Published online Jan 7, 2017. doi: 10.3748/wjg.v23.i1.25
Peer-review started: September 24, 2016
First decision: October 20, 2016
Revised: November 17, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: January 7, 2017
New technologies in endoscopic ultrasound (EUS) evaluation have been developed because of the need to improve the EUS and EUS-fine needle aspiration (EUS-FNA) diagnostic rate. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of the methods presented. Contrast-enhanced harmonic EUS uses a low mechanical index and highlights slow-flow vascularization. This technique is useful for differentiating solid and cystic pancreatic lesions and assessing biliary neoplasms, submucosal neoplasms and lymph nodes. It is also useful for the discrimination of pancreatic masses based on their qualitative patterns; however, the quantitative assessment needs to be improved. The detection of small solid lesions is better, and the EUS-FNA guidance needs further research. The differentiation of cystic lesions of the pancreas and the identification of the associated malignancy features represent the main indications. Elastography is used to assess tissue hardness based on the measurement of elasticity. Despite its low negative predictive value, elastography might rule out the diagnosis of malignancy for pancreatic masses. Needle confocal laser endomicroscopy offers useful information about cystic lesions of the pancreas and is still under evaluation for use with solid pancreatic lesions of lymph nodes.
Core tip: Contrast-enhanced harmonic endoscopic ultrasound, elastography and needle confocal laser endomicroscopy represent new, emerging technologies for improving the diagnosis obtained using endoscopic ultrasonography. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of these methods, such as their use in the guidance or orientation of endoscopic ultrasound fine needle aspiration, molecular imaging and neurophysiology assessment in gastroenterology.