Issues of endoscopic diagnosis and treatment for complications of portal hypertension

In addition to its recognized efficacy, endoscopic band ligation (EBL) of esophageal varices can lead to a number of complications, among which post-banding ulcer bleeding (PUB) has a special place. Model of end-stage liver disease >18 index in combination with emergency EBL has been found to be the most likely predictor of PUB. The choice of effective endoscopic treatment for gastric variceal (GV) is often reduced to endoscopic interventional techniques. Here, the choice of intervention under the control of endoscopic ultrasound scanning (EUS) has shown its superiority over traditional endoscopic and X-ray endovascular methods of treating. Standard EBL and endoscopic sclerotherapy (ES) have a higher complication rate in the treatment of gastrointestinal ectopic varices (GEV). Bypass surgeries do not always achieve eradication or regression of GEV. The use of EUS allows delineation of afferent vessels for direct injection of sclerosant, which is not feasible with conventional endoscopic treatment. The main causes of non-variceal portal bleeding are portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). New minimally invasive diagnostic methods allow to differentiate PGH and GAVE with high specificity, and can help in understanding the etiopathogenesis of GAVE and finding effective ways of its treatment.