Search Results (468)

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to sarcopenia and frailty, but data on white populations remain limited. This study evaluated sarcopenia, physical performance and steroid hormone associations with frailty in European MASLD patients. A cross-sectional study included 245 white MASLD patients. Clinical, biochemical, hormonal and elastography data were collected. Sarcopenia was assessed using dual-energy X-ray absorptiometry alongside mid-arm muscle circumference (MAMC), while physical performance was assessed using the liver frailty index (LFI) and the short physical performance battery (SPPB). Mean age was 56.2 years, 45.7% were male, and median liver stiffness was 5.2 kPa; 76.3% and 33.9% of patients had low MAMC and Appendicular Lean Mass Index, while 13.5% had abnormal SPPB and 16% were frail (i.e., LFI > 4.4). Poor physical performance was linked to lower dehydroepiandrosterone sulfate (DHEAS) levels using both LFI (OR: 0.98, 95% C.I.: 0.96–0.99, p = 0.01) and SPPB (OR: 1.14, 95% C.I.: 1.003–1.22, p = 0.026). Frailty assessed by LFI was associated with increased liver stiffness (OR: 1.24, 95% C.I.: 1.047–1.482, p = 0.013). We concurrently evaluated muscle mass and frailty for the first time in a white MASLD cohort. Lower DHEAS levels were associated with impaired physical performance. Further studies are needed to confirm these findings and their possible therapeutic implications. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is associated with progressive hepatic alterations, including steatosis and fibrosis, which may affect liver mechanical properties. Shear wave elastography (SWE) is a non-invasive imaging technique that enables quantitative assessment of tissue stiffness; however, its application in diabetic animal models remains limited. This study aimed to evaluate liver elasticity using SWE in a high-fat diet (HFD) and streptozotocin (STZ)-induced rat model of T2DM, using histopathological examination as the reference standard. Methods: Twenty-four rats were randomly allocated to either a control group (n = 12) or a diabetic group (n = 12). Diabetes was induced using HFD feeding followed by low-dose STZ administration. Liver elasticity was assessed in vivo using SWE at two examination sessions. Shear wave velocity measurements were obtained from eight liver regions of interest and expressed in meters per second (m/s). Following euthanasia, liver tissues were subjected to histopathological evaluation using hematoxylin and eosin, Masson’s trichrome, and periodic acid–Schiff staining. Results: Diabetic rats demonstrated marked histopathological alterations, including macrovesicular and microvesicular steatosis, hepatocellular vacuolization, increased collagen deposition, and glycogen depletion. Collagen deposition was significantly greater in diabetic animals, while glycogen content was significantly reduced (3.70 ± 1.05 vs. 26.87 ± 2.87; p < 0.05). SWE revealed consistently higher liver shear wave velocities in diabetic rats compared with controls at both examination sessions. Although liver stiffness increased over time in both groups, these changes did not reach statistical significance. Conclusions: HFD/STZ-induced diabetes was associated with increased liver stiffness and histopathological evidence of hepatic injury and fibrosis. SWE may represent a feasible non-invasive approach for assessing diabetes-related changes in liver mechanical properties. Full article

Elastography is an ultrasound-based technique that enables the non-invasive assessment of tissue stiffness. In endoscopic ultrasound (EUS), elastography was initially introduced as a strain-based method, providing qualitative or semi-quantitative information on tissue deformation. More recent technological developments have enabled the integration of shear-wave-based elastography into EUS platforms, including shear-wave measurement (SWM), point shear-wave elastography (pSWE), and two-dimensional shear-wave elastography (2D-SWE). Unlike strain elastography, shear-wave techniques provide quantitative estimates of tissue stiffness by measuring shear-wave velocity or a derived elastic modulus. This invited narrative review summarizes the technical principles, terminology, quality-control requirements, and current clinical evidence for EUS-guided shear-wave-based elastography in pancreatic and hepatobiliary diseases. Because much of the available EUS literature derives from EUS-SWM or point SWE rather than true 2D-SWE, acquisition mode is a central determinant when interpreting clinical evidence and clinical readiness. Current data suggest that EUS-guided shear-wave-based elastography is technically feasible and biologically plausible, but its clinical maturity remains indication-specific. Evidence is most encouraging in chronic pancreatitis, early chronic pancreatitis, autoimmune pancreatitis activity monitoring, and selected endo-hepatology settings, particularly liver fibrosis assessment in patients in whom transabdominal techniques may be suboptimal. In contrast, available evidence does not support EUS-guided shear-wave-based elastography as a standalone diagnostic test for differentiating solid pancreatic lesions, including pancreatic ductal adenocarcinoma, because absolute stiffness values often overlap among malignant lesions, inflammatory masses, and background parenchyma. Before routine clinical implementation, standardized acquisition protocols, disease-specific cut-offs, multicenter reproducibility data, and evidence of incremental clinical value beyond established diagnostic pathways are required. Full article

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection remain leading causes of cirrhosis and hepatocellular carcinoma (HCC) worldwide, and continue to represent a major challenge despite the growing contribution of alcohol-related and metabolic dysfunction-associated steatotic liver disease. Direct-acting antivirals now cure most patients with chronic HCV infection, while nucleos(t)ide analogues durably suppress HBV replication, producing a rapidly expanding population of treated and cured patients. Many nonetheless retain residual fibrosis, portal hypertension and long-term cancer risk, creating a need for non-invasive long-term liver assessment. Multiparametric ultrasound (MPUS) integrates the evaluation of morphology, fibrosis, steatosis, haemodynamics and perfusion within a single examination. This narrative review summarises the evidence supporting MPUS in chronic viral hepatitis, covering elastographic fibrosis assessment, Baveno VII liver and spleen stiffness criteria for clinically significant portal hypertension, contrast-enhanced ultrasound characterisation of focal liver lesions, and emerging techniques such as microvascular and viscosity-sensitive imaging. Particular attention is given to the confounding effect of inflammatory activity on liver stiffness. MPUS is presented here as a proposed evaluation framework for organising complementary measurements within a single examination, and not as an approach of demonstrated clinical superiority: no comparative or outcome-based study has yet shown that acquiring these parameters together improves clinical decisions relative to the individual techniques applied according to current guidelines. Within this framework, the most plausible role of MPUS in the elimination era is longitudinal assessment of the treated liver, a proposition that requires prospective validation against clinical endpoints. Full article

Liver involvement is frequent in rheumatoid arthritis (RA) and may progress from steatosis to fibrosis, cirrhosis, or hepatocellular carcinoma. Liver fibrosis (LF) in RA is multifactorial, but the available data are limited and the impact of methotrexate (MTX) remains controversial. In this cross-sectional study, 51 RA patients (46 females; mean age of 48.8 ± 8.2 years; and a median disease duration of 12 years) were enrolled. LF was assessed using non-invasive indices (the aspartate aminotransferase-to-platelet ratio index [APRI] and fibrosis-4 index [FIB-4]) and liver stiffness measurement (LSM) using shear wave elastography. Serum endothelin-1 (ET-1) and selected organokines (namely myostatin, resistin, and osteoprotegerin) were quantified by the ELISA. Associations of the APRI, FIB-4, and LSM with organokines and endothelin-1 were analyzed using univariable and multivariable linear regression, whereas correlations with the RA-specific cardiovascular (CV) risk score (ERS-RA) and echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) were assessed using Spearman’s rank correlation. Myostatin and resistin showed a significant positive and significant negative association with LSM, respectively, while FIB-4 was negatively correlated with lateral and medial e’ velocities and positively with the ERS-RA. MTX use, mean weekly dose, cumulative dose, and endothelin-1 were not associated with the APRI, FIB-4, LSM, or LVDD. These exploratory findings support the potential role of myostatin and resistin in LF-related phenotypes and suggest that FIB-4 may capture aspects of both hepatic and cardiovascular risk in RA. RA patients with elevated FIB-4 values may require echocardiographic assessment and comprehensive CV risk evaluation. In this cohort, MTX exposure and endothelin-1 were not associated with LF or LVDD. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease for which lifestyle modification remains the main treatment. However, the role of specific dietary components is not fully understood. We investigated whether daily tomato consumption, a source of Mediterranean diet bioactive compounds, improves hepatic steatosis in adults with MASLD. Methods: In the randomized controlled POMOSANO trial, 79 adults with MASLD (BMI ≤ 30 kg/m²) were assigned to a tomato intervention group (n = 42), consuming 200 g/day of raw tomatoes and 50 g/day of tomato sauce, or to a control group (n = 37) following a tomato-free diet. The intervention lasted 6 weeks. Hepatic steatosis was assessed by the FibroScan^® controlled attenuation parameter (CAP). Secondary outcomes included anthropometric measures, body composition, liver stiffness, and metabolic and biochemical markers. Linear mixed-effects models were used to evaluate changes over time. Results: CAP decreased in both groups, with a greater reduction in the intervention group (median change: −35.00 vs. −18.00 dB/m). The adjusted linear mixed-effects model confirmed that the change in CAP in the control group was β = −12.81 (95% CI −25.55 to −0.08; p = 0.0490). Crucially, the treatment-by-time interaction was significant (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), demonstrating a significantly greater reduction in hepatic steatosis in the tomato intervention group compared to the control group. CAP values were also significantly lower in the intervention group at follow-up (p = 0.0433). The adjusted linear mixed-effects model confirmed a significant reduction in CAP over time (β = −12.81, 95% CI −25.55 to −0.08; p = 0.0490) and a significant treatment-by-time interaction (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), indicating a greater reduction in hepatic steatosis in the intervention group. No significant between-group differences were observed for liver stiffness, FIB-4 index, body weight, body composition, or most metabolic and biochemical markers. Conclusions: Daily consumption of raw tomatoes and tomato sauce reduced hepatic steatosis in adults with MASLD, supporting tomato-rich dietary strategies as a potential nutritional approach for MASLD management. Full article

To provide a clinically oriented overview of ultrasound elastography in chronic liver disease, focusing on currently available techniques, their clinical applications, quality assurance, technical pitfalls, and emerging developments that may shape future liver imaging practice. A narrative review of the current literature was conducted using international guidelines, systematic reviews, and original studies retrieved from major scientific databases. Particular emphasis was placed on the clinical applications of ultrasound elastography, quality assurance procedures, interpretation of liver stiffness measurements, and future technological developments. Vibration-controlled transient elastography (VCTE) and shear wave elastography (SWE) have become established non-invasive techniques for liver fibrosis assessment, demonstrating excellent diagnostic performance, particularly for advanced fibrosis and cirrhosis. Beyond fibrosis staging, ultrasound elastography contributes to prognostic stratification, treatment planning, and longitudinal disease monitoring across a broad spectrum of chronic liver diseases. However, liver stiffness measurements may be influenced by technical and biological confounding factors, including inflammation, cholestasis, hepatic congestion, obesity, and postprandial status, highlighting the importance of standardised acquisition protocols and careful clinical interpretation. Emerging developments, including spleen stiffness assessment, multiparametric ultrasound, and artificial intelligence-assisted image analysis, are expected to further improve diagnostic accuracy and support precision hepatology. Ultrasound elastography has become an essential component of the non-invasive evaluation of chronic liver disease, substantially reducing the need for liver biopsy while improving fibrosis staging, prognostic stratification, and longitudinal patient monitoring. Its optimal clinical implementation requires appropriate patient selection, adherence to quality assurance procedures, and careful interpretation within the broader clinical context. Future advances in multiparametric ultrasound, artificial intelligence, and international standardisation are expected to further strengthen the role of ultrasound elastography within precision hepatology and personalised liver disease management. Ultrasound elastography should be integrated into routine liver imaging as part of a multimodal diagnostic approach. Standardised acquisition protocols, continuous quality assurance, and appropriate operator training are essential to ensure reliable and reproducible liver stiffness measurements. Radiographers play a key role in examination quality, protocol adherence, and multidisciplinary patient care, contributing to accurate diagnosis and improved clinical decision-making. Full article

The liver’s regenerative capacity is essential for resection and transplantation, but chronic liver diseases compromise this ability. Conventional preoperative tests poorly predict regeneration in diseased livers, necessitating new intraoperative tools. Optical coherence tomography (OCT) provides real-time high-resolution “optical biopsy” and functional tissue assessment, making it a promising method for evaluating liver regenerative potential. The aim of this study was to identify characteristic criteria derived from MM OCT that could be used intraoperatively to detect the presence and type of pathology, and to assess the reduction in liver regenerative potential in patients. In this study, we used intraoperative multimodal OCT (MM OCT)—combining attenuation mapping and elastography—for real-time, label-free assessment of changes in liver structure, and stiffness during regeneration. MM OCT also provides higher resolution and specificity than conventional clinical imaging. In a rat model, we induced steatosis by high-fat diet and fibrosis by CCl₄ injections, then induced regeneration by 70% partial hepatectomy (PH). MM OCT monitoring was performed on day 0 (pre-PH), day 3, and day 7 (post-PH). Pathologies and regeneration were verified by biochemical blood tests, histological analysis, and real time-PCR for steatosis- and fibrosis-specific genes. As a result, attenuation coefficient and Young’s modulus obtained by MM OCT enable real-time assessment of liver tissue changes in steatosis and fibrosis, which vary with regeneration stage. Steatosis showed uniformly high attenuation and low stiffness before and after resection. Fibrosis exhibited heterogeneous attenuation and marked stiffness fluctuations—high pre-resection values dropped at day 3 and rose again by day 7. Attenuation coefficient detects lipid droplets in hepatocytes and identifies high-density hepatocyte zones near collagen septa, distinguishing them from densely packed unaltered cells. Thus, MM OCT identifies pathology type, lipid infiltration and collagen presence—features that serve as indicators of impaired liver regenerative capacity. Full article

Background/Objectives: Psoriatic disease (PsD) is a chronic cutaneous and systemic inflammatory condition associated with an increased risk of metabolic-dysfunction-associated steatotic liver disease (MASLD) and its complications. Our objective was to determine the prevalence of MASLD in our overall cohort and to analyze it across PsO, PsA, and healthy control groups. The secondary objective was to describe hepatic steatosis and fibrosis using transient elastography (FibroScan^®) and to characterize hepatic scores within each study group. The third objective was to assess whether specific cardiovascular risk factors were associated with the development of hepatic steatosis or fibrosis in individuals with PsD and healthy controls. Methods: A cross-sectional study was conducted at a single tertiary care center, enrolling consecutive patients from the Dermatology and Rheumatology Departments. Individuals with pre-existing liver disorders were excluded. The control cohort comprised 102 healthy volunteers without chronic inflammatory or hepatic conditions. All participants underwent comprehensive clinical assessments, serum biomarker analysis, and FibroScan^®. Results: A total of 330 participants were included, 228 with PsD (101 with psoriasis (PsO) and 127 with psoriatic arthritis (PsA)) and 102 healthy controls. MASLD was present in 39% of the overall cohort, with a prevalence of 47.5% in PsO, 32.2% in PsA, and 8.8% in healthy controls (p < 0.001). FibroScan^® measurements indicated a tendency toward increased liver stiffness and higher controlled attenuation parameter (CAP) values in patients with PsD. Both PsO and PsA groups showed a higher prevalence of cardiometabolic risk factors compared with controls (p < 0.05). Non-invasive fibrosis indices were also significantly altered in both patient groups. Conclusions: Patients with PsD demonstrated a higher prevalence of MASLD, hepatic fibrosis, and cardiometabolic abnormalities compared with healthy controls in our cohort. Full article

Introduction: The correct risk stratification is the key to achieving a low postoperative mortality after liver resection for HCC, including the evaluation of liver function and the presence of portal hypertension. The aim of this study was to evaluate the accuracy of Hepatic Venous-Portal pressure Gradients (HVPG), Indocyanine Green retention test (ICG-R15) and Liver Stiffness (LSM) in predicting the risk of post-hepatectomy liver failure and major postoperative complications in selected cirrhotic patients. Methods: A multicenter prospective study was designed, including consecutive cirrhotic patients undergoing liver resection for HCC. The predictive ability of HVPG, LSM and ICG-R15 was tested by evaluating the Area Under the ROC Curves. Results: Ninety-eight cirrhotic patients undergoing liver resection for HCC were included. Twelve patients (12.2%) developed at least one of the complications included within the composite endpoint. Three patients (3%) developed post-hepatectomy liver failure (PHLF) (one graded A and two graded C according to the International Study Group of Liver Surgery), five patients (5.1%) developed large ascites, five patients (5.1%) developed severe postoperative complications, two patients (2%) died during the hospital stay (PHLF). HVPG showed the higher AUC (0.778, 95% CI 0.641- 0.898; p < 0.001), followed by LSM (0.669, 95% CI 0.471–0.847; p = 0.097) and ICG-R15 (0.593, 95% CI 0.378–0.788; p = 0.615). Conclusions: In our cohort of selected HCC patients undergoing elective surgery, the predictive ability of HVPG on developing a composite endpoint including PHLF, in-hospital mortality, large postoperative ascites and major postoperative complications is higher than LSM and ICG-R15. Full article

Background/Objectives: Chronotype describes individual preferences regarding the timing of sleep, food intake, and other daily activities and is commonly evaluated using the Morningness–Eveningness Questionnaire (MEQ). Individuals with a morning chronotype generally prefer earlier sleep–wake schedules, whereas those with an evening chronotype exhibit delayed circadian timing and achieve peak alertness later in the day. Previous evidence has linked evening chronotype to an elevated risk of obesity and metabolic dysfunction; however, its association with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), particularly with hepatic steatosis and fibrosis, has not yet been fully elucidated. Methods: This cross-sectional study included 119 medication-naïve adults, predominantly with obesity (mean age 41.5 ± 11.9 years; 58 men, 49%), recruited at the Nutrition Center of the National Institute of Gastroenterology “Saverio de Bellis.” Hepatic steatosis (controlled attenuation parameter [CAP] > 275 dB/m) and liver fibrosis (liver stiffness > 8.2 kPa) were assessed by transient elastography (FibroScan). Results: Hepatic steatosis was detected in 62% of participants (n = 74), whereas fibrosis was identified in 15% (n = 18). When chronotype was analyzed as a continuous variable, no significant correlations were observed with either CAP (r = 0.017, p = 0.852) or liver stiffness measurements (r = −0.045, p = 0.629). Although these associations did not reach statistical significance, the corresponding confidence intervals remained compatible with small-to-moderate effect sizes, particularly for fibrosis, reflecting the limited number of participants with fibrotic disease. Conclusions: In this sample, chronotype was not significantly associated with FibroScan-derived measures of hepatic steatosis or fibrosis. Associations with selected metabolic and behavioral characteristics were identified, although these findings require confirmation in adequately powered longitudinal investigations. To our knowledge, only a limited number of studies have explored these relationships using objective FibroScan-derived measurements in medication-naïve individuals. Consequently, the present findings should be considered hypothesis-generating and warrant validation in larger prospective cohorts. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Background: Transient elastography (TE) is widely used for noninvasive assessment of liver fibrosis. In patients undergoing hemodialysis, however, liver stiffness measurements (LSM) may be affected by rapid intradialytic changes in volume status, venous congestion, and other non-fibrotic determinants. We prospectively evaluated peridialytic variability in liver stiffness and the concordance of serum fibrosis indices with elevated LSM in patients receiving maintenance hemodialysis. Methods: In this prospective paired pilot study, 45 adults on maintenance hemodialysis underwent LSM and controlled attenuation parameter (CAP) assessments immediately before and after a dialysis session; paired data were available for 41 patients. The Fibrosis-4 index (FIB-4) and the aspartate aminotransferase-to-platelet ratio index (APRI) were calculated from routine laboratory values. Paired comparisons, correlation analyses, and receiver operating characteristic curves were used to assess within-patient changes and the ability of serum indices to identify elevated pre-dialysis liver stiffness (LSM ≥ 8 kPa). Because no histologic or imaging reference standard for fibrosis was available, these analyses were interpreted as evidence of concordance with elevated LSM rather than as diagnostic accuracy for liver fibrosis. Results: Median LSM was 7.1 kPa (interquartile range [IQR] 5.2–12.1) pre-dialysis and 7.7 kPa (IQR 5.8–12.2) post-dialysis, with no significant paired change (median ΔLSM −0.2 kPa [IQR −1.1 to 1.2]; p = 0.898). However, the proportion with LSM ≥ 8 kPa increased from 36.6% to 46.3%, with 4 of 41 patients (9.8%) newly exceeding the threshold. CAP values showed no significant paired change (p = 0.511). Intradialytic weight loss was not associated with ΔLSM (rho = −0.13, p = 0.44). FIB-4 and APRI showed poor correlation with LSM and limited concordance with elevated LSM (area under the curve 0.553 and 0.578, respectively, with wide confidence intervals). Conclusions: In this exploratory hemodialysis cohort, cohort-level median LSM did not change significantly after dialysis, but clinically relevant individual-level reclassification occurred in approximately 10% of patients. Measurement timing may alter LSM-based classification, underscoring the need for dialysis-specific validation of LSM thresholds and noninvasive assessment strategies. Full article

Background/Objectives: The Ishak and Knodell classifications are used to evaluate fibrosis on percutaneous liver biopsy (PLB) in chronic hepatitis (CH). Hepatosteatosis (HS) can also be seen in PLBs performed on patients. In addition to PLB, the shear-wave elastography (SWE) technique is increasingly used to evaluate liver fibrosis. Whether the presence of HS contributed to fibrosis in CH cases that underwent PLB was evaluated by comparing SWE and Ishak–Knodell grades. Methods: CH cases were divided into three groups based on the presence of HS on biopsy and the percentage of HS (none, <10%, or ≥10%). Ishak–Knodell fibrosis grades and SWE values in kilopascal (kPa) were available for all included cases. Fibrosis scores and kPa values were compared within themselves and between groups for all three groups. Whether steatosis affected kPa results within the same fibrosis grades was evaluated. Results: There were 236 patients with CH: 109 (46.2%) had HS on liver biopsy, and 127 (53.8%) did not. Among the 109 patients with HS, 78 (71.5%) had pathological steatosis ≥ 10%. In all Ishak and Knodell grades (except F3), there was no significance between the liver stiffness values (kPa) of those with ≥10% HS and those with HS < 10%/none (p > 0.05). For the Ishak–Knodell F3 grade, there was a significant difference in both comparisons (p < 0.05). Conclusions: Liver kPa results are compatible with fibrosis grades, and SWE can be easily applied in the follow-up of CH patients with HS. In this way, unnecessary invasive procedures are prevented, and patient comfort can be maintained. Full article

Background/Objective: Endohepatology has recently emerged as a field combining advanced endoscopy and hepatology. Endoscopic ultrasound (EUS) plays a key role in the management of patients with chronic liver disease. The main objective of this paper is to provide critical review on the recent advances in EUS-based liver diagnostics and therapeutics and how such advances have been central in establishing the field of Endohepatology. Methods: We searched the PubMed database for articles published since 1995 focused on the use of EUS in the field of Endohepatology. Our aim is to synthesize a narrative, non-systematic review emphasized on the evolving concepts, technical advancements, and clinical applications, particularly in areas where high-quality randomized data remain limited. Results: EUS-guided liver biopsy (EUS-LB) now offers diagnostic yield comparable to those of the percutaneous approaches. In addition, EUS-guided fine-needle biopsy (EUS-FNB) design and suction techniques have further optimized tissue sampling. Furthermore, EUS-guided portal pressure gradient (EUS-PPG) measurement is a promising alternative tool in risk stratification of patients with chronic advanced liver disease. EUS-based elastography enables real-time quantification of liver stiffness and fibrosis and evaluation of space-occupying lesions. Moreover, EUS-guided interventions can play important roles in the management of patients with portal hypertension-related bleeding. Finally, emerging applications include EUS-guided radiofrequency ablation (EUS-RFA), portal venous sampling, and intrahepatic shunt creation, which may further expand minimally invasive treatment options. Conclusions: State-of-the-art innovations expanded the role of EUS not only in diagnostics but also in the therapeutic role of EUS and provided a new paradigm for the care of patients with liver disease. Full article