Therapeutic EUS: New tools, new devices, new applications

Abstract

Linear echoendoscopes with large instrument channels enable EUS-guided interventions in organs and anatomical spaces in proximity to the gastrointestinal tract. Novel devices and tools designed for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. New-generation biopsy needles provide higher histology rates and require less passes. Specially designed stents and stent insertion devices enable intra- and extra-hepatic bile and pancreatic duct stenting as well as gallbladder drainage. Currently, EUS-guided biliary drainage in obstructive jaundice due to malignant distal bile duct obstruction is feasible and safe when ERCP has failed. It might replace ERCP as first choice intervention in future. EUS-guided transmural stenting is regarded as the preferred intervention in the management of symptomatic peripancreatic fluid collections. Creating a new anastomosis between different organs such as gastrojejunostomy has also become possible with lumen-apposing stents. EUS-guided creation of a gastrogastrostomy is a promising novel technique to access the excluded stomach to facilitate conventional ERCP in patients with Roux-en-Y gastric bypass anatomy. The role of EUS in tumor ablation and targeted angiotherapy is also constantly expanding. In this review, we report on the newest developments of therapeutic EUS within the past 4 years.

Repeated balloon dilatation with long-term biliary drainage for treatment of benign biliary-enteric anastomosis strictures

“…Specially designed stents and stent insertion devices enable intra- and extra-hepatic bile stenting as well as gallbladder drainage. [ 15 , 16 ] However, as it relies extremely on experience of the operator, EUS-guided transluminal interventions are restricted in the clinical application. Although the transhepatic approach is invasive, in some difficult cases, percutaneous transhepatic surgical approaches, including percutaneous transhepatic balloon dilatation with or without long-term biliary drainage and stent placement, have been suggested as possible alternatives.…”

Effect of motivational interviewing on postoperative weight control in patients with obstructive sleep apnea-hypopnea syndrome

“…If postoperative weight control is not good, some patients with OSAHS will experience rebound symptoms after surgery. Obesity requires comprehensive treatment based on exercise and diet, and if necessary, medication, surgery, or endoscopic ultrasound interventions are required[ 12 - 15 ]. Thus, effective lifestyle interventions play an important role in the treatment of OSAHS.…”

Validation of a novel swine model for training in EUS-FNA (with videos)

“…A wide range of EUS-guided techniques, including the EUS-FNA, injection, drainage, and anastomosis, were developed and have promoted an expansive prospect for clinical application of this technology. [ 1 ] As the application of EUS continues to expand, a prominent contradiction has arisen between the ever-growing clinical demands and the limited number of competent endosonographers. [ 2 ] In China, the number of credentialed endosonographers is far from sufficient to cover the large population, and there is a significant spatial disequilibrium of EUS development among different geographical regions in the nation.…”