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The review discusses emerging clinical roles driven largely by endoscopic ultrasound (EUS), including EUS-guided liver biopsy and gastric varices care, and evaluates EUS-based approaches for portal pressure assessment and shear-wave elastography. It also highlights opportunities such as endobariatrics in obesity management and potential impacts in liver transplantation. Gaps and practical safety concerns are addressed.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endohepatology-evolving-indications-challenges-unmet-needs-and-opportunities/411816/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endohepatology-evolving-indications-challenges-unmet-needs-and-opportunities/411816.png","ImageObject",300,407,{"name":92,"@type":93},"Elsa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What does endohepatology cover and how has it expanded beyond traditional endoscopy in liver disease?","Question",{"text":113,"@type":114},"Endohepatology combines hepatology with advanced endoscopy. It expands liver endoscopy from primarily managing varices to multiple EUS-driven clinical domains and interventions in hepatology.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which EUS applications are highlighted as having robust evidence or emerging promise?",{"text":118,"@type":114},"The text highlights robust data for EUS liver biopsy and gastric varices management. It also points to exciting frontiers for portal pressure assessment and promise for EUS shear wave elastography, with needs for standardization and comparison.",{"name":120,"@type":111,"acceptedAnswer":121},"Why does the review emphasize unresolved gaps and pragmatic concerns?",{"text":122,"@type":114},"Despite advancement, it notes remaining gaps in knowledge and practical concerns tied to application of endohepatology. These must be balanced against patient safety and optimization of outcomes.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},411816,1790810873,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":36,"preview_page_count":4},137455077381,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Gastro Hep Advances 2026;5:100838  \nNARRATIVE REVIEWS   \nEndohepatology: Evolving Indications, Challenges, Unmet Needs and Opportunities  \nAkash Roy,1 Mithun Sharma,2 Anand V. Kulkarni,2 Sundeep Lakhtakia,3 Aniruddha Pratap Singh,3 Rakesh Kalapala,3 Gregory G. Ginsberg,4  \nD. Nageshwar Reddy,3 ,* and K. Rajender Reddy4 ,*  \n1Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India; 2Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India; 3Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; and 4Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania  \nEndohepatology provides a unison of 2 rapidly developing fields of hepatology and advanced endoscopy. Conventionally, endoscopy in liver disease was restricted primarily to the management of varices. However, multiple new domains have emerged in advanced endoscopy, driven mainly by endoscopic ultrasound (EUS), and as such find several applications in clinical hepatology. Robust data have emerged regarding EUS liver biopsy and the management of gastric varices, and are becoming the first line of care at experienced centers. EUS-guided portal pressure gradient and direct measurements appear to bean exciting frontier for portal pressure assessment. EUS shear wave elastography holds promise but needs standardization and comparison to well-established noninvasive surrogates. Endobariatrics opens up new avenues in optimizing comprehensive obesity management. Interesting crossroads emerge in liver transplantation, where endohepatology may provide a unique single setting investigation and therapeutic solution. Several other potential uses are emerging but need to be replicated across settings. While the advancements usher in excitement, several gaps in knowledge and pragmatic concerns remain with the application of endohepatology, which need to be balanced against patient safety and in optimizing outcomes.  \nKeywords: Endohepatology; Liver Biopsy; Portal Pressure; Gastric Varices  \nIntroduction  \nHepatology, as a discipline, has undergone rapid  \ntransformations over the past several decades, with remarkable advances in individual disease entities.1,2 As a broad discipline, it encompasses the study of the liver, gallbladder, and biliary tree.3 Progress in hepatology has been on multiple levels, ranging from the discovery to cure of the hepatitis C virus, treatment strategies for hepatitis B, understanding and drug discoveries in metabolic dysfunction–associated fatty liver disease (MASLD), rapid  \nstrides in locoregional and systemic therapy for hepatocellular carcinoma (HCC), and remarkable global progress in liver transplantation (LT) .2 While hepatology has witnessed rapid developments, endoscopy, specifically for liver disorders, has been mainly limited to screening and limited therapeutic interventions in managing gastroesophageal varices.4  \nParallel to developments in hepatology, the field of diagnostic and interventional endoscopy has also undergone significant advancements.5 While endoscopic retrograde cholangiopancreatography has revolutionized the management of pancreaticobiliary disorders, the advent of endoscopic ultrasound (EUS) has ushered in an entirely new domain of endoscopic evaluation and interventions.6 At this crossroads of two rapidly developing sciences, an intersection arises between the applications of advanced endoscopic techniques in the realm of hepatology, which has been designated as “endohepatology.” Novel procedures, such as EUS-guided liver biopsy (EUS-LB), glue embolization of gastric varices, portal pressure measurement, EUS elastography, contrast-enhanced EUS, endoscopic ablation of tumors, endobariatrics in obesity management for MASLD, and multiple other interventions, constitute the ever-increasing scope of endohepatology.7 (Figure 1)  \nWhile advances in endoscopy and its application in hepatology ga","cbCairlH6zCzhO6N","https://ap.wps.com/l/cbCairlH6zCzhO6N","pdf",2634217,16,"English","# Introduction\n# EUS-LB","[{\"question\":\"What does endohepatology cover and how has it expanded beyond traditional endoscopy in liver disease?\",\"answer\":\"Endohepatology combines hepatology with advanced endoscopy. It expands liver endoscopy from primarily managing varices to multiple EUS-driven clinical domains and interventions in hepatology.\"},{\"question\":\"Which EUS applications are highlighted as having robust evidence or emerging promise?\",\"answer\":\"The text highlights robust data for EUS liver biopsy and gastric varices management. It also points to exciting frontiers for portal pressure assessment and promise for EUS shear wave elastography, with needs for standardization and comparison.\"},{\"question\":\"Why does the review emphasize unresolved gaps and pragmatic concerns?\",\"answer\":\"Despite advancement, it notes remaining gaps in knowledge and practical concerns tied to application of endohepatology. These must be balanced against patient safety and optimization of outcomes.\"}]","Endohepatology: Evolving Indications, Challenges, Unmet Needs and Opportunities | PDF",1790589719]