The evolving role of endoscopic ultrasound from diagnosis to therapy in hepatic vascular interventions

Endohepatology, the integration of advanced endoscopy into hepatology, is rapidly evolving beyond standard diagnostics. This review focuses on its burgeoning vascular applications, particularly through endoscopic ultrasound (EUS). EUS-guided portal pressure gradient measurement (EUS-PPG) is establishing a new paradigm for direct portal hypertension assessment. Therapeutically, EUS enables precise vascular interventions such as coil and glue embolization for gastric varices and spontaneous portosystemic shunts, moving beyond blind techniques. Pioneering, bench-to-bedside procedures like the creation of EUS-guided intrahepatic portosystemic shunts (EUS-IPS) represent the next frontier. While technical complexity remains, EUS is a transformative platform within endohepatology. This article explores these cutting-edge applications and prognosticates future techniques set to redefine the management of complex hepatobiliary and vascular diseases.