Endoscopic frontiers in the field of hepatology

J. O. Clarke, P. J. Thuluvath

Research output: Contribution to journalArticle

Abstract

Hepatology is considered a cognitive specialty, but it will not be surprising if a subgroup of future hepatologists ("invasive hepatologists") performed a variety of advanced endoscopic, laparoscopic, vascular or ablative procedures just like interventional gastroenterologists, interventional radiologists or minimally invasive surgeons. The increase in the prevalence of liver diseases including hepatocellular carcinoma, and effective treatment of end-stage liver disease with liver transplantation has expanded the subspecialty of hepatology into a major specialty. Therefore, it is only natural that some of the trainees in hepatology, familiar with invasive procedures just like their counterparts in gastroenterology, may become subspecialized in invasive aspects of this specialty, traditionally performed by interventional endoscopists, radiologists and surgeons. Moreover, there will be major developments in the management of the complications of liver disease. Endoscopic screening with esophageal capsule endoscopy and, to a lesser extent, ultrathin upper gastrointestinal endoscopy may replace conventional endoscopy. In addition to standard treatments for esophageal varices, removable esophageal stents with expansile pressure may be utilized in refractory variceal hemorrhage. Transjugular intrahepatic portosystemic shunts may be performed by hepatologists. Advances in argon plasma coagulation, cryotherapy and photodynamic therapy may result in novel treatment options for portal hypertensive gastropathy. Single-fiber cholangioscopy will allow for directed endoscopic screening for cholangiocarcinoma and primary sclerosing cholangitis in high-risk individuals. Minilaparoscopy will allow a macroscopic assessment of the liver surface as well as the ability to target specific regions for histopathology, and treatment including radiofrequency ablation of liver cancer. Endoscopic ultrasound (EUS) may provide the potential to directly measure portal vein pressure and this may have a future role in titration and optimization of pharmacological therapy of portal hypertension. EUS and fine needle aspiration may be used for staging hepatocellular and bile duct cancer. Finally, natural orifice transluminal surgery and endoscopic ultrasound-guided angiography may allow for targeted therapies traditionally outside the realm of the hepatologists.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalMinerva Gastroenterologica e Dietologica
Volume53
Issue number1
StatePublished - Mar 2007

Fingerprint

Gastroenterology
Liver Diseases
Therapeutics
Argon Plasma Coagulation
Natural Orifice Endoscopic Surgery
Bile Duct Neoplasms
Transjugular Intrahepatic Portasystemic Shunt
Capsule Endoscopy
Portal Pressure
Sclerosing Cholangitis
End Stage Liver Disease
Cryotherapy
Gastrointestinal Endoscopy
Cholangiocarcinoma
Esophageal and Gastric Varices
Photochemotherapy
Portal Hypertension
Liver Neoplasms
Fine Needle Biopsy
Portal Vein

Keywords

  • Endoscopy
  • Liver disease, therapy
  • Liver diseases, diagnosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clarke, J. O., & Thuluvath, P. J. (2007). Endoscopic frontiers in the field of hepatology. Minerva Gastroenterologica e Dietologica, 53(1), 101-109.

Endoscopic frontiers in the field of hepatology. / Clarke, J. O.; Thuluvath, P. J.

In: Minerva Gastroenterologica e Dietologica, Vol. 53, No. 1, 03.2007, p. 101-109.

Research output: Contribution to journalArticle

Clarke, JO & Thuluvath, PJ 2007, 'Endoscopic frontiers in the field of hepatology', Minerva Gastroenterologica e Dietologica, vol. 53, no. 1, pp. 101-109.
Clarke, J. O. ; Thuluvath, P. J. / Endoscopic frontiers in the field of hepatology. In: Minerva Gastroenterologica e Dietologica. 2007 ; Vol. 53, No. 1. pp. 101-109.
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