Abstract
The implications of endoscopic ultrasound (EUS) have expanded considerably in recent years to cover more fields in invasive gastroenterology practice, as both an investigative and therapeutic modality. The utility of EUS in the diagnosis and management of focal liver lesions has gained a special attractiveness recently. The EUS probe proximity to the liver and its excellent spatial resolution enables real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS. Aside from its notable capability to execute targeted biopsies and therapeutic interventions, EUS has developed into a hopeful therapeutic tool for the management of solid liver lesions. Herein, we provide a comprehensive state-of-the-art review on the efficacy and safety of EUS in the diagnosis and management of focal solid liver lesions. Medline/PubMed and Embase database searches were conducted by two separate authors (T.K. and W.S.), all relevant studies were assessed, and relevant data was extracted and fully reported. EUS-guided diagnosis of focal liver lesions by sonographic morphologic appearance and cytological and histopathological finding of biopsies obtained via fine needle aspiration/biopsy have been shown to significantly improve the diagnosis of solid liver lesions compared with traditional imaging tools. Similarly, EUS-guided treatment has been shown to consistently have excellent technical success, high efficacy, and minor adverse events. The evolving valuable evidences of EUS utility might satisfy the unmet need of optimizing management of focal solid liver lesions.
Highlights
Endoscopic ultrasound (EUS) was introduced as a diagnostic modality almost 40 years ago.Interestingly, it has rapidly gained popularity as an interventional and therapeutic tool in various gastrointestinal and liver disorders
Using the Medline/PubMed and Embase database, we performed a search with the keywords: EUS or endoscopic ultrasound or echoendoscopes and any of the following: liver or hepatic, solid, focal lesions, diagnosis, enhancement, fine needle aspiration or biopsy, treatment or therapeutic, ablation, ethanol injection, radiofrequency ablation (RFA), Neodymium: yttium-aluminum-garnet ablation, high-intensity focused ultrasound (HIFU), photodynamic therapy (PDT), and brachytherapy
Most interventions were in the hands of surgeons; as the imaging modalities have evolved, a significant volume of interventions have moved to the hands of invasive radiologist and, with the great developments in invasive endoscopy field, the gastroenterologists took command on a large volume of interventions that were outside the reach of endoscopy in the past
Summary
Wisam Sbeit 1,2 , Anas Kadah 1,2 , Amir Mari 2,3 , Mahmud Mahamid 4,5 and Tawfik Khoury 1,2, *. Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth 16100, Israel. Received: 20 August 2020; Accepted: September 2020; Published: September 2020
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