Endohepatology in the Management of Liver Diseases.

IF 3.7 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Thomas J Wang, Ajaypal Singh
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引用次数: 0

Abstract

Endohepatology is an emerging field that encompasses various diagnostic and therapeutic endoscopic ultrasound (EUS) techniques for the management of liver disease. It encompasses diagnostic techniques for fibrosis staging and portal hypertension evaluation, as well as therapeutic interventions for conditions like variceal bleeding. Given the medical complexity and fragility that are often encountered in patients with liver disease, careful attention is of paramount importance to minimize risk and invasiveness when possible while extracting maximal value with a therapeutic intent. EUS-guided access to liver, bile ducts, and the hepatic vasculature provides the ability for diagnostic evaluation and interventions, which are not limited by body habitus and the need for central vascular access. Established EUS-guided techniques include liver biopsy, direct portal pressure gradient measurements, and gastric variceal coiling and injection therapies. More emerging techniques, including liver palpation, shear wave elastography, portal venous sampling, rectal variceal coiling, and partial splenic artery embolization, have also been described in the literature. This review details the rationale and evidence behind both established and emerging EUS-guided techniques, highlighting their current and potential future impact on endohepatology.

内源性肝病在肝病治疗中的应用
内窥镜超声(EUS)是一个新兴的领域,包括各种诊断和治疗的内窥镜超声(EUS)技术,用于肝脏疾病的管理。它包括纤维化分期和门脉高压评估的诊断技术,以及静脉曲张出血等疾病的治疗干预。鉴于肝病患者经常遇到的医疗复杂性和脆弱性,在可能的情况下,仔细注意最小化风险和侵入性,同时提取最大的治疗价值是至关重要的。eus引导下进入肝脏、胆管和肝血管提供了诊断评估和干预的能力,不受身体习惯和需要中央血管进入的限制。已建立的eus引导技术包括肝活检、直接门静脉压力梯度测量、胃静脉曲张盘绕和注射治疗。更多的新兴技术,包括肝触诊、剪切波弹性成像、门静脉取样、直肠静脉曲张卷曲和部分脾动脉栓塞,也在文献中有所描述。这篇综述详细介绍了现有的和新兴的eus引导技术背后的基本原理和证据,强调了它们目前和未来对内源性肝病的潜在影响。
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来源期刊
Seminars in liver disease
Seminars in liver disease 医学-胃肠肝病学
CiteScore
8.20
自引率
2.40%
发文量
38
期刊介绍: Seminars in Liver Disease is a quarterly review journal that publishes issues related to the specialties of hepatology and gastroenterology. As the premiere review journal in the field, Seminars in Liver Disease provides in-depth coverage with articles and issues focusing on topics such as cirrhosis, transplantation, vascular and coagulation disorders, cytokines, hepatitis B & C, Nonalcoholic Steatosis Syndromes (NASH), pediatric liver diseases, hepatic stem cells, porphyrias as well as a myriad of other diseases related to the liver. Attention is also given to the latest developments in drug therapy along with treatment and current management techniques. Seminars in Liver Disease publishes commissioned reviews. Unsolicited reviews of an exceptional nature or original articles presenting remarkable results will be considered, but case reports will not be published.
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