The Expansion of the Role of Endoscopic Ultrasound in the Field of Endohepatology

Background/Objective: Endohepatology has recently emerged as a field combining advanced endoscopy and hepatology. Endoscopic ultrasound (EUS) plays a key role in the management of patients with chronic liver disease. The main objective of this paper is to provide critical review on the recent advances in EUS-based liver diagnostics and therapeutics and how such advances have been central in establishing the field of Endohepatology. Methods: We searched the PubMed database for articles published since 1995 focused on the use of EUS in the field of Endohepatology. Our aim is to synthesize a narrative, non-systematic review emphasized on the evolving concepts, technical advancements, and clinical applications, particularly in areas where high-quality randomized data remain limited. Results: EUS-guided liver biopsy (EUS-LB) now offers diagnostic yield comparable to those of the percutaneous approaches. In addition, EUS-guided fine-needle biopsy (EUS-FNB) design and suction techniques have further optimized tissue sampling. Furthermore, EUS-guided portal pressure gradient (EUS-PPG) measurement is a promising alternative tool in risk stratification of patients with chronic advanced liver disease. EUS-based elastography enables real-time quantification of liver stiffness and fibrosis and evaluation of space-occupying lesions. Moreover, EUS-guided interventions can play important roles in the management of patients with portal hypertension-related bleeding. Finally, emerging applications include EUS-guided radiofrequency ablation (EUS-RFA), portal venous sampling, and intrahepatic shunt creation, which may further expand minimally invasive treatment options. Conclusions: State-of-the-art innovations expanded the role of EUS not only in diagnostics but also in the therapeutic role of EUS and provided a new paradigm for the care of patients with liver disease.