DAY 3 - Endohepatology Updates: From Biopsies to Pressure Measurements

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver condition, affecting up to 25% of individuals globally. With the growing obesity epidemic, rates are projected to rise, leading to increased complications such as cirrhosis, portal hypertension, and hepatocellular carcinoma.

At the American College of Gastroenterology (ACG) 2024 Annual Scientific Meeting in Philadelphia, Dr. Frances Dang, Advanced Endoscopy Fellow and Clinical Instructor at the University of California Irvine, presented groundbreaking insights into the role of liver biopsy, elastography, management of gastric varices, and endoscopic ultrasound in liver disease care and treatment.

Dr. Dang introduced the concept of EndoHepatology, a novel union between Endoscopy and Hepatology, highlighting the growing importance of endoscopic procedures, particularly Endoscopic Ultrasound (EUS), in liver patient care. She emphasized two key areas: EUS-guided liver biopsy and EUS-guided Portosystemic Pressure Gradient Measurement.

EUS-guided liver biopsy offers significant advantages, including technical reproducibility regardless of body habitus and potentially less pain for patients. Dr. Dang noted that these biopsies consistently exceed the minimum requirements set by the American Association for the Study of Liver Diseases (AASLD). She stressed the importance of proper technique and increasing awareness among hepatologists about this method's efficacy.

The EUS-guided Portosystemic Pressure Gradient Measurement (EUS-PPG) represents a significant advancement in portal hypertension assessment. Dr. Dang explained that EUS-PPG provides direct measurement of both hepatic and portal veins, offering advantages over traditional methods, especially in pre-sinusoidal portal hypertension and NASH-cirrhosis cases. The technique is more accessible, repeatable, and potentially more accurate than current non-invasive markers of fibrosis. Dr. Dang also mentioned ongoing clinical studies, including the PORTAL and ENCOUNTER trials, which aim to validate this technique further.

Dr. Dang concluded by presenting the concept of a "one-stop shop" for endoscopic liver evaluation. This approach combines multiple procedures under a single anesthesia session, improving efficiency for patients requiring regular screenings for conditions like esophageal varices. She also announced an upcoming prospective endo-hepatology registry study led by UC Irvine, aiming to enroll 1000 patients over four years (The first patient enrolled the previous week). This study will explore the clinical applicability of endo-hepatology workups in various scenarios, potentially reshaping liver disease management protocols.

This comprehensive presentation underscores the rapid advancements in endohepatology, promising more accurate diagnoses, efficient treatment strategies, and improved patient experiences in liver disease management. As these techniques continue to evolve, they may significantly impact the approach to MASLD and its complications, addressing a growing global health concern.