Evolution of interventional endoscopic ultrasound

Abstract

Endoscopic ultrasound (EUS) has become an indispensable modality for the assessment of the gastrointestinal tract and adjacent structures since its origin in the 1980s. Following the development of the linear echoendoscope, EUS has evolved from a purely diagnostic modality to a sophisticated tool for intervention, with numerous luminal, pancreaticobiliary, and hepatic applications. Broadly, these applications may be subdivided into three categories: transluminal drainage or access procedures, injection therapy, and EUS-guided liver interventions. Transluminal drainage or access procedures include management of pancreatic fluid collection, EUS-guided biliary drainage, EUS-guided bile duct drainage, EUS-guided pancreatic duct drainage, and enteral anastomosis formation. Injection therapies include therapeutic EUS-guided injections for management of malignancies accessible by EUS. EUS-guided liver applications include EUS-guided liver biopsy, EUS-guided portal pressure gradient measurement, and EUS-guided vascular therapies. In this review, we discuss the origins of each of these EUS applications, evolution of techniques leading to the current status, and future directions of EUS-guided interventional therapy.

Choledocholithotripsy using peroral direct cholangioscopy through a standard gastroscope for a giant common bile duct stone: a case report

“…ERCP is widely used as a minimally invasive modality for the treatment of CBD stones [ 3 ]. However, it is often difficult to remove a giant CBD stone (larger than 15 mm in diameter) by using a routine ERCP.…”

Primary closure for pancreatic duct after stenting assisted by multiple endoscopes can be a new surgical method for the treatment of main pancreatic duct stones associated with pancreatic duct dilation

“…The approach does not encompass pancreaticojejunostomy, which is in line with the physiological continuity of the digestive tract. The pancreatic duct stent can be removed using a duodenoscope after subsequent therapy [ 5 ]. It is worthwhile acknowledging that this new surgical technique demands extensive expertise in pancreatic duct suturing.…”

Asymptomatic pancreatic enlargement without pancreatic enzyme elevation: a rare case of immune checkpoint inhibitor-associated pancreatitis

“…EUS may play an important diagnostic role [ 9 ], but reports of EUS imaging findings of ICI-associated pancreatitis are rare. In our patient, the findings included swelling of the pancreatic head ( Figure 1C ) with scattered hyperechoic and hypoechoic areas but without dilation of the main pancreatic duct.…”