The role of therapeutic endoscopic ultrasound now and for the future

Abstract

Therapeutic endoscopic ultrasound (EUS) became possible after the advent of the linear echoendoscope and the EUS guided fine needle aspiration. Over the past two decades, the indications for therapeutic EUS have expanded and evidence regarding its utility has been steadily accumulating. Randomized studies have shown EUS to be effective for cancer pain relief (celiac plexus neurolysis), pancreatic fluid collection drainage, and biliary drainage. Prospective studies have shown EUS-guided biliary drainage to be safe and effective in patients with failed ERCP. There is evidence to suggest that EUS is effective for pancreatic duct drainage, gallbladder drainage, and drainage of pelvic collections. EUS may also be useful for targeted cancer treatment via brachytherapy, radiofrequency ablation, or injection therapy. Therapeutic EUS is likely to play an increasingly important role in endoscopic therapy of gastrointestinal diseases in the near future.

Keywords::

• biliary drainage
• endoscopy
• endosonography
• pseudocyst
• therapeutic

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Interventional endoscopic ultrasound (EUS) has shown impressive growth over the past decade.

• Technology has improved, but further improvements are urgently needed.

• Good randomized and prospective studies have become available in certain areas like pseudocyst drainage, celiac neurolysis and biliary drainage.

• EUS-guided pancreatic duct interventions appear to be effective in preventing surgery. Prospective follow-up studies are needed in this area.

• It appears likely that EUS-guided biliary drainage will become the preferred rescue modality after failed ERCP in distal CBD obstruction.

• Radiofrequency ablation has shown early promise for cancer-directed therapy. Larger prospective studies are needed.

• Opportunities for training in interventional EUS are lacking due to low patient volume at most centers.

Notes

EUS: Endoscopic ultrasound.

EUS: Endoscopic ultrasound; EUS-CDS: EUS-guided choledochoduodenostomy; EUS-HGS: EUS-guided hepaticogastrostomy; PTBD: Percutaneous transhepatic biliary drainage.

EUS: Endoscopic ultrasound; MPD: Main pancreatic duct.

EUS: Endoscopic ultrasound; RCT: Randomized controlled trial.

EUS: Endoscopic ultrasound; EUS-CGN: EUS-guided celiac ganglion neurolysis; EUS-CPN: EUS-guided celiac plexus neurolysis.