Journal of Diagnostics Concepts & Practice >

2025 , Vol. 24 >Issue 04: 365 - 372

DOI: https://doi.org/10.16150/j.1671-2870.2025.04.002

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Research progress on endoscopic ultrasonography in vascular interventional diagnosis and therapy

  • CHENG Guilian ,
  • SHI Tianze ,
  • HU Duanmin
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  • Department of Gastroenterology, Second Affiliated Hospital of Soochow University, Jiangsu Suzhou 215000, China

Received date: 2025-06-02

  Revised date: 2025-07-27

  Accepted date: 2025-08-12

  Online published: 2025-09-09

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Abstract

This study systematically reviews the advances in the application of endoscopic ultrasonography (EUS) in both portal and non-portal vascular interventions. EUS-guided sclerotherapy and coil embolization effectively occlude perforating vessels in esophageal, gastric, and ectopic varices, significantly reducing recurrence rates—particularly in refractory cases and patients with large shunt pathways. Moreover, EUS-guided portal pressure measurement achieves a technical success rate of 95% and demonstrates strong correlation with hepatic venous pressure gradient, showing potential as a non-invasive alternative. Meanwhile, EUS-guided fine-needle aspiration enables minimally invasive biopsy for definitive diagnosis of portal vein thrombi, with no complications reported. In non-portal vascular interventions, EUS provides precise therapeutic solutions for refractory lesions by embolizing bleeding ulcers, pseudoaneurysms, and feeding vessels of gastrointestinal stromal tumors. Although current evidence is predominantly derived from small-scale studies, the safety and efficacy of EUS-guided vascular intervention (EUS-VI) have been preliminarily validated. Future research should focus on large-scale randomized controlled trials to further evaluate and optimize technical standards, ultimately establishing EUS-VI as a first-line diagnostic and therapeutic option for vascular lesions.

Key words： Endoscopic ultrasonography; Vascular intervention; Portal hypertension; Portal pressure measurement

Cite this article

CHENG Guilian , SHI Tianze , HU Duanmin . Research progress on endoscopic ultrasonography in vascular interventional diagnosis and therapy[J]. Journal of Diagnostics Concepts & Practice, 2025 , 24(04) : 365 -372 . DOI: 10.16150/j.1671-2870.2025.04.002

References

[1] SHIBUKAWA G, IRISAWA A, SAITO A, et al. Variceal recurrence after endoscopic sclerotherapy associated with the perforating veins in lower esophagus independently[J]. Hepatogastroenterology, 2004, 51(57):744-747.
[2] IRISAWA A, SAITO A, OBARA K, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe periesophageal colla-teral veins and large perforating veins[J]. Gastrointest Endosc, 2001, 53(1):77-84.
[3] LAHOTI S, CATALANO M F, ALCOCER E, et al. Obli-teration of esophageal varices using EUS-guided sclerotherapy with color Doppler[J]. Gastrointest Endosc, 2000, 51(3):331-333.
[4] DE PAULO G A, ARDENGH J C, NAKAO F S, et al. Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins[J]. Gastrointest Endosc2,006,63(3):396-463.
[5] MANN R, GOYAL H, PERISETTI A, et al. Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques[J]. World J Gastroenterol, 2021, 27(40):6874-6887.
[6] SARIN S K, LAHOTI D, SAXENA S P, et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients[J]. Hepatology, 1992, 16(6):1343-1349.
[7] KAPLAN D E, RIPOLL C, THIELE M, et al. AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis[J]. Hepato-logy (Baltimore, Md.), 2024, 79(5): 1180-1211.
[8] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 中华肝脏病杂志, 2022, 30(10):1029-1043.
  Chinese Society of Hepatology, Chinese Society of Gast-roenterology, Chinese Society of Digestive Endoscopology of Chinese Medical Association. Guidelines on the mana-gement of esophagogastric variceal bleeding in cirrhotic portal hypertension[J]. Chin J Hepatol, 2022, 30(10):1029-1043.
[9] AL-OSAIMI A M, SABRI S S, CALDWELL S H. Balloonoc-cluded retrograde transvenous obliteration (BRTO): preprocedural evaluation and imaging[J]. Semin Intervent Radiol, 2011, 28(3):288-295.
[10] KOK K, BOND R P, DUNCAN I C, et al. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature[J]. Endoscopy, 2004, 36(5):442-446.
[11] LEE Y T, CHAN F K, NG E K, et al. EUS-guided injection of cyanoacrylate for bleeding gastric varices[J]. Gastrointest Endosc, 2000, 52(2):168-174.
[12] ROMERO-CASTRO R, PELLICER-BAUTISTA F, GIOVANNINI M, et al. Endoscopic ultrasound (EUS)-guided coil embolization therapy in gastric varices[J]. Endoscopy, 2010, 42(Suppl 2):E35-E36.
[13] ROBLES-MEDRANDA C, OLEAS R, VALERO M, et al. Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial[J]. Endoscopy, 2020, 52(4):268-275.
[14] BINMOELLER K F, WEILERT F, SHAH J N, et al. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos)[J]. Gastrointest Endosc, 2011, 74(5):1019-1025.
[15] MCCARTY T R, BAZARBASHI A N, HATHORN K E, et al. Combination therapy versus monotherapy for EUS-guided management of gastric varices: A systematic review and meta-analysis[J]. Endosc Ultrasound, 2020, 9(1):6-15.
[16] CHANDAN S, NGUYEN A K, MOHAN B P, et al. EUS-guided therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis[J]. Endosc Ultrasound, 2023, 12(4):351-361.
[17] XIAO Y, HUANG Z, CAO J, et al. Balloon-occluded retrograde transvenous obliteration combined with EUS-guided coil embolization and endoscopic cyanoacrylate injection therapy of gastric varices with huge gastrorenal shunt (with videos)[J]. Endosc Ultrasound, 2023, 12(1):157-159.
[18] NAGASHIMA K, KASHIMA K, KUNOGI Y, et al. Treatment of endoscopic ultrasound-guided coil deployment for isolated gastric varices using 0.035-inch hydrocoil: Experience of three cases[J]. DEN Open, 2023, 4(1):e252.
[19] O'ROURKE J, TODD A, SHEKHAR C, et al. EUS-guided thrombin injection and coil implantation for gastric varices: feasibility, safety, and outcomes[J]. Gastrointest Endosc, 2024, 100(3):549-556.
[20] NORTON I D, ANDREWS J C, KAMATH P S. Management of ectopic varices[J]. Hepatology, 1998, 28(4):1154-1158.
[21] KHOUQEER F, MORROW C, JORDAN P. Duodenal varices as a cause of massive upper gastrointestinal blee-ding[J]. Surgery, 1987, 102(3):548-552.
[22] KAKIZAKI S, TOYODA M, ICHIKAWA T, et al. Clinical characteristics and treatment for patients presenting with bleeding duodenal varices[J]. Dig Endosc, 2010, 22(4):275-281.
[23] WALLSTABE I, ZUREK M, GEYER C. Endoscopic ultrasound-guided injection of N-butyl-2-cyanoacrylate into portal venous collateral vessels that were feeding bleeding duodenal varices[J]. Endoscopy, 2019, 51(10):E293-E294.
[24] LIENHART I, LESNE A, COUCHONNAL E, et al. Massive duodenal variceal bleed: endoscopic ultrasonography of ruptured varix and successful endoscopic clipping treatment[J]. Endoscopy, 2016, 48 (Suppl 1) UCTN:E80-E81.
[25] SO H, PARK DO H, JUNG K, et al. Successful endoscopic ultrasound-guided coil embolization for severe duodenal bleeding[J]. Am J Gastroenterol, 2016, 111(7):925.
[26] SHUDO R, YAZAKI Y, SAKURAI S, et al. Clinical study comparing bleeding and nonbleeding rectal varices[J]. Endoscopy, 2002, 34(3):189-194.
[27] SHARMA M, SOMASUNDARAM A. Massive lower GI bleed from an endoscopically inevident rectal varices: diagnosis and management by EUS (with videos)[J]. Gastrointest Endosc, 2010, 72(5):1106-1108.
[28] WEILERT F, SHAH J N, MARSON F P, et al. EUS-guided coil and glue for bleeding rectal varix[J]. Gastrointest Endosc, 2012, 76(4):915-916.
[29] JANA T, MISTRY T, SINGHAL S. Endoscopic ultrasound-guided hemostasis of rectal varices[J]. Endoscopy, 2017, 49(S 01):E136-E137.
[30] CONNOR E K, DURAN-CASTRO O L, ATTAM R. Therapy for recurrent bleeding from rectal varices by EUS-guided sclerosis[J]. Gastrointest Endosc, 2015, 81(5):1280-1281.
[31] MESSALLAM A A, KUMBHARI V, SAXENA P, et al. Large bleeding rectal varices treated with endoscopic ultrasound-guided coiling and cyanoacrylate injection[J]. Endoscopy, 2014, 46(Suppl 1)UCTN:E28-E29.
[32] DHAR J, SAMANTA J. Endoscopic ultrasound-guided vascular interventions: An expanding paradigm[J]. World J Gastrointest Endosc, 2023, 15(4):216-239.
[33] DHAR J, SAMANTA J. Role of endoscopic ultrasound in the field of hepatology: Recent advances and future trends[J]. World J Hepatol, 2021, 13(11):1459-1483.
[34] LEVY M J, WONG KEE SONG L M, KENDRICK M L, et al. EUS-guided coil embolization for refractory ectopic variceal bleeding (with videos)[J]. Gastrointest Endosc, 2008, 67(3):572-574.
[35] TSYNMAN D N, DECROSS A J, MALIAKKAL B, et al. Novel use of EUS to successfully treat bleeding parastomal varices with N-butyl-2-cyanoacrylate[J]. Gastrointest Endosc, 2014, 79(6):1007-1008.
[36] FUJII-LAU L L, LEISE M D, KAMATH P S, et al. Endoscopic ultrasound-guided portal-systemic pressure gra-dient measurement[J]. Endoscopy, 2014, 46(Suppl 1)UCTN:E654-E656.
[37] MARTINEZ-MORENO B, MARTíNEZ MARTíNEZ J, HERRERA I, et al. Correlation of endoscopic ultrasound-guided portal pressure gradient measurements with hepatic venous pressure gradient: a prospective study[J]. Endoscopy, 2025, 57(1):62-67.
[38] ZHANG W, PENG C, ZHANG S, et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension[J]. Gastrointest Endosc, 2021, 93(3):565-572.
[39] ROMERO-CASTRO R, CARMONA-SORIA I, JIMéNEZ-GARCíA V A, et al. Endoscopic ultrasound-guided portal pressure gradient measurement: improving safety and overcoming technical difficulties[J]. Endoscopy, 2023, 55(S 01):E878-E880.
[40] LAI R, STEPHENS V, BARDALES R. Diagnosis and staging of hepatocellular carcinoma by EUS-FNA of a portal vein thrombus[J]. Gastrointest Endosc, 2004, 59(4):574-577.
[41] MORENO M, GIMENO-GARCíA A Z, CORRIENTE M M, et al. EUS-FNA of a portal vein thrombosis in a patient with a hidden hepatocellular carcinoma: confirmation technique after contrast-enhanced ultrasound[J]. Endoscopy, 2014, 46(Suppl 1)UCTN:E590-E591.
[42] 张奕蕊, 胡端敏, 吴伟. 超声内镜引导下细针抽吸术对门静脉癌栓的诊断价值(含视频)[J]. 中华消化内镜杂志, 2022, 39(12):1014-1017.
  ZHANG Y R, HU D M, WU W. Diagnostic value of endoscopic ultrasound-guided fine needle aspiration for portal vein tumor thrombus (with video)[J]. Chin J Dig Endosc, 39(12):1014-1017.
[43] BUSCAGLIA J M, DRAY X, SHIN E J, et al. A new alternative for a transjugular intrahepatic portosystemic shunt: EUS-guided creation of an intrahepatic portosystemic shunt (with video)[J]. Gastrointest Endosc, 2009, 69(4):941-947.
[44] POINCLOUX L, CHABROT P, MULLIEZ A, et al. Interventional endoscopic ultrasound: A new promising way for intrahepatic portosystemic shunt with portal pressure gradient[J]. Endosc Ultrasound, 2017, 6(6):394-401.
[45] ZHANG F, ZHUGE Y, WANG L. EUS-guided portal vein location before transjugular intrahepatic portosystemic shunt for the treatment of cavernomatous transformation of the portal vein (with video)[J]. Gastrointest Endosc, 2024, 99(2):281-282.
[46] ZHANG Z G, LI Z, YANG Y, et al. Hemodynamic effect through a novel endoscopic intervention in management of varices and hypersplenism (with video)[J]. Gastrointest Endosc, 2022, 95(1):172-183.e2.
[47] TIELLEMAN T, BUJANDA D, CRYER B. Epidemiology and risk factors for upper gastrointestinal bleeding[J]. Gastrointest Endosc Clin N Am, 2015, 25(3):415-428.
[48] MARYA N B, SAWAS T, CHANDRASEKHARA V, et al. Every trick in the book: EUS angiotherapy for management of refractory bleeding secondary to a complicated duodenal ulcer in a patient with Roux-en-Y gastric bypass[J]. VideoGIE, 2020, 5(10):461-463.
[49] MEDINA-PRADO L, BAILE-MAXíA S, BOZHYCHKO M, et al. Recurrent upper gastrointestinal ulcer bleeding treated by coil embolization guided by endoscopic ultrasonography[J]. Endoscopy, 2020, 52(11): E424-E425.
[50] ROBB P M, YEATON P, BISHOP T, et al. Endoscopic ultrasound guided embolization of a pancreatic pseudoa-neurysm[J]. Gastroenterology Res, 2012, 5(6):239-241.
[51] GAMBIEZ L P, ERNST O J, MERLIER O A, et al. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis[J]. Archives of Surgery (Chicago, Ill.: 1960), 1997, 132(9): 1016-1021.
[52] SHARMA M, SOMANI P, SUNKARA T, et al. Endoscopic ultrasound-guided coil embolization and thrombin injection of a bleeding gastroduodenal artery pseudoaneurysm[J]. Endoscopy, 2019, 51(2):E36-E37.
[53] HU B, CHENG G, GONG Z, et al. Endoscopic ultrasound-guided embolization: Successful management of hemorrhage from gastric artery aneurysm rupture[J]. Endoscopy, 2025, 57(S 01):E523-E524.
[54] MAHARSHI S, SHARMA S S, SHARMA D, et al. Endoscopic ultrasound-guided thrombin injection, a management approach for visceral artery pseudoaneurysms[J]. Endosc Int Open, 2020, 8(3):E407-E412.
[55] KUMBHARI V, GONDAL B, OKOLO III P I, et al. Endoscopic ultrasound-guided angiotherapy of a large blee-ding gastrointestinal stromal tumor[J]. Endoscopy, 2013, 45(Suppl 2)UCTN:E326-E327.
[56] SHARMA M, SOMANI P, SUNKARA T, et al. Endoscopic ultrasound-guided management of bleeding periampullary tumor[J]. Endoscopy, 2018, 50(7):E192-E193.
[57] HU B, CHENG G, GONG Z, et al. Endoscopic ultrasound-guided embolization with imatinib for duodenal gastrointestinal stromal tumors in inoperable or treatment-unwilling patients[J]. Endoscopy, 2025, 57(S 01):E515-E516.
[58] ROMERO-CASTRO R, JIMENEZ-GARCIA V A, IRISAWA A, et al. Endoscopic ultrasound-guided angiotherapy in bleeding gastrointestinal stromal tumors with coil deployment and cyanoacrylate injection[J]. Endoscopy, 2021, 53(4):E124-E125.
[59] BAETTIG B, HAECKI W, LAMMER F, et al. Dieulafoy's disease: endoscopic treatment and follow up[J]. Gut, 1993, 34(10):1418-1421.
[60] SCHMULEWITZ N, BAILLIE J. Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center[J]. Am J Gastroenterol, 2001, 96(6):1688-1694.
[61] RAJU G S, FARUQI S, BHUTANI M S, SOLOWAY R. Catheter probe EUS-assisted treatment with hemoclips of a colonic Dieulafoy's lesion with recurrent bleeding[J]. Gastrointest Endosc, 2004, 60(5):851-854.
[62] LEVY M J, WONG KEE SONG L M, FARNELL M B, et al. Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding[J]. Am J Gastroenterol, 2008, 103(2):352-359.
[63] JIANG S, LI H, ZHANG L, et al. Generic Diagramming Platform (GDP): a comprehensive database of high-quality biomedical graphics[J]. Nucleic Acids Res, 2025, 53(D1):D1670-D1676.
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