Published online Jun 10, 2015. doi: 10.4253/wjge.v7.i6.628
Peer-review started: November 1, 2014
First decision: November 27, 2014
Revised: January 24, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: June 10, 2015
Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.
Core tip: Therapeutic endoscopic ultrasound (EUS) has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.
Endoscopic ultrasound (EUS) is an important diagnostic and therapeutic technique in the field of gastroenterology. The ability to visualise and access organs in vicinity of the gastrointestinal tract has opened this exciting field with many interventional EUS procedures now overtaking conventional approaches for treatment of various gastrointestinal diseases. While advances have been made in all aspects of diagnostic and therapeutic EUS, the present review will focus on advances in therapeutic EUS and use of EUS in drainage of pancreatic collections, celiac plexus neurolysis, biliary/pancreatic duct drainage, and in the drainage of intra-abdominal abscesses.