Endoscopic ultrasound in hepatology: ushering a new era in liver disease management

Purpose of review This review aims to provide an up-to-date overview of the expanding role of endoscopic ultrasound (EUS) in endohepatology, highlighting its potential to transform the diagnostic and therapeutic landscape for liver diseases. Given the increasing complexity of liver disease management, this review discusses both established and emerging applications of EUS in liver parenchyma assessment, portal hypertension diagnosis and related complications treatment and liver biopsy techniques. Recent findings Recent studies demonstrate that EUS can accurately assess liver fibrosis, detect focal lesions, and evaluate portal hypertension, with significant advancements in EUS-guided liver biopsy and treatment of gastric varices. Key findings include improved diagnostic accuracy with EUS-FNB over traditional methods and the potential for endoscopic ultrasound portal pressure gradient (EUS-PPG) in portal pressure measurements. Summary EUS holds significant promise in diagnosing and treating liver diseases, with applications in assessing liver fibrosis, identifying focal liver lesions, and managing portal hypertension. Future research will likely focus on enhancing EUS's role in therapeutic procedures, such as managing portal vein thrombosis and creating intrahepatic portosystemic shunts, offering a new avenue for minimally invasive treatment options.