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World J Gastrointest Endosc. Jun 16, 2022; 14(6): 354-366
Published online Jun 16, 2022. doi: 10.4253/wjge.v14.i6.354
Role of endoscopic ultrasound in vascular interventions: Where are we now?
Alessandro Fugazza, Kareem Khalaf, Matteo Colombo, Silvia Carrara, Marco Spadaccini, Glenn Koleth, Edoardo Troncone, Roberta Maselli, Alessandro Repici, Andrea Anderloni
Alessandro Fugazza, Matteo Colombo, Silvia Carrara, Marco Spadaccini, Glenn Koleth, Roberta Maselli, Alessandro Repici, Andrea Anderloni, Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital, Rozzano 20089, Italy
Kareem Khalaf, Alessandro Repici, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Italy
Edoardo Troncone, Department of Systems Medicine, University of Rome "Tor Vergata", Roma 00133, Italy
Author contributions: Fugazza A and Khalaf K conceived the design of the work, writing the article and acquiring data; Colombo M, Carrara S, Spadaccini M, Koleth G, Troncone E and Maselli R acquired data and prepared the figures; Repici A and Anderloni A revised it critically for important intellectual content; all authors reviewed and approved the final version of the paper.
Conflict-of-interest statement: Fugazza A is a consultant for Boston Scientific and Olympus. Repici A is a consultant for Boston Scientific, Fujifilm, ERBE. Anderloni A is a consultant for Boston Scientific and Olympus. The remaining authors have no conflict of interest.
: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Fugazza, MD, Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Italy. email@example.com
Received: December 27, 2021
Peer-review started: December 27, 2021
First decision: February 21, 2022
Revised: March 8, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: June 16, 2022
From a mere diagnostic tool to an imperative treatment modality, endoscopic ultrasound (EUS) has evolved and revolutionized safer efficient options for vascular interventions. Currently it is an alternative treatment option in the management of gastrointestinal bleeding, primarily variceal type bleeding. Conventional treatment option prior to EUS incorporation had limited efficiency and high adverse events. The characterization and detail provided by EUS gives a cutting edge towards a holistically successful management choice. Data indicates that EUS-guided combination therapy of coil embolization and glue injection has the higher efficacy for the treatment of varices. Conversely, similar treatment options that exist for esophageal and other ectopic variceal bleeding was also outlined. In conclusion, many studies refer that a combination therapy of coil and glue injection under EUS guidance provides higher technical success with fewer recurrence and adverse events, making its adaptation in the guideline extremely favorable. Endo-hepatology is a novel disciple with a promising future outlook, we reviewed topics regarding portal vein access, pressure gradient measurement, and thrombus biopsy that are crucial interventions as alternative of radiological procedures. The purpose of this review is to provide an update on the latest available evidence in the literature regarding the role of EUS in vascular interventions. We reviewed the role of EUS in variceal bleeding in recent studies, especially gastric varices and novel approaches aimed at the portal vein.
Core Tip: Currently endoscopic ultrasound (EUS) is an alternative treatment option in the management of gastrointestinal bleeding, primarily variceal type bleeding. This manuscript tackles a comprehensive review for the uses of EUS in the majority of vascular interventions with regard to gastrointestinal bleeding and offers a directive for the technical aspects in carrying out a procedural treatment of combination coil and glue therapy for gastric varices.