Role of Endoscopic Ultrasound in Liver Disease: Where Do We Stand?

As the burden of liver disease in the general populace steadily increases, so does the need for both advanced diagnostic and treatment options. Endoscopic ultrasound is a reliable diagnostic and therapeutic method that has an established role, foremost in pancreatobiliary pathology. This paper aims to summarize the growing role of endoscopic ultrasound in hepatology based on the search of the current literature. A number of applications of endoscopic ultrasound are reviewed, including both noninvasive methods and tissue acquisition in focal and diffuse liver disease, portal hypertension measurement, detection and management of gastric and esophageal varices, treatment of focal liver lesions and staging of pancreatobiliary malignancies, treatment of cystic and solid liver lesions, as well as liver abscess drainage. Both hepatologists and endoscopists should be aware of the evolving role of endoscopic ultrasound in liver disease. The inherent invasive nature of endoscopic examination limits its use to a targeted population identified using noninvasive methods. Endoscopic ultrasound is one the most versatile methods in gastroenterology, allowing immediate access with detection, sampling, and treatment of digestive tract pathology. Further expansion of its use in hepatology is immanent.

Comparison of fine-needle cytologic diagnosis between the left and right liver lobes of dogs and cats with diffuse liver disease

Background and Aim: Ultrasound-guided fine-needle sample collection for cytology with manual restraint is frequently used for the primary assessment of diffuse liver disease in veterinary patients in Thailand. For better diagnosis, repeated collection of samples ensures the collection of adequate, representative samples, which increase diagnostic accuracy. However, in those that are unable to receive general anesthesia, it is difficult to collect the samples from several liver locations in manually restrained dogs and cats. The study aimed to compare the cytologic diagnosis of the ultrasound-guided fine-needle non-aspiration technique between the left and right liver lobes in dogs and cats with neoplastic and non-neoplastic diffuse liver disease. Materials and Methods: This prospective study included 25 client-owned dogs and cats with diffuse liver diseases. Two liver samples were randomly collected from the left and right liver lobes under ultrasound guidance for cytologic examination. All slides were subsequently examined blindly by experienced pathologists for cytologic analysis with cytologic agreement scores (CASs). Results: Among all 50 samples obtained from ultrasound-guided fine-needle sample collection of the left and right liver, 78% were diagnostic and 22% were non-diagnostic. In the diagnostic group, 73.3% of fine-needle samples had concordant results between the left and right liver, which exhibited 100% cytologic agreement in lymphoma and 63.6% in non-neoplastic groups. Samples collected from the left liver had slightly higher CAS and higher cytologic quality than had those from the right liver lobe (p=0.053). Conclusion: The location and number of sample collections did not have a significant difference in the cytologic diagnosis of diffuse liver disease, especially in patients with lymphoma. For manually restrained patients, one time ultrasound-guided non-aspiration cytology procedure from the left liver lobe not only decreased restraint duration and minimized tissue trauma but also allowed for an adequate cytologic diagnosis in diffuse liver disease compared to multiple collections.

Analysis of Point Shear Wave Elastography and Biochemical Markers for the Detection of Liver Fibrosis

Background and Objectives: This work focuses on the possibility of using the point shear wave elastography (pSWE) method for detecting biochemical markers in diffuse liver diseases. Additionally, this study addresses the issue of the influence of ultrasound factors on the pSWE quality indicators of the obtained measurements. Materials and Methods: A pSWE examination was performed on 139 patients (69 female and 70 male) diagnosed with diffuse liver disease. The average age for all patients was 50.7 ± 15.0 years (female: 52.7 ± 15.2 years; male: 48.8 ± 14.6 years). Of these 139 patients, 65 met the inclusion criteria regarding biochemical parameters. The pSWE quality indicators were related to abnormalities found in B-mode ultrasound. Results: A strong positive correlation was found between the results of the pSWE and all biochemical indexes analysed, with the exception of age/platelet count (PLT), for which an average correlation was obtained. The greatest correlation was observed between the elastography and King’s Score index. There was no correlation observed between elastography and any of the analysed parameters or biochemical indexes considered. The pSWE measurements were impaired by factors such as thick soft tissue, uneven hepatic surface, hepatomegaly and female gender. No statistically significant difference in pSWE quality indicators parameters was found between disease entities. Conclusions: pSWE seems to be a complementary method for detecting biochemical indexes, but its results can be influenced by numerous factors.

Modern Principles of Liver Fibrosis Diagnosis in Patients With Chronic Diffuse Liver Lesions: Literature Review and Clinical Case Description

Introduction. Chronic diffuse liver lesions, which is at a certain stage and phase of the disease characterized by excessive accumulation of components of the extracellular matrix, namely fibrosis, – are a heterogeneous multi etiological group of diseases that are characterized by the high prevalence, subclinical course in the initial stages, low curability and reversibility of the pathological process in the late stages, and therefore cause considerable clinical, epidemiological and socio-economic problem of our time. The main way of progression of chronic diffuse liver lesions, regardless of the etiological factor that led to its damage – is the process of fibrogenesis. Quantitative indicators of the severity and rate of fibrosis progression are the most important clinical parameter, the determination of which is crucial for choosing the right treatment and for monitoring its effectiveness. Today, there is no universal method and only a combination of different laboratory and instrumental methods of examination can significantly increase their diagnostic value for early detection of liver fibrosis in the case of chronic diffuse liver diseases. However, the range of possibilities of certain diagnostic methods is constantly expanding and recently the elastographic method has become increasingly important. The aim of the study. To make the literature review concerning the modern principles of liver fibrosis diagnosis in patients with chronic diffuse liver lesions, to describe the clinical case. Materials and methods. The content analysis, method of the system and comparative analysis, the bibliosemantic method of study of the actual scientific studies concerning modern principles of diagnosis of patients with diffuse liver disease, a clinical case is described. Results. The literature review demonstrates the importance and relevance of early and comprehensive diagnosis of chronic diffuse liver disease. Hepatic fibrosis is the basis for portal hypertension, varicose veins, ascites and liver failure. Decompensated cirrhosis is associated with high mortality and the only effective treatment is liver transplantation. Assessment of the degree of liver fibrosis is important for several reasons: to determine the prognosis of chronic liver damage, to select patients for specific (etiotropic) treatment and possible liver transplantation. Therefore, the problem of diagnosis and detection of early initial stages of liver fibrosis for the timely appointment of therapeutic agents, which are aimed at reducing the rate of its progression and prevent cirrhosis and liver cancer, is extremely important for modern medicine. It is known that the “gold standard” for the diagnosis of liver fibrosis is a liver biopsy, but the method has many limitations and contraindications. Elastography is one of the most promising non-invasive methods to diagnose liver fibrosis and steatosis in the case of chronic diffuse liver lesions, which can be used as an alternative to biopsy. Given its widespread implementation in clinical practice, groups of scientists from around the world are paying more and more attention to the study of factors that may affect the results of elastometry and its diagnostic effectiveness. The advantages of the method of liver elastography include: non-invasive, no contraindications, simplicity, fast execution and interpretation; the ability to determine the stage of fibrosis in patients who can not perform a liver biopsy (coagulopathy, thrombocytopenia); the possibility of repeated procedures to assess the increase in severity. Conclusions. Thanks to modern scientific achievements, the latest technologies have been introduced into clinical practice, with the help of which clinicians successfully improve the diagnosis of chronic diffuse liver diseases, in particular, through the use of quantitative detection of fibrotic changes in it, establishing the nature of abdominal fluid (serous or mucinous), assessment of hepatic venous pressure due to safe non-invasive and informative method of shear wave elastography of the liver, a method that not only allows to objectify the verification of the diagnosis, but also to dynamically assess the efficiency of treatment.