Endoscopic ultrasound in the evaluation of portal hypertension.

There is no question that EUS has a role in the imaging of gastric varices. EUS can be used to accurately differentiate thickened folds or submucosal lesions from varices. Its use in the evaluation of perigastric varices has progressed from the days in which EUS scopes were used, but were not as sensitive as endoscopy, to the current use of EUS probes, which very accurately measure the radius and the wall thickness (WT) of esophageal varices. These probes can locate varices not seen at endoscopy and can be used to calculate the variceal WT. EUS has been used to predict which patients will respond to therapy and which will not and it can be used to assess the results of therapeutic intervention. EUS of periesophageal varices may also be used to predict which patients will and will not respond to therapy. Although the use of EUS imaging in the evaluation of varices is still in its infancy, it holds great promise for the future.