Diagnostic and Therapeutic Indications for Endoscopic Ultrasound (EUS) in Patients with Pancreatic and Biliary Disease—Novel Interventional Procedures

Abstract

There is growing evidence supporting the substantial, essential and indispensable role of endoscopic ultrasound (EUS) as a key diagnostic armamentarium for upper GI oncologic surgery. Well described in countless publications, EUS holds that position in gastroenterological expert centers all over Europe. Despite its undisputable contributions to oncologic upper GI surgery, the availability of this technique at the expert level shows up in an irregular spread pattern. Endoscopic ultrasound’s primary use during the first few years after its creation was the detection of pancreatic cancer. From then on, EUS developed in different directions, becoming a diagnostic tool that increasingly better defines its status as a method of minimally invasive therapeutic applications and a useful addition to surgical options. As a result, several surgical interventions could even be replaced by ultrasound-targeted interventions. This process took place in just a few years and was made possible by technical development that sensibly combined high-resolution ultrasound with therapeutic endoscopy. The present article will serve to cover the most prevalent uses with supporting data considering the growing list of suggested indications for EUS while also examining cutting-edge initiatives that might soon become the standard of clinical practice. Endoscopic centers with high expertise are needed to train future experts in the growing field of EUS interventions.

Improve Care in Patients with Pancreatic Pathology

“…Important choices regarding the preservation or sampling of organs or the execution or non -performance of endoscopic resection can be done thanks to the endoscopic ultrasound, especially when the involvement of the lymph nodes can be proved by imaging [26].…”

A patient-centered, multidisciplinary approach to treating borderline resectable pancreatic adenocarcinoma

“…Diagnostic confirmation is dependent on tissue biopsy. Esophagogastroduodenoscopy with endoscopic ultrasound (EUS) is most often used to establish the diagnosis (22). EUS uses a high-frequency transducer at the tip of the endoscope that facilitates the generation of high-resolution images of the pancreas through the stomach or duodenum (23).…”

Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective

“…Furthermore, a recent combination of EUS with artificial intelligence (AI) assisted models may also help in the early detection of pancreatic cancers and differentiate it from chronic and autoimmune pancreatitis with a high degree of accuracy [ 6 , 16 , 17 , 18 ]. However, despite its many advantages, EUS is not always available due to the technical complexity and the operator-dependent nature of the procedure, a steep learning curve for therapeutic endoscopists, and hospital limitations such as the need for specific equipment, specialized training of ancillary staff, and hospital costs [ 6 , 19 ].…”