Hospitalist in Optimizing Endoscopic Operations. Gastrointest Endosc Clin N Am 2021; 31 (04) 681-693
    CrossrefPubMedSearch in Google Scholar
  • 2 Chang KJ, Samarasena JB, Iwashita T. et al. Endo-hepatology: a new paradigm. Gastrointest Endosc Clin N Am 2012; 22 (02) 379-385
    CrossrefPubMedSearch in Google Scholar
  • 3 Laleman W, Vanderschueren E, Van der Merwe S. et al. The use of endoscopic ultrasound in the diagnosis and management of portal hypertension. Best Pract Res Clin Gastroenterol 2022; 60–61: 101811
    PubMedSearch in Google Scholar
  • 4 Laleman W, Vanderschueren E, Mehdi ZS. et al. Endoscopic procedures in hepatology: Current trends and new developments. J Hepatol 2024; 80 (01) 124-139
    CrossrefPubMedSearch in Google Scholar
  • 5 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (02) 185-205
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy 2018; 50 (09) 910-930
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Pugliese N, Ponziani FR, Cerini F. et al. Link between persistent, unexplained gamma-glutamyltransferase elevation and porto-sinusoidal vascular disorder. JHEP Rep Innov Hepatol 2024; 6 (09) 101150
    PubMedSearch in Google Scholar
  • 8 De Gottardi A, Rautou PE, Schouten J. et al. Porto-sinusoidal vascular disease: proposal and description of a novel entity. Lancet Gastroenterol Hepatol 2019; 4 (05) 399-411
    CrossrefPubMedSearch in Google Scholar
  • 9 Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (federführend), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche M. Crohn/Colitis ulcerosa Vereinigung (DCCV), Deutsche Leberhilfe e.V., Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM), Deutsche Gesellschaft für Endoskopie und Bildgebende Verfahren (DGE-BV). et al. [Practice guideline autoimmune liver diseases – AWMF-Reg. No. 021–27]. Z Gastroenterol 2017; 55 (11) 1135-1226
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Diehl DL. Endoscopic Ultrasound-guided Liver Biopsy. Gastrointest Endosc Clin N Am 2019; 29 (02) 173-186
    CrossrefPubMedSearch in Google Scholar
  • 11 Mathew A. EUS-guided routine liver biopsy in selected patients. Am J Gastroenterol 2007; 102 (10) 2354-2355
    CrossrefPubMedSearch in Google Scholar
  • 12 Dewitt J, McGreevy K, Cummings O. et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc 2009; 69: 535-542
    CrossrefPubMedSearch in Google Scholar
  • 13 Manning DS, Afdhal NH. EUS-guided liver biopsy: a procedure looking for an indication. Gastrointest Endosc 2009; 69: 543-545
    CrossrefPubMedSearch in Google Scholar
  • 14 Shuja A, Alkhasawneh A, Fialho A. et al. Comparison of EUS-guided versus percutaneous and transjugular approaches for the performance of liver biopsies. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 2019; 51 (06) 826-830
    CrossrefPubMedSearch in Google Scholar
  • 15 Patel HK, Therapondos G, Galliano G. et al. Endoscopic Ultrasound-Guided Liver Biopsy Using Newer 19G FNB Needles Compared to Percutaneous and Transjugular Liver Biopsy: A Tertiary Center Experience. Tech Innov Gastrointest Endosc 2022; 24 (02) 127-135
    PubMedSearch in Google Scholar
  • 16 Ali AH, Panchal S, Rao DS. et al. The efficacy and safety of endoscopic ultrasound-guided liver biopsy versus percutaneous liver biopsy in patients with chronic liver disease: a retrospective single-center study. J Ultrasound 2020; 23 (02) 157-167
    PubMedSearch in Google Scholar
  • 17 Schulman AR, Thompson CC, Odze R. et al. Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques. Gastrointest Endosc 2017; 85 (02) 419-426
    CrossrefPubMedSearch in Google Scholar
  • 18 Mohan BP, Shakhatreh M, Garg R. et al. Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89 (02) 238-246.e3
    CrossrefPubMedSearch in Google Scholar
  • 19 Ching-Companioni RA, Diehl DL, Johal AS. et al. 19 G aspiration needle versus 19 G core biopsy needle for endoscopic ultrasound-guided liver biopsy: a prospective randomized trial. Endoscopy [Internet] 2019; 51 (11) 1059-1065
    PubMedSearch in Google Scholar
  • 20 Aggarwal SN, Magdaleno T, Klocksieben F. et al. A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo. Gastrointest Endosc 2021; 93 (05) 1133-1138
    CrossrefPubMedSearch in Google Scholar
  • 21 Kasugai H, Yamamoto R, Tatsuta M. et al. Value of heparinized fine-needle aspiration biopsy in liver malignancy. AJR Am J Roentgenol 1985; 144 (02) 243-244
    CrossrefPubMedSearch in Google Scholar
  • 22 Mok SRS, Diehl DL, Johal AS. et al. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc 2018; 88 (06) 919-925
    CrossrefPubMedSearch in Google Scholar
  • 23 Ching-Companioni RA, Johal AS, Confer BD. et al. Single-pass 1-needle actuation versus single-pass 3-needle actuation technique for EUS-guided liver biopsy sampling: a randomized prospective trial (with video). Gastrointest Endosc 2021; 94 (03) 551-558
    CrossrefPubMedSearch in Google Scholar
  • 24 Rockey DC, Caldwell SH, Goodman ZD. et al. Liver biopsy. Hepatol Baltim Md 2009; 49 (03) 1017-1044
    CrossrefPubMedSearch in Google Scholar
  • 25 Neuberger J, Patel J, Caldwell H. et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69 (08) 1382-403
    CrossrefPubMedSearch in Google Scholar
  • 26 Pineda JJ, Diehl DL, Miao CL. et al. EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointest Endosc 2016; 83 (02) 360-365
    CrossrefPubMedSearch in Google Scholar
  • 27 McCarty TR, Bazarbashi AN, Njei B. et al. Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis. Clin Endosc 2020; 53 (05) 583-593
    CrossrefPubMedSearch in Google Scholar
  • 28 Bang JY, Ward TJ, Guirguis S. et al. Radiology-guided percutaneous approach is superior to EUS for performing liver biopsies. Gut 2021; 70 (12) 2224-2226
    CrossrefPubMedSearch in Google Scholar
  • 29 Diehl DL, Confer B, Adler DG. et al. EUS-guided versus percutaneous liver biopsy: Do we have a winner?. Endosc Ultrasound 2022; 11 (05) 339-341
    CrossrefPubMedSearch in Google Scholar
  • 30 Hajifathalian K, Chang KJ, Sharaiha RZ. Radiology-guided percutaneous approach is superior to EUS for performing liver biopsies. Gut 2022; 71 (04) 845-846
    CrossrefPubMedSearch in Google Scholar
  • 31 Mony S, Shah I, Vyas N. et al. Su1372 EUS GUIDED LIVER BIOPSY IS MORE COST-EFFECTIVE THAN PERCUTANEOUS LIVER BIOPSY IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE(NAFLD). Gastrointest Endosc 2018; 87 (06) AB326-AB327
    PubMedSearch in Google Scholar
  • 32 Abdelfattah TS, Hassouneh R, Sarairah H. et al. S0974 Post-Procedure Pain and Complications From Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy for Benign Parenchymal Liver Disease. Off J Am Coll Gastroenterol ACG 2020; 115: S496
    PubMedSearch in Google Scholar
  • 33 de Franchis R, Bosch J, Garcia-Tsao G. et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2022; 76 (04) 959-974
    CrossrefPubMedSearch in Google Scholar
  • 34 Ma J, Gong X, Luo J. et al. Impact of Intrahepatic Venovenous Shunt on Hepatic Venous Pressure Gradient Measurement. J Vasc Interv Radiol JVIR 2020; 31 (12) 2081-2088
    CrossrefPubMedSearch in Google Scholar
  • 35 Navasa M, Parés A, Bruguera M. et al. Portal hypertension in primary biliary cirrhosis. Relationship with histological features. J Hepatol 1987; 5 (03) 292-298
    PubMedSearch in Google Scholar
  • 36 Baffy G, Bosch J. Overlooked subclinical portal hypertension in non-cirrhotic NAFLD: Is it real and how to measure it?. J Hepatol 2022; 76 (02) 458-463
    CrossrefPubMedSearch in Google Scholar
  • 37 Bassegoda O, Olivas P, Turco L. et al. Decompensation in Advanced Nonalcoholic Fatty Liver Disease May Occur at Lower Hepatic Venous Pressure Gradient Levels Than in Patients With Viral Disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2022; 20 (10) 2276-2286.e6
    PubMedSearch in Google Scholar
  • 38 Götz M, Anders M, Biecker E. et al. S2k Guideline Gastrointestinal Bleeding – Guideline of the German Society of Gastroenterology DGVS. Z Gastroenterol 2017; 55 (09) 883-936
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Villanueva C, Albillos A, Genescà J. et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Lond Engl 2019; 393: 1597-1608
    PubMedSearch in Google Scholar
  • 40 Abraldes JG, Tarantino I, Turnes J. et al. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatol Baltim Md 2003; 37 (04) 902-908
    CrossrefPubMedSearch in Google Scholar
  • 41 Reiberger T, Ulbrich G, Ferlitsch A. et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut 2013; 62 (11) 1634-1641
    CrossrefPubMedSearch in Google Scholar
  • 42 Villanueva C, Graupera I, Aracil C. et al. A randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis. Hepatol Baltim Md 2017; 65 (05) 1693-1707
    CrossrefPubMedSearch in Google Scholar
  • 43 Huang JY, Samarasena JB, Tsujino T. et al. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus standard transjugular approach: a comparison animal study. Gastrointest Endosc 2016; 84 (02) 358-362
    CrossrefPubMedSearch in Google Scholar
  • 44 Huang JY, Samarasena JB, Tsujino T. et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc 2017; 85 (05) 996-1001
    CrossrefPubMedSearch in Google Scholar
  • 45 Choi AY, Chang KJ, Samarasena JB. et al. Endoscopic Ultrasound-Guided Porto-systemic Pressure Gradient Measurement Correlates with Histological Hepatic Fibrosis. Dig Dis Sci 2022; 67 (12) 5685-5692
    CrossrefPubMedSearch in Google Scholar
  • 46 Hajifathalian K, Westerveld D, Kaplan A. et al. Simultaneous EUS-guided portosystemic pressure measurement and liver biopsy sampling correlate with clinically meaningful outcomes. Gastrointest Endosc 2022; 95 (04) 703-710
    CrossrefPubMedSearch in Google Scholar
  • 47 Choi AY, Kolb J, Shah S. et al. Endoscopic ultrasound-guided portal pressure gradient with liver biopsy: 6 years of endo-hepatology in practice. J Gastroenterol Hepatol 2022; 37 (07) 1373-1379
    CrossrefPubMedSearch in Google Scholar
  • 48 Zhang W, Peng C, Zhang S. et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension. Gastrointest Endosc 2021; 93 (03) 565-572
    CrossrefPubMedSearch in Google Scholar
  • 49 Martinez-Moreno B, Martínez Martínez J, Herrera I. et al. Correlation of endoscopic ultrasound-guided portal pressure gradient measurements with hepatic venous pressure gradient: a prospective study. Endoscopy 2025; 57 (01) 62-67
    PubMedSearch in Google Scholar
  • 50 de Franchis R, Faculty BV. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53 (04) 762-768
    CrossrefPubMedSearch in Google Scholar
  • 51 Elkrief L, Lazareth M, Chevret S. et al. Liver Stiffness by Transient Elastography to Detect Porto-Sinusoidal Vascular Liver Disease With Portal Hypertension. Hepatol Baltim Md 2021; 74 (01) 364-378
    PubMedSearch in Google Scholar
  • 52 Lin H, Lai JCT, Wong GLH. et al. Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis. Aliment Pharmacol Ther 2023; 58 (09) 920-928
    CrossrefPubMedSearch in Google Scholar
  • 53 Benmassaoud A, Chen YI. Sedation during EUS-guided portal pressure gradient measurement: the elephant in the room. Gastrointest Endosc 2022; 96 (04) 690-691
    CrossrefPubMedSearch in Google Scholar
  • 54 Reverter E, Blasi A, Abraldes JG. et al. Impact of deep sedation on the accuracy of hepatic and portal venous pressure measurements in patients with cirrhosis. Liver Int Off J Int Assoc Study Liver 2014; 34 (01) 16-25
    PubMedSearch in Google Scholar
  • 55 Steinlauf AF, Garcia-Tsao G, Zakko MF. et al. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatol Baltim Md 1999; 29 (04) 1070-1073
    CrossrefPubMedSearch in Google Scholar
  • 56 Zhang H, Yang L, Yu Z. et al. Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study. Hepatol Commun 2023; 7 (01) e0002
    PubMedSearch in Google Scholar
  • 57 European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69 (02) 406-460
    CrossrefPubMedSearch in Google Scholar
  • 58 Albillos A, Krag A. Beta-blockers in the era of precision medicine in patients with cirrhosis. J Hepatol 2023; 78 (04) 866-872
    CrossrefPubMedSearch in Google Scholar
  • 59 Magaz M, Baiges A, Hernández-Gea V. Precision medicine in variceal bleeding: Are we there yet?. J Hepatol 2020; 72 (04) 774-784
    CrossrefPubMedSearch in Google Scholar
  • 60 Sarin SK, Lahoti D, Saxena SP. et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatol Baltim Md 1992; 16 (06) 1343-1349
    CrossrefPubMedSearch in Google Scholar
  • 61 Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med 1995; 123 (04) 280-287
    CrossrefPubMedSearch in Google Scholar
  • 62 Onofrio F de Q, Pereira-Lima JC, Valença FM. et al. Efficacy of endoscopic treatments for acute esophageal variceal bleeding in cirrhotic patients: systematic review and meta-analysis. Endosc Int Open 2019; 7 (11) E1503-E1514
    Thieme ConnectPubMedSearch in Google Scholar
  • 63 Garcia-Pagán JC, Barrufet M, Cardenas A. et al. Management of gastric varices. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2014; 12 (06) 919-928.e1
    PubMedSearch in Google Scholar
  • 64 Gralnek IM, Camus Duboc M, Garcia-Pagan JC. et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (11) 1094-1120
    Thieme ConnectPubMedSearch in Google Scholar
  • 65 Nett A, Binmoeller KF. Endoscopic Management of Portal Hypertension-related Bleeding. Gastrointest Endosc Clin N Am 2019; 29 (02) 321-337
    CrossrefPubMedSearch in Google Scholar
  • 66 Kovacs TOG, Jensen DM. Varices: Esophageal, Gastric, and Rectal. Clin Liver Dis 2019; 23 (04) 625-642
    CrossrefPubMedSearch in Google Scholar
  • 67 Laleman W. Endoscopic ultrasound-guided intervention for gastric varices: sticky stuff might not (yet) be enough. Endoscopy 2020; 52 (04) 244-246
    PubMedSearch in Google Scholar
  • 68 Ríos Castellanos E, Seron P, Gisbert JP. et al. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev 2015; 2015 (05) CD010180
    PubMedSearch in Google Scholar
  • 69 Hu Z, Zhang D, Swai J. et al. Risk of rebleeding from gastroesophageal varices after initial treatment with cyanoacrylate; a systematic review and pooled analysis. BMC Gastroenterol 2020; 20 (01) 181
    CrossrefPubMedSearch in Google Scholar
  • 70 Chirapongsathorn S, Manatsathit W, Farrell A. et al. Safety and efficacy of endoscopic cyanoacrylate injection in the management of gastric varices: A systematic review and meta-analysis. JGH Open Open Access J Gastroenterol Hepatol 2021; 5 (09) 1047-1055
    CrossrefPubMedSearch in Google Scholar
  • 71 Guo YW, Miao HB, Wen ZF. et al. Procedure-related complications in gastric variceal obturation with tissue glue. World J Gastroenterol 2017; 23 (43) 7746-7755
    CrossrefPubMedSearch in Google Scholar
  • 72 Binmoeller KF, Weilert F, Shah JN. et al. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos). Gastrointest Endosc 2011; 74 (05) 1019-1025
    CrossrefPubMedSearch in Google Scholar
  • 73 Robles-Medranda C, Oleas R, Valero M. et al. Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial. Endoscopy 2020; 52 (04) 268-275
    Thieme ConnectPubMedSearch in Google Scholar
  • 74 Mohan BP, Chandan S, Khan SR. et al. Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis. Endoscopy 2020; 52 (04) 259-267
    Thieme ConnectPubMedSearch in Google Scholar
  • 75 Kouanda A, Binmoeller K, Hamerski C. et al. Safety and efficacy of EUS-guided coil and glue injection for the primary prophylaxis of gastric variceal hemorrhage. Gastrointest Endosc 2021; 94 (02) 291-296
    CrossrefPubMedSearch in Google Scholar
  • 76 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, Clinical Practice Guideline Panel, Chair, EASL Governing Board representative, Panel members: EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol 2021; 75 (03) 659-689
    CrossrefPubMedSearch in Google Scholar
  • 77 Ali AH, Al Juboori A, Petroski GF. et al. The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study. J Clin Med 2022; 11 (05) 1201
    PubMedSearch in Google Scholar
  • 78 Yamashita Y, Yamazaki H, Shimokawa T. et al. Shear-wave versus strain elastography in endoscopic ultrasound for the diagnosis of chronic pancreatitis. Pancreatol Off J Int Assoc Pancreatol IAP Al 2023; 23 (01) 35-41
    CrossrefPubMedSearch in Google Scholar
  • 79 Yamamiya A, Irisawa A, Hoshi K. et al. Recent Advances in Endosonography-Elastography: Literature Review. J Clin Med 2021; 10 (16) 3739
    CrossrefPubMedSearch in Google Scholar
  • 80 Lewey SM. Top tips in EUS elastography (with videos). Gastrointest Endosc 2023; 97 (03) 574-584
    CrossrefPubMedSearch in Google Scholar
  • 81 Kohli DR, Mettman D, Andraws N. et al. Comparative accuracy of endosonographic shear wave elastography and transcutaneous liver stiffness measurement: a pilot study. Gastrointest Endosc 2023; 97 (01) 35-41.e1
    CrossrefPubMedSearch in Google Scholar
  • 82 Ang TL, Kwek ABE, Wang LM. Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions. Gut Liver 2018; 12 (05) 483-496
    CrossrefPubMedSearch in Google Scholar
  • 83 Alvarez-Sánchez MV, Napoléon B. Contrast-enhanced harmonic endoscopic ultrasound imaging: basic principles, present situation and future perspectives. World J Gastroenterol 2014; 20 (42) 15549-15563
    CrossrefPubMedSearch in Google Scholar
  • 84 Dietrich CF, Nolsøe CP, Barr RG. et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020; 46 (10) 2579-2604
    CrossrefPubMedSearch in Google Scholar
  • 85 Schulman AR, Ryou M, Aihara H. et al. EUS-guided intrahepatic portosystemic shunt with direct portal pressure measurements: a novel alternative to transjugular intrahepatic portosystemic shunting. Gastrointest Endosc 2017; 85 (01) 243-247
    PubMedSearch in Google Scholar
  • 86 Buscaglia JM, Dray X, Shin EJ. et al. A new alternative for a transjugular intrahepatic portosystemic shunt: EUS-guided creation of an intrahepatic portosystemic shunt (with video). Gastrointest Endosc 2009; 69 (04) 941-947
    PubMedSearch in Google Scholar