Following PPG measurements, EUSguided liver biopsy was done from the left and right lobes with a 19G FNB needle, returning several long tissue cores (FIG 6).
The patient awoke from the procedure without any abdominal pain. She was observed for one hour without any adverse events noted. The liver histology showed no minimal steatosis without NASH or increased fibrosis. With the above information, the patient has been cleared for further consideration for RYGB bariatric surgery.
Discussion: There is an emerging field of endo-hepatology, which expands the role of endosonography for the evaluation and treatment of liver diseases. Up until recently, the intersection of endoscopy and hepatology was limited to diagnosis and treatment of varices. The technique of EUSguided liver biopsy (EUS-LB) is seeing increased use and has been the initial basis of endo-hepatology. EUS-guided management of gastric varices is another important advancement. EUS-guided injection of coils followed by tissue glue may decrease risks of glue embolization that may be seen without coil use, and also has the potential for better varix eradication.
2020. It is likely that expanded use of EUS-guided portosystemic pressure gradient (EUS-PPG) assessment will increase, and hopefully minimize the need for transjugular access for wedged portal pressures. The ability to perform a comprehensive liver evaluation with EUS-guided biopsy and portal pressure assessment in one setting allows a more efficient approach to the liver patient, while at the same time keeping the patient within the care of the gastroenterology/ hepatology service. We expect to see expansion of the field of endo-hepatology in the future as gastroenterologists and hepatologists become more familiar with these diagnostic tools.
Efforts to develop methods for measuring portal pressures with EUS guidance have been underway for several years, and FDA clearance of the EchoTip Insight was achieved in
In June, we began the election process for the position of Governor in Eastern Pennsylvania. The election process recently ended, and the winner of the election is the incumbent, Joyann Kroser, MD, FACG.
Joyann Kroser, MD, FACG
Dr. Kroser will serve for a second three-year term commencing at the conclusion of the College’s Annual Meeting this October. Regards, Amy S. Oxentenko, MD, FACG ACG Secretary
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