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World J Gastroenterol. Jul 14, 2014; 20(26): 8424-8448
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8424
Endoscopic ultrasound-guided treatments: Are we getting evidence based - a systematic review
Carlo Fabbri, Carmelo Luigiano, Andrea Lisotti, Vincenzo Cennamo, Clara Virgilio, Giancarlo Caletti, Pietro Fusaroli
Carlo Fabbri, Vincenzo Cennamo, Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, 40139 Bologna, Italy
Carmelo Luigiano, Clara Virgilio, Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, 95122 Catania, Italy
Andrea Lisotti, Giancarlo Caletti, Pietro Fusaroli, Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Hospital S Maria della Scaletta, 40026 Imola, Italy
Author contributions: Fabbri C and Fusaroli P designed research, edited and finalized the text; Lisotti A and Luigiano C performed literature search, analyzed the data and wrote the text; Virgilio C, Cennamo V and Caletti G reviewed the paper for important intellectual content.
Correspondence to: Pietro Fusaroli, MD, Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Hospital S Maria della Scaletta, Via Montericco 4, 40026 Imola, Italy. pietro.fusaroli@unibo.it
Telephone: +39-542-662407 Fax: +39-542-662409
Received: November 1, 2013
Revised: January 30, 2014
Accepted: March 12, 2014
Published online: July 14, 2014

Abstract

The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field.

Key Words: Endoscopic ultrasound, Pseudocyst drainage, Necrosectomy, Celiac plexus neurolysis, Levels of evidence, Fine needle injection

Core tip: Endoscopic ultrasound (EUS)-guided interventions have become increasingly popular. The advantages of EUS guidance over percutaneous and surgical routes are well established for pseudocyst drainage and celiac plexus neurolysis as they have been assessed in high level of evidence literature. However, for other very fashionable procedures such as bile duct and pancreatic duct drainage, the role of EUS guidance has only been reported as preliminary studies in limited number of patients. The level of evidence of each EUS-guided intervention is accurately reported in this review in order to provide the readers with the current status of knowledge and allow insights into potential future direction of research.


Citation: Fabbri C, Luigiano C, Lisotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P. Endoscopic ultrasound-guided treatments: Are we getting evidence based - a systematic review. World J Gastroenterol 2014; 20(26): 8424-8448
INTRODUCTION

Endoscopic ultrasound (EUS) has evolved from a purely diagnostic imaging modality to an interventional procedure that provides a minimally invasive alternative to interventional radiologic and surgical techniques.

Several innovative techniques now constitute the portfolio of interventional EUS, such as EUS-guided drainage (GD) of pancreatic fluid collections (PFCs), EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage (BD), EUS-guided pancreatography and pancreatic duct drainage (PDD), EUS-guided gallbladder drainage, EUS-GD of abdominal and pelvic fluid collections, EUS-guided celiac plexus block (CPB) and celiac plexus neurolysis (CPN), EUS-guided pancreatic cyst ablation, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement, brachytherapy and EUS-guided vascular interventions. However, EUS-guided treatments are technically challenging and require expertise in both standard diagnostic EUS and endoscopic interventional procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and gastrointestinal stenting.

For such a reason, it is important that we carefully monitor the results of our EUS-guided treatments in order to either implement them in clinical practice or abandon/thoroughly revise them. Evidence based medicine is known as a strategic tool to do so.

Following our previous systematic analysis of the levels of evidence (LE) of the EUS literature[1-4], we reviewed the entire body of literature accumulated over the past 2 decades on EUS-guided treatments. Our main aim was to critically appraise the published articles, based on the classification of studies according to LE, in order to assess the scientific progress made in this field.

All articles relevant to EUS-guided interventional procedures were extracted up to September 2013. Moreover, the references of reviewed articles were scrutinized to obtain any other reference that eluded the primary search.

This review is based on the results of searches carried out in PubMed and Google Scholar.Original research articles [randomized controlled trials (RCT), prospective studies (PS) and retrospective studies (RS)], meta-analyses, systematic reviews and surveys pertinent to EUS-guided interventional procedures were included.

Studies enrolling up to 10 patients were categorized as case series. We also included letters and case reports describing recent, innovative or original EUS-guided treatments. Commentaries, non-English language articles, congress proceedings and abstracts, and articles in which EUS did not represent the principal matter were not included.

In regard to data collection, priority was assigned to the study subject, design and methods, the type and year of publication and the number of patients enrolled. The content of each study was further analyzed to identify relevant clinical issues. In particular, when the same group of patients from the same institution was included in two consecutive papers (e.g., preliminary study and final results study), we included only the data from the most recent one to avoid duplicated results.

Levels of evidence were stratified according to the North of England evidence-based guidelines[5,6]. LE Ia: Evidence obtained from meta-analysis of RCTs; LE Ib: Evidence obtained from at least one RCT; LE IIa: Evidence obtained from at least one well designed controlled study without randomization; LE IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study; LE III: Evidence obtained from well-designed non-experimental descriptive studies such as comparative studies, correlation studies, and case studies; LE IV: Evidence obtained from expert committee reports or opinions, or clinical experiences of respected authorities.

A total of 381 pertinent articles were finally included for the purpose of this systematic review. Published research focused primarily on EUS-guided cholangiography and biliary drainage (85 studies), followed by EUS-GD of pancreatic fluid collections (84 studies), EUS-guided CPN or CPB (52 studies), EUS-guided tumor ablation (34 studies), EUS-guided ethanol ablation (28 studies), EUS-guided fiducial placement (26 studies), EUS-guided vascular interventions (23 studies), EUS-guided necrosectomy (20 studies), EUS-guided pancreatography and pancreatic duct drainage (15 studies), EUS-guided gallbladder drainage (7 studies) and EUS-GD of abdominal (non-peripancreatic) and pelvic collections (7 studies). A detailed classification of the studies according to the subclasses and the corresponding LE is presented in Table 1. As expected, we identified a predominance of LE III and IV articles in all types of EUS-guided treatments, reflecting the relative novelty of these techniques. Nevertheless, a fair number of high LE articles (LE Ia and Ib) were identified for EUS-GD of pancreatic fluid collections and EUS-guided CPN, forming a solid base of evidence for these established indications. On the other hand, novel therapeutic applications, such as EUS-guided cholangiography and biliary drainage and EUS-guided tumor ablation, still lack relevant clinical data and should still be considered strictly investigational. A focused description of all forms of EUS-guided treatment is given below, in a schematic format.

Table 1 Level of evidence per subject.
Level of evidenceIaIbIIaIIbIIIIVTotal
EUS-GD of pancreatic fluid collections15016422084
EUS-guided necrosectomy110015320
EUS-guided cholangiography and biliary drainage0107374085
EUS-guided pancreatography and pancreatic duct drainage00009615
EUS-guided gallbladder drainage0103127
EUS-GD of abdominal (non-peripancreatic) and pelvic collections0002327
EUS-guided Celiac Plexus Neurolysis or Block4715161952
EUS-guided ethanol ablation010513928
EUS-guided tumor ablation000942134
EUS-guided fiducial placement0002101426
EUS-guided vascular intervention010215523
Total617151165141381
EUS-GUIDED DRAINAGE OF PFCs

EUS-GD is regarded as an established technique for the treatment of PFCs. Up to now, the reported evidence pertains about 2115 patients enrolled in safety and efficacy studies overall[7-64]. Mean technical and clinical success rates reported in series with more than 10 patients were 97% and 90%, respectively and mean overall recurrence rate was 8%[8-64] (Table 2). The mean overall complication rate was 17% including bleeding (69 cases), superinfection (52 cases), stents migration that required endoscopic reintervention (51 cases), perforation treated with surgery (27 cases) and pneumoperitoneum treated conservatively (18 cases). However, only 5 cases of death were deemed to be procedure related[8-64].

Table 2 Endoscopic ultrasound-guided drainage of pancreatic fluid collections.
Ref.DesignCasesTechnical successClinical successRecurrenceComplications1
Binmoeller et al[8]RS2793%78%22%52%
Pfaffenbach et al[9]PS1191%82%18%None
Giovannini et al[10]PS35100%89%9%3%
Norton et al[11]RS1493%93%23%14%
Vosoghi et al[12]RS14100%93%7%7%
Enya et al[13]PS13100%85%0%None
Hookey et al[14]RS3296%93%12%11%
Krüger et al[15]PS3594%88%12%33%
Azar et al[16]RS2391%82%18%4%
Antillon et al[17]PS3394%87%4%15%
Kahaleh et al[18]PS46100%93%NR19%
Ahlawat et al[19]PS11100%82%18%18%
Arvanitakis et al[20]RCT46100%94%11%22%
Lopes et al[21]RS5194%84%17%25%
Varadarajulu et al[22]PS23100%95%0%None
Lopes et al[23]PS31100%94%19%26%
Ardengh et al[24]PS7794%91%11%6%
Varadarajulu et al[25]RS20100%95%NRNone
Varadarajulu et al[26]RCT24100%96%NR4%
Varadarajulu et al[27]PS6095%93%4%2%
Barthet et al[28]PS28100%89%NR25%
Talreja et al[29]PS18100%95%0%44%
Park et al[30]RCT3995%95%6%7%
Yasuda et al[31]RS2692%87%17%None
Itoi et al[32]PS13100%100%0%None
Varadarajulu et al[33]PS10100%90%0%None
Ang et al[34]PS10100%100%0%10%
Ahn et al[35]RS4798%100%11%11%
Jazrawi et al[36]RS10100%100%10%None
Sadik et al[37]PS26100%88%4%15%
Will et al[38]PS13297%96%15%29%
Seicean et al[39]PS2483%79%0%17%
Heinzow et al[40]RS4288%78%21%21%
Varadarajulu et al[41]PS148100%99%NR5%
Varadarajulu et al[42]RS602100%69%0%8%
Varadarajulu et al[43]RS20100%100%5%None
Zheng et al[44]PS1490%90%0%19%
Voermans et al[45]RCT52100%82%9%11%
Mangiavillano et al[46]PS2186%81%14%5%
Seewald et al[47]RS8097%83%13%26%
Itoi et al[48]RS15100%100%0%6%
Puri et al[49]PS40100%97%2%7%
Fabbri et al[50]PS20100%95%5%15%
Rasmussen et al[51]RS2286%86%18%18%
Khashab et al[52]RS10100%100%0%None
Penn et al[53]PS20100%85%18%15%
Weilert et al[54]PS18100%78%NR33%
Rana et al[55]RS202100%100%0%5%
Binmoeller et al[56]RS14100%79%NR21%
Nan et al[57]RS21100%100%NR5%
Kato et al[58]RS6788%83%15%1%
Künzli et al[59]RS10897%84%18%20%
Siddiqui et al[60]RS8899%79%3%30%
Rische et al[61]RS18100%94%6%33%
Varadarajulu et al[62]RCT20100%95%0%None
Total55 studies186797% (83%-100%)90% (69%-100%)8% (0%-23%)17% (0%-52%)
EUS vs surgical drainage

A recent RCT[62] comparing EUS and surgery for pancreatic pseudocyst drainage, showed no pseudocyst recurrence during the follow-up in the former group and no evidence that surgical cystogastrostomy was superior to EUS. Moreover, EUS treatment was associated with shorter hospital stay, better physical and mental health of patients, and lower costs. EUS-GD of PFCs is not inferior to surgical drainage in terms of safety and efficacy (LE Ib).

EUS vs blind endoscopic drainage

Meta-analysis of EUS-GD of PFCs showed superior technical and treatment success rates and more favorable safety profiles than traditional non-EUS guided drainage[65] (LE Ia).

Varadarajulu et al[26] published the first RCT, randomizing 30 patients to undergo either EUS-GD or endoscopic conventional transmural drainage (ECTD). All patients assigned to EUS underwent successful drainage (100%), while the procedure was technically successful in only 5/15 patients (33%) assigned to ECTD. All 10 patients who failed drainage by ECTD underwent successful drainage of the PFC on a crossover to EUS. Major procedure-related bleeding was encountered in 2 patients in whom ECTD was performed (LE Ib). Park et al[30] enrolled 60 patients in a RCT with the same design as above. Technical success of the drainage was significantly higher in the EUS group (94%) than in the ECTD group (72%) (P = 0.039) in intention-to-treat analysis. In 8 cases where ECTD had failed because of non-bulging PFCs, crossover to EUS-GD was always successful. Complications occurred in 7% of the EUS group vs 10% of the ECTD group (P = NS). During follow-up, PFC resolution was achieved in 97% in the EUS group and in 91% in the ECTD group (P = NS) (LE Ib). EUS-GD of PFCs has superior technical and clinical outcomes compared to blind endoscopic drainage (LE Ia).

Forward view vs linear scanning EUS

EUS-GD of PFCs is commonly performed with linear scanning echoendoscopes, whose tangential approach to PFCs may be challenging for operators. Theoretically, technical difficulties might be overcome using a forward-viewing echoendoscope which allows a straight approach to PFCs. However, a recent RCT[45] comparing the performance of linear vs forward-viewing echoendoscopes in draining PFCs failed to demonstrate any significant difference in technical success, mean procedure time, safety or efficacy between the two types of echoendoscopes.

The use of forward-viewing echoendoscope for EUS-guided drainage of PFCs does not confer any significant advantage in terms of safety and efficacy compared to the use of linear scanning echoendoscope (LE Ib).

Timing of stent removal

In order to evaluate the incidence of PFCs recurrence after successful EUS-GD, 28 patients were randomized either to stent removal (n = 13) or to stent left in place (n = 15) and were followed up for a median period of 14 months. PFCs recurrence was observed in 5 patients in the stent retrieval group, as opposed to none in the other group (P = 0.013)[20]. After successful EUS-GD of PFCs, stent retrieval is associated with higher recurrence rate than leaving stent in place (LE Ib).

Nasocystic drainage to maintain patency: Siddiqui et al[60] evaluated in a RS EUS-guided nasocystic drainage alongside transmural stents in PFCs with viscous solid debris. Association with the nasocystic drainage resulted in lower stent occlusion rate and better short-term clinical outcomes compared to those patients who underwent standard EUS-GD. The placement of a nasocystic drainage may increase the clinical success rate, especially in PFCs containing abundant debris (LE III).

Multiple transluminal gateway technique: Varadarajulu et al[42], showed that drainage of necrotic PFCs with multiple instead of a single transmural access, placing multiple stents and a nasocystic drainage in each tract, led to better long-term clinical outcomes. Multiple instead of single transmural points of access allow better drainage of the necrotic contents and improve treatment success (LE III).

Use of covered self-expandable metal stents: Covered self-expandable metal stents have been recently tested for drainage of PFCs and walled-off pancreatic necrosis with the intent of creating a larger fistula compared to plastic stents. Increased success rate and reduced time to resolution were shown in case series and pilot studies[48,50,53,54] (LE IIb). However stents designed for other indications were used. Recently, new devices have been introduced for the purpose of PFCs drainage, provided with larger diameter and antimigration features such as the “NAGI” stent (Taewoong-Medical Co, Seoul, South Korea) or the “AXIOS” stent (Xlumena Inc., Mountain View, California, United States)[66,67].

A case series[68] described the use of the AXIOS stent in 9 patients who underwent EUS-guided drainage of PFCs. The technical success rate was 89% (8/9) due to one failure of the delivery system and all patients had successful outcome achieving complete PFC resolution. One patient developed a tension pneumothorax immediately after transesophageal drainage. No migrations were reported, and all stents were removed easily. Only one patient presented a recurrence 4 wk after stent removal. Use of covered self-expandable metal stents seems to improve the clinical outcome in these patients; however, larger studies comparing metal and plastic stents are warranted (LE IIb).

EUS-GUIDED NECROSECTOMY

Debridement of pancreatic necrosis has traditionally been managed surgically. In recent years, EUS-guided endoscopic necrosectomy has become an alternative.

This technique involves a transmural (transgastric or transduodenal) EUS-guided access to the necrotic area, followed by large caliber (e.g., 18 mm) balloon dilation of the tract between the collection and the gastrointestinal wall, allowing for passage of a gastroscope into the collection to visualize the necrotic material. A variety of tools, such as baskets, snares, and nets have been used to remove the necrotic tissue. EUS-guided necrosectomy has been reported in 283 published cases so far. In the published studies a median of 4 (1-35) sessions was required to achieve resolution of the necrotic collection[69]. Mean technical and clinical success rates reported were 100% and 88%, respectively; mean overall complication rate was 28% and mean overall recurrence rate was 7%[61,70-84] (Table 3). A recent RCT[78] by the Dutch Pancreatitis Study Group showed a lower rate of proinflammatory response, organ failure and major complications in patients undergoing EUS-guided necrosectomy as compared to surgical necrosectomy (LE Ib).

Table 3 Endoscopic ultrasound-guided necrosectomy.
Ref.DesignCasesTechnical successClinical successRecurrenceComplications1
Seewald et al[70]RS13100%85%15%30%
Charnley et al[71]RS13100%92%0%None
Voermans et al[72]RS25100%93%7%40%
Hocke et al[73]RS3097%83%3%23%
Schrover et al[74]RS8100 %75%12%25%
Mathew et al[75]RS6100%100%0%None
Escourrou et al[76]RS13100%100%0%46%
Jürgensen et al[77]RS35100%97%0%17%
Bakker et al[78]RCT10100%100%20%40%
Will et al[79]RS18100%100%11%17%
Rische et al[61]RS22100%86%14%36%
Yamamoto et al[80]RS4100%50%NR25%
Hritz et al[81]RS4100%100%0%None
Yasuda et al[82]RS57100%75%7%33%
Ang et al[83]RS8100%87%13%None
Sarkaria et al[84]RS17100%88%0%6%
Total16 studies283100% (97%-100%)88% (50%-100%)7% (0%-20%)28% (0%-46%)
EUS-GUIDED CHOLANGIOGRAPHY AND BILIARY DRAINAGE

When biliary ductal access via endoscopic retrograde cholangiopancreatography (ERCP) fails, rescue measures include precut papillotomy, percutaneous transhepatic biliary drainage (PTBD), surgical bypass and EUS-guided BD. Three different EUS-guided BD approaches have been described: direct transluminal stenting via transgastric or transduodenal route, rendezvous technique passing a guidewire through an intrahepatic or extrahepatic access to the papilla, and antegrade stent placement.

EUS-guided BD has currently been performed in 1127 published cases, with mean technical and clinical success rates of 91% and 88%, respectively. However, mean overall complication rate was 26% with mortality of 0.4% (4/1127 patients)[85-113] (Table 4).

Table 4 Endoscopic ultrasound-guided cholangiography and biliary drainage.
Ref.DesignCasesTechnical successClinical successComplications1
Bories et al[86]RS1191%80%72%
Maranki et al[87]RS4984%80%18%
Brauer et al[88]PS1292%72%16%
Horaguchi et al[89]PS16100%94%37%
Kim et al[90]RS1580%80%None
Fabbri et al[91]PS1675%75%8%
Park et al[92]RS5796%89%47%
Hara et al[93]PS1894%94%77%
Komaki et al[94]RS15100%100%46%
Ramírez-Luna et al[95]PS1191%82%18%
Shah et al[96]RS6885%85%9%
Iwashita et al[97]RS4073%73%12%2
Dhir et al[98]RS5898%98%3%
Artifon et al[99]RCT13100%100%15%
Song et al[100]PS1587%87%47%
Kim et al[101]PS1392%84%38%
Vila et al[102]RS10670%70%23%
Horaguchi et al[103]RS21100%100%10%
Hara et al[104]PS1894%89%27%
Park et al[105]PS4591%87%11%
Kawakubo et al[106]RS14100%100%14%
Dhir et al[107]RS3597%97%23%
Khashab et al[108]RS3594%91%14%
Gornals et al[109]RS1587%73%40%
Gupta et al[110]RS24099%87%35%
Dhir et al[111]RS6897%97%21%3
Kawakubo et al[112]RS6495%95%42%
Total27 studies108891% (70%-100%)87% (70%-100%)29% (3%-77%)
EUS-guided BD vs percutaneous BD

In a recent RCT 25 patients with unresectable malignant biliary obstruction and a previous failed ERCP attempt were assigned either to EUS-guided or to percutaneous transhepatic BD. The authors reported 100% technical and clinical success in both study groups, with no difference in incidence of adverse events[99] (LE Ib). Combining EUS and ERCP in the same procedure was a cost saving strategy compared to referring the patient for percutaneous transhepatic BD[109] (LE III). EUS-guided BD appears to be a valid alternative to percutaneous BD, showing similar efficacy and safety (LE Ib). However, data are still very preliminary and large RCT are needed to demonstrate whether EUS can represent a valid alternative to percutaneous route in this setting.

EUS-guided rendezvous BD vs precut papillotomy

The outcome of 58 patients undergoing EUS-guided rendezvous drainage because of bile duct obstruction, after failed selective biliary cannulation, was compared to an historical cohort of 144 patients treated with precut papillotomy. Treatment success was significantly higher for the EUS-guided rendezvous patients than for those who underwent precut papillotomy, while there was no difference in complications rate[98]. EUS-guided rendezvous drainage seems to be superior to precut papillotomy in patients with bile duct obstruction after failed ERCP (LE III).

EUS-guided rendezvous BD vs EUS-guided transluminal BD

A recent RS (33 patients) compared the outcome of two different techniques in patients who underwent a standardized approach to EUS-guided BD, with an initial attempt at using the rendezvous technique (n = 13) followed by the transluminal approach (n = 20) in case of rendezvous failure. The Authors reported that both techniques achieved the same effectiveness and safety[108]. Transluminal EUS-guided BD may represent a safe and effective alternative in case of failure of rendezvous technique (LE III).

EUS-guided transhepatic BD vs EUS-guided extrahepatic BD

EUS-guided BD can be performed either via intrahepatic (through the stomach) or via extrahepatic (through the duodenum) route. In a recent RS, despite similar technical and clinical success rate, extrahepatic access was associated with significantly shorter procedure and hospitalization time and with less complications[107] (LE III). Another multicenter RS enrolling 68 patients who underwent transluminal EUS-guided BD for malignant obstructive jaundice showed similar technical and clinical success both in patients who underwent transhepatic and extrahepatic drainage. However, transhepatic access was burdened with a significantly higher complication rate compared to the extrahepatic route (30.5% vs 9.3%, P = 0.03); multivariate analysis identified the transhepatic route as the only factor independently related to the risk of procedure-related adverse event[111] (LE III). EUS-guided BD shows similar technical and clinical success rate with both transhepatic and extrahepatic access. However, extrahepatic access seems to be safer than transhepatic access (LE III).

EUS-GUIDED PANCREATOGRAPHY AND PANCREATIC DUCT DRAINAGE

EUS-guided PDD has been reported in 248 published cases so far. They are usually indicated after failed ERCP in patients with benign conditions such as ductal stones, strictures or post-surgical stenosis[85,96,102,113-120] (Table 5).

Table 5 Endoscopic ultrasound-guided pancreatography and pancreatic duct drainage.
Ref.DesignCasesTechnical successClinical successComplications1
Will et al[114]RS12100% (SPDD: 67%)50%43%
Tessier et al[115]RS3692% (SPDD: 92%)69%55%
Kahaleh et al[116]RS13100% (SPDD: 77%)77%15%
Barkay et al[117]RS2186% (SPDD: 48%)86%10%
Ergun et al[118]RS20100% (SPDD: 90%)72%20%
Shah et al[96]RS25100% (SPDD: 86%)100%16%
Vila et al[102]RS1958% (SPDD: NR)NR26%
Kurihara et al[119]RS14100% (SPDD: 93%)93%7%
Fujii et al[120]RS4598% (SPDD: 73%)53%24%
Total9 studies205100% (58%-100%)74.5% (53%-100%)20%(7%-55%)
Outcomes of EUS-guided PDD

EUS-guided PDD is a challenging procedure and it is technically more demanding than EUS-guided BD. As a result, technical and clinical outcomes of EUS-guided PDD were less favorable than for EUS-guided BD with an overall technical success rate of 78%[96,102,113-120] (LE III). Technical failures were mainly due to difficult orientation of the echoendoscope along the axis of the pancreatic duct, inability to dilate the transmural tract because of dense fibrosis, and impossible endotherapy because of too acute angle of access to the pancreatic duct[96,102,113-120]. As a note of interest, successful ERCP was reported in some cases after EUS-guided pancreatography by needle injection of contrast medium with or without methylene-blue[96,117] (LE III). EUS-guided PDD is a challenging procedure, showing suboptimal clinical success and relevant complication rate (LE III).

Technical issues and complications

EUS-guided rendezvous technique was usually attempted first, followed by the transenteric EUS-guided PDD in case of rendezvous failure[119] (LE III). EUS-guided transenteric stenting required more dilation of the needle tract than rendezvous technique, leading to serious adverse events such as pancreatitis (4%), pancreatic juice leakage (3%), bleeding (3%), and perforation (3%)[119] (LE III). The most common site for pancreatic duct access was through the gastric body, in view of the straight and stable echoendoscope position and the ease of access to the pancreatic duct[96,102,113-120] (LE III). Plastic stents were used for EUS-guided PDD unlike metal stents. In fact, covered metal stents can block side branches leading to obstructive pancreatitis and uncovered metal stents can cause pancreatic juice leakage between the stomach and pancreas[96,102,113-120] (LE III). EUS-guided PDD via transenteric route shows higher complication rate than via rendezvous route (LE III).

EUS-GUIDED GALLBLADDER DRAINAGE

Patients with acute cholecystitis unresponsive to medical therapy, require decompression of the gallbladder if they are unsuitable for emergency surgery. Available treatments are percutaneous transhepatic gallbladder drainage and EUS-guided gallbladder drainage. The latter has been performed in 97 published cases with mean technical and clinical success rates are 98% and 98%, respectively; overall mean complication rate was 16%[48,121-134] (Table 6).

Table 6 Endoscopic ultrasound-guided drainage of gallbladder.
Ref.DesignCasesTechnical successClinical successComplications1
Baron et al[121]CR1100%100%None
Kwan et al[122]RS3100%100%33%
Lee et al[123]PS9100%100%11%
Takasawa et al[124]CR1100%100%None
Kamata et al[125]CR1100%100%None
Kamata et al[126]CR1100%100%None
Song et al[127]PS8100%100%37%
Súbtil et al[128]RS4100%100%25%
Itoi et al[129]CR2100%100%None
Jang et al[130]PS15100%100%13%
Jang et al[131]RCT3097%97%7%
Itoi et al[48]RS5100%100%None
Itoi et al[132]CR1100%100%None
de la Serna-Higuera et al[133]RS1385%85%15%
Widmer et al[134]RS3100%100%None
Total15 studies97100% (85%-100%)100% (85%-100%)0% (0%-37%)
EUS-guided vs percutaneous gallbladder drainage

Recently a non-inferiority RCT[131] was conducted to evaluate the technical feasibility, efficacy and safety of EUS-guided vs percutaneous drainage in this setting. The authors enrolled 59 patients and reported similar technical success rate (97% vs 97%), clinical success (100% vs 96%) and rate of adverse events (7% vs 3%) in the two study groups (LE Ib).

Transgastric vs transduodenal approach

Both transgastric and transduodenal approaches have been performed to achieve EUS-guided gallbladder drainage. In a pilot study, plastic stent migration was observed in a patient 3 wk after trans-gastric drainage. The authors suggested that transduodenal approach toward the gallbladder neck could avoid plastic stent migration[127] (LE IIb). On these basis, specific lumen-apposing metal stents with large distal and proximal flares have been developed[48,130,133]. EUS-guided gallbladder drainage shows similar feasibility, efficacy and safety profiles to percutaneous drainage (LE Ib).

EUS-GUIDED DRAINAGE OF ABDOMINAL NON-PERIPANCREATIC AND PELVIC COLLECTIONS

EUS-GD represents a valid treatment of fluid collections located in anatomic regions adjacent to the gastrointestinal tract (i.e., subphrenic space, perihepatic, left lobe of the liver, proximal small bowel, left colon, perirectal space, etc.). EUS-GD of abdominal (non-peripancreatic) and pelvic collections has been performed in 120 published cases so far, with mean technical and clinical success rates of 99% and 92%, respectively[135-154] (LE IIb). Overall complication rate was 13% (Table 7). Pelvic collections may present a clinical challenge because of their location, usually surrounded by major organs and anatomic structures (urinary bladder, rectum, prostate, vagina or uterus). All published data available reported the use of a drainage catheter or plastic stents[136,146,153] (LE III). Fully covered metal stents have recently been adopted for the drainage of pelvic abscesses[154] in order to minimize the risk of peritoneal leaks, to provide a larger diameter fistula and to avoid early stent occlusion; all these characteristics were shown to increase the clinical success rate and the time to collection resolution (LE III). EUS-guided drainage represents a preferential treatment of deep-seated abdominal fluid collections (LE IIb).

Table 7 Endoscopic ultrasound-guided drainage of non-peripancreatic and pelvic collections.
Ref.DesignCasesTechnical successClinical successComplications1
Attwell et al[135]CR1100%100%None
Giovannini et al[136]PS12100%75%25%
Seewald et al[137]CR2100%100%None
Seewald et al[138]CR1100%100%None
Kahaleh et al[139]CR2100%100%None
Lee et al[140]CR1100%100%None
Jah et al[141]CR1100%100%None
Shami et al[142]RS5100%100%None
Ang et al[143]CR1100%100%None
Piraka et al[144]PS7100%100%28%
Noh et al[145]PS3100%100%None
Puri et al[146]RS14100%93%None
Itoi et al[147]CR1100%100%None
Decker et al[148]CR1100%100%None
Gupta et al[149]RS2090%90%35%
Ulla-Rocha et al[150]RS6100%100%None
Varadarajulu et al[151]CR1100%100%None
Knuth et al[152]CR1100%100%None
Ramesh et al[153]RS38100%87%None
Luigiano et al[154]CR2100%100%None
Total20 studies120100% (90%-100%)100% (75%-100%)0% (0%-35%)
EUS-GUIDED CELIAC PLEXUS NEUROLYSIS AND BLOCK

CPN and CPB provide pain relief and reduces narcotic use in patients with intra-abdominal malignancies and chronic pancreatitis[155]. The injection of a neurolytic drug into the celiac plexus disrupts the signal transmission to spinal cord and central nervous system. Due to the anatomical location of the celiac plexus around the origin of the celiac trunk and the superior-mesenteric artery, EUS-CPN provides direct, real-time visualization leading to a safer approach than trans-abdominal or posterior access (Table 8).

Table 8 Endoscopic ultrasound-guided plexus neurolysis/celiac plexus block n (%).
Ref.DesignIndicationsTechniquesTechnical successClinical success (pain relief)Complications
Wiersema et al[167]RSPC (n = 25)CPN100%79%-88%4 transient diarrhea
Metastases (n = 5)
Gress et al[163]RCTCP (n = 10)EUS-guided100%50%None
CP (n = 8)CT-guided25%
Gunaratnam et al[168]PSPC (n = 58)CPN100%78%5 transient abdominal pain
Gress et al[169]PSCP (n = 90)CPB100%55%3 diarrhea
Tran et al[170]RSPC (n = 10)CPN100%70%NR
Ramirez-Luna et al[171]RSPC (n = 11)CPN100%72.20%None
Levy et al[172]RSPC (n = 18)CGN (n = 17)NR16/17 (94)12 hypotension
CGB (n = 1)0/1 (0)6 diarrhea
CP (n = 18)CGN (n = 5)NR4/5 (80)
CGB (n = 13)5/13 (38)
O'Toole et al[173]RSPC (n = 2)CPB (n = 189)NRNR2 post-procedural pain
CP (n = 187)1 retroperitoneal abscess
PC (n = 21)CPN (n = 31)NRNR1 hypotension
CP (n = 10)
Santosh et al[164]RCTCP (n = 27)EUS-CPB100%70%2 diarrhea
CP (n = 29)Percutaneous-CPB-30%
Leblanc et al[165]RCTCP (n = 23)CPB (central)100%15/23 (65)None
CP (n = 27)CPB (bilateral)16/27 (59)
Sahai et al[174]RSPC (n = 34)/CP (n = 37)Central CPN100%45.90%1 adrenal artery bleeding
PC (n = 45)/CP (n = 44)Bilateral CPN70.40%
Sakamoto et al[175]PSPC (n = 67)34CPN100%72%-79%None
33 BPN96.90%19%-78%
Wyse et al[158]RCTPC (n = 96)48 CPN100%60.70%None
48 control--
LeBlanc et al[160]RCTPC (n = 29)CPB (central)100%20/29 (69)None
PC (n = 21)CPB (bilateral)17/21 (81)
Téllez-Ávila et al[161]RSPC (n = 53)Central (n = 21)NR10/21 (48)None
Bilateral (n = 32)18/32 (56)
Iwata et al[176]RSPC (n = 47)CPN100%68.10%NR
Ascunce et al[177]RSPC (n = 64)CPN100%50%1 hypotension
Stevens et al[166]RCTCP (n = 40)Triamcinolone + bupivacaine (n = 21)100%68.4%-85.7%1 severe hypertension
Bupivacaine (n = 19)4 pain exacerbation
1 gastric hematoma
Wiechowska-Kozlowska et al[178]RSPC (n = 29)CPN100%86%3 diarrhea
1 hypotonia
2 post-procedural pain
Wang et al[179]PSPC (n = 23)Celiac ganglion irradiation100%82.60%None
Leblanc et al[180]PSPC (n = 20)10 mL (n = 10)100%80%3 nausea and vomiting
20 mL (n = 10)100%2 diarrhea
1 lightheadness
Seicean et al[181]PSPC (n = 32)CPN100%75%NR
Doi et al[162]RCTPC (n = 68)CPN (n = 34)100%45.50%1 GI bleeding
CGN (n = 34)88.20%73.50%3 hypotension
5 diarrhea
17 pain exacerbation
Total23 studies1327-100% (88.2%-100%)71.9% (45.5%-90%)-
EUS-CPN in patients with pancreatic cancer

EUS-CPN vs analgesics: EUS-CPN (8 studies, 283 patients) was demonstrated safe and effective in alleviating refractory pain due to pancreatic cancer: pooled proportion 80.1% (74.5%-85.2%)[156] (LE Ia). Alcohol-based EUS-CPN was found safe and effective in this setting: the pooled proportion of patients (5 studies, 119 patients) that experienced pain relief was 72.5%[157] (LE Ia). In a recent RCT, 96 patients with advanced pancreatic cancer were randomly assigned to early EUS-guided CPN or to conventional pain management; the authors observed greater pain relief in the early EUS-CPN group at three months than in conventional management group [-67% (-87 to -25), P = 0.01][158] (LE Ib). Finally, compared to opioids, EUS-CPN (6 studies, 358 patients) was demonstrated to reduce pain at four and eight wk [visual analog score -0.42 (-0.70 to -0.13) and -0.44 (-0.89 to -0.01)] and significantly reduced opioid consumptions in the EUS-CPN group (P < 0.00001)[159]. EUS-CPN is superior to analgesic therapy in reducing pain (LE Ia).

Single central injection vs bilateral injections: Leblanc et al[160] randomized 50 patients with pancreatic cancer to receive one or two injections of alcohol for CPN without observing any difference in onset or duration of pain relief in the two groups[161]. There is no difference between central vs bilateral injections in EUS-CPN (LE Ib).

EUS-CPN vs EUS-direct celiac ganglia neurolysis: Thirty-four patients were assigned to undergoing either EUS-celiac ganglia neurolysis (CGN) or classical EUS-CPN. The authors observed higher treatment response rate (73.5% vs 45.5%, P = 0.026) and complete response rate (50.0% vs 18.2%, P = 0.010) in the EUS-CGN group compared to the EUS-CPN group[162]. EUS-CGN is superior to conventional EUS-CPN in inducing pain relief (LE Ib).

EUS-CPN and EUS-CPB in patients with chronic pancreatitis

EUS-CPN vs analgesics: In patients with pain due to chronic pancreatitis (9 studies, 376 patients) alcohol-based EUS-CPN provided pain relief in 59.4% (95%CI: 54.5-64.3)[157]. EUS-CPN is effective in pain control due to chronic pancreatitis; however, in this setting, due to the relative lower efficacy than in oncologic disease, the development of techniques or new injected drugs seem to be needed (LE Ia).

EUS-CPB vs analgesic: Meta-analysis for efficacy of steroid-based EUS-guided celiac plexus block (EUS-CPB) in patients with refractory pain due to chronic pancreatitis (6 studies, 221 patients) showed an effective alleviation of abdominal pain only in 51.46% of them[158]. EUS-CPB is moderately effective in pain control due to chronic pancreatitis. In this setting, the development of new techniques and/or injected drugs is needed (LE Ia).

EUS-guided vs percutaneous-CPB: An RCT comparing the safety and efficacy of EUS-guided vs CT-guided celiac plexus block in patients with chronic pancreatitis showed that EUS-CPB was significantly more effective in short-term (50% vs 25% at 4 wk) and long-term (30% vs 12% at the end of follow-up) pain control[163] (LE Ib). Another RCT comparing EUS-guided (29 patients) vs percutaneous fluoroscopy-guided (27 patients) CPB with bupivacaine (10 mL) and triamcinolone (3 mL) in patients with chronic pancreatitis demonstrated an improvement in pain scores (visual analog score) in 70% of cases in the EUS group vs 30% of cases in the percutaneous group (P = 0.044)[164] (LE Ib). EUS-CPB provides better pain control than percutaneous-CPB (LE Ib).

Single central injection vs bilateral injections: LeBlanc et al[165] randomized 50 patients with chronic pancreatitis to receive one or two injections of bupivacaine and triamcinolone without observing any difference in duration of pain relief or onset of pain in the two groups. There is no difference between central vs bilateral injections in EUS-CPB (LE Ib).

Bupivacaine and triamcinolone vs bupivacaine alone: In order to evaluate the effect of the addition of triamcinolone to bupivacaine in EUS-CPB, 40 patients were randomized to receive either bupivacaine alone or bupivacaine and triamcinolone. There was no significant difference in pain control between the two groups (14.3% vs 15.8% for controls), therefore the trial was stopped for futility[166]. There is no advantage of adding triamcinolone to bupivacaine for EUS-CPB (LE Ib).

Complications of EUS-CPN and EUS-CPB

Most frequent (up to 30% of patients) adverse events related to EUS-CPN/CPB are represented by diarrhea, abdominal pain and hypotension; however, they are usually mild (grade I-II) and self-limiting[167-181] (Table 8). Nevertheless, we found reports of serious adverse events related to EUS-CPN/CPB including bleeding, abscess, abdominal ischemia, permanent paralysis and also death (LE III) (Table 9). In our opinion, the risk of serious morbidity and mortality should be weighed against expected benefits particularly in patients with a long life expectancy (i.e., patients with chronic pancreatitis).

Table 9 Serious adverse events of endoscopic ultrasound-guided celiac plexus neurolysis/celiac plexus block.
Ref.JournalYearComplicationIndicationTechnique
Gress et al[247]Gastrointest Endosc19971 retroperitoneal bleedingCPEUS-CPN
1 retroperitoneal abscessCPEUS-CPB
Mahajan et al[248]Gastrointest Endosc20023 empyemaCPEUS-CPB
Muscatiello et al[249]Endoscopy20061 retroperitoneal abscessPCEUS-CPN
Sahai et al[174]Am J Gastroenterol20091 retroperitoneal bleedingCPEUS-CPB
O’Toole et al[173]Endoscopy20091 retroperitoneal abscessCPEUS-CPB
Ahmed et al[250]Endoscopy20091 ischemiaCPEUS-CPN
Shin SK et al[251]Korean J Pain20101 ejaculatory failureCPEUS-CPB
Lalueza et al[252]Endoscopy20111 brain abscessCPEUS-CPN
Gimeno-Garcia et al[253]Endoscopy20121 ischemia/deathCPEUS-CPN
Fujii et al[254]Endoscopy20121 spinal cord infarction/paralysisPCEUS-CPN-G
Mittal et al[255]Neurology20121 spinal cord infarction/paralysisPCEUS-CPN-G
Loeve et al[256]Gastrointest Endosc20131 gastric necrosis/deathPCEUS-CPN
Jang et al[257]Clin Endosc20131 hepatic-bowel infarction/deathPCEUS-CPN
Doi et al[162]Endoscopy20131 GI bleeding (puncture site)PCEUS-CGN
EUS-GUIDED ETHANOL INJECTION
Pancreatic cystic lesions

The initial steps for performing EUS-guided ethanol cyst ablation are similar to those for pancreatic EUS-FNA including antibiotic prophylaxis and puncturing the cysts with a 22-gauge needle. After partial or total evacuation of cystic fluid for diagnostic purposes, a volume of ethanol equal to that aspirated should be injected and maintained for 3-5 min. After aspiration of the total amount of ethanol injected, a chemotherapeutic agent (i.e., paclitaxel) may be injected and left inside the cystic cavity[182-190] (Table 10).

Table 10 Endoscopic ultrasound-guided ethanol injection of abdominal solid and cystic tumors.
Ref.DesignIndicationsLesion size (mm)TechniquesClinical successComplications
Gan et al[187]PSPancreatic cystic lesions (n = 25)6-30Ethanol35%None
Oh et al[185]PSPancreatic cystic lesions (n = 14)17-52Ethanol and paclitaxel79%1 acute pancreatitis
6 hyperamylasemia
1 abdominal pain
Oh et al[182]PSSeptated pancreas cysts (n = 10)20-68Ethanol and paclitaxel60%1 acute pancreatitis
DeWitt et al[183]RCTPancreatic cystic lesions (n = 42)10-58Ethanol vs saline33%1 acute pancreatitis
5 abdominal pain
1 cystic bleeding
DeWitt et al[184]PSPancreatic cystic lesions (n = 12)10-50Ethanol75% at follow-up-
Oh et al[186]PSPancreatic cystic lesions (n = 52)17-68Ethanol and paclitaxel62%1 acute pancreatitis
1 abdominal pain
1 fever
1 splenic vein thrombosis
DiMaio et al[189]RSPancreatic cystic lesions (n = 13)20.1 ± 7.1Ethanol (single/multi)38%1 abdominal pain
Oh et al[190]RSPancreatic cystic lesions (n = 1)5.2Ethanol 99% 28 mL + paclitaxelFailure, underwent surgeryPortal vein thrombosis
Jurgensen et al[192]RSPancreatic NET (n = 1)13Ethanol 95% 8 mLComplete remissionPain + lipase increase
Muscatiello et al[193]RSPancreatic NET (n = 1)11 and 7Ethanol 40% 2 mLNo recurrence at 18 moSmall pancreatic necrosis
Deprez et al[194]RSPancreatic NET (n = 1)13Ethanol 98% 3.5 mLComplete remissionHematoma and duodenal ulcer
Vleggaar et al[195]RSPancreatic NET (n = 1)10Ethanol 96% 0.3 mLAsymptomatic at 6 moNone
Levy et al[191]RSPancreatic NET (n = 5)8-21Ethanol 95-99% 0.1-3 mL60% symptoms resolutionNone
Barclay et al[196]RSSolid Hepatic Metastasis (n = 1)33Ethanol 98% 6 mLGood condition at 5.5 yrLiver hematoma
Gunter et al[197]RSGI stromal tumor (n = 1)40Ethanol 95%Complete remissionAbdominal pain
1.5 mLMucosal ulceration
Hu et al[198]RSLiver metastasis (n = 1)35Ethanol 100% 10 mLLocal control and decrease in sizeFever
Artifon et al[199]RSLeft adrenal metastasis (n = 1)50Ethanol 98% 15 mLPalliation of related painNone
DeWitt et al[200]RSMetastatic lymph node (n = 1)10-11EthanolLocally successfulNone
4 + 2 mL
Total (cystic lesion)8 studies169 patients6-68-60% (33%-79%)-

Ethanol vs saline: Ethanol injection with EUS led to a greater reduction in cyst size compared to simple saline injection (43% vs 11%); moreover, ethanol injection resulted in complete cyst ablation in 33% of cases (12 out of 36)[183] (LE Ib). Follow-up by CT scan at 2 years of patients who had obtained complete cyst ablation after treatment showed persistent resolution of pancreatic cystic lesions in 75% of cases[184] (LE IIb). Ethanol injection and lavage induces a significantly greater reduction in cyst size and allows a significantly higher rate of cyst ablation than saline alone (LE Ib).

Ethanol plus paclitaxel: In their experience on 52 patients with uniloculated or oligoloculated pancreatic cyst treated with ethanol lavage followed by paclitaxel injection, Oh et al[186] observed complete resolution in 62% of patients after 1-year follow-up. The authors identified small cyst size as a positive predictive factor of treatment response. Addition of paclitaxel to ethanol injection is safe and effective and leads to a greater treatment rate of pancreatic cystic lesions compared to ethanol alone (LE IIb).

Solid lesions

EUS-guided injection of ethanol has been applied to a variety of solid tumors including pancreatic endocrine tumors, hepatic metastases, and submucosal tumors[191-200]. In a single-center RS, Levy et al[191] reported safety and efficacy of EUS-guided ethanol injection in five patients with pancreatic insulinoma. The authors obtained symptoms resolution in 60% of patients with no complications[191] (LE III). Ethanol injection is feasible and safe in solid pancreatic insulinomas (LE III).

EUS-GUIDED TUMOR ABLATION
EUS-guided fine needle injection

EUS-fine needle injection (FNI) is a simple technique to deliver chemotherapeutic agents into tumoral tissue for the treatment of locally advanced pancreatic or esophageal cancer. The technical outcome of all the studies about EUS-FNI reached 100%, paralleling the ability of performing EUS-FNA for cytological diagnosis. However, the clinical outcome varied greatly according to the different chemical or biological agents being tested[201] (Table 11).

Table 11 Endoscopic ultrasound-guided tumor ablation.
Ref.DesignIndicationsTechniquesTypeTumor responseComplications
Chang et al[202]PSPancreatic cancer (n = 8)InjectionCytoimplant2 partial;None
1 minor
Hecht et al[203]PSPancreatic cancer (n = 21)InjectionONYX-015 + iv gemcitabine2 partial;2 sepsis
2 minor;2 duodenal perforations
6 stable;
11 progression
Chang et al[211]RSPancreatic cancer (n = 1)InjectionTNFerade + chemoradiotxSurgical resectionNone
Hecht et al[205]PSPancreatic cancer (n = 50)Injection (27 EUS-guided)TNFerade + chemoradiotx1 complete;6 GI bleeding
3 partial;6 deep vein thrombosis
4 minor;2 pulmonary embolism
12 stable2 pancreatitis
6 cholangitis
Irisawa et al[204]PSPancreatic cancer (n = 7)InjectionImmature dendritic cells2 mixed;None
2 stable;
3 progressive
Hanna et al[207]PSPancreatic cancer (n = 9)Injection (6 EUS-guided)BC-819 + chemoradiotx2 surgically resectable;None
3 partial
Chang et al[206]PSEsophageal cancer (n = 24)InjectionTNFerade6 complete;5 thromboembolic events (highest dose)
2 stable
Arcidiacono[208]PSPancreatic cancer (n = 22)Cryothermal AblationEUS-CTP6 partial response (only 6 patients analyzed)3 hyperamylasemia
Maier et al[212]PSHead/neck cancer (n = 21)BrachytxIr-192 needles4 full;None
15 partial;
3 none
Lah et al[213]RSMetastatic celiac lymph nodes (n = 1)BrachytxI-125 seedsResponseNone
Martinez-Monge et al[214]RSMetastatic mediastinal lymph node (n = 1)BrachytxI-125 seedsResponseNone
Sun et al[209]PSPancreatic cancer (n = 15)BrachytxI-125 seeds4 partial;1 site infection
3 minor;3 hematologic side effects
5 stable;
3 progressive
Jin et al[210]PSPancreatic cancer (n = 22 )BrachytxI-125 seeds4 partial;1 seed migration
10 stable

Allogeneic mixed lymphocyte culture: The first study assessing EUS-FNI for pancreatic cancer tested the safety and efficacy of allogeneic mixed lymphocyte culture in locally advanced pancreatic adenocarcinoma in 8 patients. The procedure (single session of EUS-guided injection) was safe and two partial responses and one minor response were reported (median survival 13.2 mo)[202] (LE IIb).

Adenovirus ONYX-015: ONYX-015, a modified adenovirus (deletion in the E1B gene) which replicate in tumor cells leading to cell death, was used for EUS-FNI in pancreatic cancer in combination with systemic gemcitabine. The authors enrolled 21 patients in this phase I study and reported two patients with partial regression and two with minor response. However, 4 serious adverse events were observed (two sepsis and two duodenal perforations)[203] (LE IIb).

Immature dendritic cells: Irisawa et al[204] reported a pilot study (phase I) with injection of immature dendritic cells (DCs). DCs were used for EUS-FNI in view of their potent induction of primary T-cell response against tumor antigens. Among 7 patients with locally advanced pancreatic adenocarcinoma, one complete and three partial responses were reported. No adverse events were described[204] (LE IIb).

TNFerade: EUS-FNI of TNFerade, a replication-deficient adenovirus vector carrying the tumor necrosis factor-α gene, was tested in a multicenter study on 50 patients with locally advanced pancreatic cancer in combination with systemic fluorouracil. The authors observed 1 complete response, 3 partial responses, and 12 patients with stable disease after treatment. Interestingly, seven patients became suitable for surgery after EUS-FNI and 6 of them underwent R0 resection. According to the authors, an RCT is warranted to further assess these encouraging results[205] (LE IIb).

The efficacy of EUS-FNI of TNFerade was also assessed in 24 patients with locally advanced but still resectable esophageal cancer (20% stage II, 80% stage III). EUS-FNI of TNFerade was combined with cisplatin, 5-fluorouracil and radiation therapy. Six complete responses and 2 stable diseases were observed. The median survival was 47.8 mo and 5-year survival and disease-free survival rates were 41% and 38%, respectively. Additionally, EUS-FNI proved to be safe[206] (LE IIb).

BC-819: The safety, tolerability and preliminary efficacy of EUS-FNI of BC-819, a DNA plasmid developed to target the expression of diphtheria-toxin gene under the control of H19 regulatory sequences, was recently tested in 6 patients with pancreatic cancer in combination with chemoradiotherapy. Three patients showed partial response and other two patients who were downstaged were able to undergo surgical resection[207]. Intratumoral EUS-FNI in patients with advanced pancreatic and esophageal cancer is technically easy, safe and can induce tumor downstaging in some cases (LE IIb).

EUS-guided cryothermal ablation

The safety and efficacy of cryothermal ablation was assessed using a newly developed cryotherm probe (CTP) in 22 patients with locally advanced pancreatic cancer. CTP is a large bore flexible bipolar device that combines radiofrequency with cryogenic cooling in the same session. EUS-guided CTP ablation was feasible in 16 patients. CT scan was performed in all cases after treatment; in 6/16 patients a reduction in tumor size was clearly seen. The procedure was well tolerated in all cases[208] (LE IIb).

EUS-guided brachytherapy

The feasibility, safety and efficacy of EUS-guided implantation of radioactive seeds in patients with locally advanced pancreatic cancer were assessed in a few studies[209-214]. Partial tumor response ranged from 13.6% to 27% while a stable disease was observed in 45.5%-53% of cases in two pilot studies[209,210]. In both series, up to 30% of patients reported transient pain reduction within the first period after treatment. Adverse event rate range was 0%-20% (pancreatitis and pseudocyst formation) in association to systemic, non-EUS-related, adverse events (LE IIb). EUS-guided CTP ablation and brachytherapy are feasible in a subset of patients with locally advanced pancreatic cancer. However, their safety and clinical outcome have to be further investigated (LE IIb).

EUS-guided fiducial placement

Imaging-guided radiation therapy is based upon a real-time tracking system to target the tumor to be irradiated. In order to minimize irradiation of adjacent normal tissue in pancreatic malignancies, the placement of radiopaque fiducials inside or near the tumor allows a radiographic marking enabling precise tumor targeting. Firstly, fiducials were placed in patients with advanced pancreatic cancer were placed with surgical or radiological techniques. In the last decade, the less invasive EUS-guided fiducial placement was shown to be safe and precise[215-227] (Table 12).

Table 12 Endoscopic ultrasound-guided fiducial placement n (%).
Ref.DesignIndicationsTechniquesTechnical successNeedleComplications
Pishvaian et al[215]PSAbdominal/mediastinal cancer (n = 13)Fiducial placement11/13 (84.6)19 Gauge1 infection
Varadarajulu et al[222]RSPancreatic cancer (n = 9)Fiducial placement9/9 (100)NRNone
DiMaio et al[223]RSAbdominal/mediastinal cancer (n = 30)Fiducial placement29/30 (97)22 GaugeNone
Sanders et al[217]PSPancreatic cancer (n = 51)Fiducial placement46/51 (90)19 Gauge1 mild pancreatitis
Park et al[216]PSPancreatic cancer (n = 57)Fiducial placement50/57 (88)19 GaugeNone
Ammar et al[224]RSAbdominal cancer/lymph nodes (n = 13)Single fiducial marker9/9 trans-gastric22 GaugeNone
4/4 trans-duodenal
Varadarajulu et al[225]PSPancreatic cancer (n = 2)Fiducial placement2/2 (100)19 Gauge flexibleNone
Khashab et al[218]RSPancreatic cancer (n = 39)Fiducial placement (traditional vs coiled)39/39 (100)19 and 22 GaugeNone
Law et al[226]RSSmall pancreatic NET (n = 2)Fiducial placement2/2 (100)22 GaugeNone
Majumder et al[219]RSPancreatic cancer (n = 39)Fiducial placement35/39 (89.7)19 Gauge1 mild pancreatitis
4 abdominal pain
Yang et al[220]RSProstate cancer (n = 16)Fiducial placement16/16 (100)19 GaugeNone
Yang et al[221]RSProstate cancer recurrence (n = 6)Fiducial placement6/6 (100)19 GaugeNone
Trevino et al[227]RSRectal cancer (n = 1)Fiducial placement3/3 (100)19 Gauge (forward-view EUS)None
Total13 studies278-100% (84.6%-100%)-0%

Safety and effectiveness: Two PSs enrolling a total of 101 patients with locally advanced or recurrent pancreatic cancer reported high technical and clinical success rates (88%-90%). Overall complication rate was low with only few minor adverse events (one patient experienced minor bleeding from the site of EUS needle entrance and one experienced mild pancreatitis). Migration of the gold fiducials was reported in 7% of cases[216,217] (LE IIb).

Traditional vs coiled fiducials: Khashab et al[218] compared the technical success, safety, visibility and migration of two different types of fiducials (traditional vs coiled). In their RS, no differences were observed in visibility, degree of fiducial migration, number of fiducial placement, technical difficulty or complication rate (LE III).

Ideal fiducial geometry: A recent study compared the achievement of the iIdeal fiducial geometry (IGF) (defined as the placement of 3 fiducials with at least 2 cm of distance, at least 15 degrees angle, and non-planar placement) in 39 patients who underwent EUS-guided fiducial placement vs 38 who underwent surgical fiducial placement. In this RS, the authors identified a significantly higher rate of IGF reached with surgical vs EUS placement (47% vs 18%, P = 0.0011). However, it was observed that despite the lower IGF rate in the EUS group, fiducial tracking for irradiation therapy was successful in a similar percentage of patients from the two groups (> 80%)[219] (LE III). EUS-guided fiducial placement is safe and leads to technical and clinical success in about 90% of patients (LE IIb).

Non-pancreatic cancer: Two recent retrospective case series reported the feasibility and safety of fiducial placement in 16 patients with prostate cancer and in 6 with prostate cancer recurrence. The authors reported extremely high success rates (16/16 and 6/6 respectively) with no incidence of adverse events[220,221] (LE III). EUS-guided fiducial placement was feasible and safe in patients with prostate cancer or prostate cancer recurrence (LE III).

EUS-GUIDED VASCULAR INTERVENTIONS

EUS combined with color/power Doppler allows precise identification of vascular anatomy, potential high risk vessels with/without portal hypertension, and occult sources of bleeding such as Dieulafoy’s lesions and pseudoaneurysms. Moreover, EUS provides direct access to vascular structures next to gastrointestinal wall, allowing precise vascular interventions[228-246] (Table 13).

Table 13 Endoscopic ultrasound-guided vascular interventions n (%).
Ref.DesignIndicationsTechniquesTechnical successRebleedingComplications
Fockens et al[229]RSDieulafoy’s lesion (n = 4)Polidocanol injection4/4 (100)2/4 (50)None
Levy et al[234]RSDieulafoy’s lesion (n = 1)Alcohol 99% injection1/1 (100)NoNone
Gonzalez et al[235]RSDieulafoy’s lesion (n = 2)Polidocanol2/2 (100)NoNone
or CYA injection
Levy et al[234]RSVarious (n = 4)Alcohol 99% or CYA injection4/4 (100)NoNone
Gonzalez et al[235]RSPseudo-aneurysm (n = 3)CYA injection3/3 (100)NoNone
Gonzalez et al[235]RSGastric varices (n = 2)CYA injection2/2 (100)NoNone
Lee et al[231]RSGastric varices (n = 101)EUS-assisted CYA injection-Early 4/54 (7.4)None
Late 10/54 (18)
Lahoti et al[236]RSEsophageal varices (n = 5)Sclerotherapy5/5 (100)No1 esophageal stricture
Romero-Castro et al[237]RSGastric varices (n = 5)CYA injection5/5 (100)NoNone
De Paulo et al[230]RCTEsophageal varices (n = 50)Endo vs EUS-guided CYA injection24/25 (96)2/24 recurrence of varices (8.3)None
Levy et al[238]RSCholedochojejunal anastomotic varices (n = 1)Coil embolization1/1 (100)NoNone
Romero-Castro et al[239]RSGastric varices (n = 4)Coil embolization3/4 (75)NoNone
Binmoeller et al[233]RSGastric varices (n = 30)CYA injection + coil embolization30/30 (100)4/24 (16.6)None
Romero-Castro et al[232]RSGastric varices (n = 30)CYA injection (n = 19) vs coils (n = 11)97.4 % vs 90.9%NR9 CYA embolization;
1 chest pain; 1 fever;
1 variceal bleeding
Weilert et al[240]RSRectal varices (n = 1)CYA injection plus coils100%NoNone
Gonzalez et al[241]RSSplenic artery aneurism (n = 1)CYA injection1/1 (100)NoNone
Roberts et al[242]RSVisceral pseudoaneurysm (n = 1)HistoAcryl injection1/1 (100)NoNone
Roach et al[243]RSSMA aneurysm (n = 1)Thrombin injection1/1 (100)NoNone
Chaves et al[244]RSSMA aneurysm (n = 1)Thrombin injection1/1 (100)NoNone
Robinson et al[245]RSSplenic artery aneurysm (n = 1)Thrombin injection1/1 (100)NoNone
Lameris et al[246]RSVisceral pseudoaneurysm (n = 1)Thrombin + collagen injection1/1 (100)NoNone
EUS-guided treatment of non-variceal bleeding

The efficacy of EUS-guided treatments of non-variceal upper gastrointestinal bleeding was reported only in form of small case series and case reports. Fockens et al[229] first reported about the usefulness of EUS in the diagnosis of small abnormal vessels in 8 patients with Dieulafoy’s lesions. In 50% of cases it was possible to perform EUS-guided injection of sclerosing agent into the aberrant vessels[229] (LE III).

EUS-guided treatment of portal hypertension

Endoscopic vs EUS-guided sclerotherapy of esophageal collateral veins: An RCT compared the safety and efficacy of EUS-guided and endoscopic sclerotherapy (ethanolamine oleate injection) in 50 patients affected by liver cirrhosis. The authors did not observe any difference in variceal eradication, number of sessions needed to achieve the eradication, variceal recurrence and adverse event rates[230] (LE Ib). EUS-guided sclerotherapy does not confer any significant advantage in terms of safety and efficacy compared to classical endoscopic sclerotherapy (LE Ib).

Gastric variceal bleeding: In a RS, EUS-assisted cyanoacrylate (CYA) injection until obliteration of all gastric varices collateral was compared to an historical group of cirrhotic patients who underwent standard endoscopic injection, only in case of recurrent bleeding. While early re-bleeding rate was similar in the two groups (7.4% vs 12.8%, respectively, P = NS), late recurrent bleeding was significantly reduced in patients who underwent CYA injection under EUS control to check for complete obliteration (18.5% vs 44.7%, P = 0.0053, OR = 0.28)[231] (LE IIb). EUS guidance allows an higher rate of gastric variceal obliteration and reduces recurrent bleeding (LE IIb).

Coil embolization vs CYA injection for gastric varices: A multicenter RS compared feasibility, safety and applicability of coil embolization vs sclerotherapy (CYA injection) under EUS guidance. Thirty patients (11 coil group vs 19 CYA group) underwent EUS-guided treatment for gastric varices. The rate of variceal obliteration was similar in the two groups (90.9% vs 94.7%, respectively) without differences in number of EUS sessions. Eleven patients (11/19) in the sclerotherapy group experienced adverse events; in 9 of them an asymptomatic pulmonary glue embolism was found on CT scan, while 1 patient experienced fever and another experienced chest pain; on the other hand, only one patient treated with coil embolization experienced an adverse event (esophageal variceal bleeding). The comparison among the two treatment groups demonstrated a significantly lower incidence of any grade adverse events in the embolization group (58% vs 9%, P < 0.01); only 3 patients, two in the CYA and one in the coil group, experienced symptomatic adverse events[232] (LE IIb).

Combined coil embolization and CYA injection for gastric varices: The authors reported about 30 patients who underwent EUS-guided trans-esophageal combined embolization and sclerotherapy of gastric varices using in the majority of cases a forward-view echoendoscope. Successful treatment was achieved in all cases (30 out of 30, 100%) after a mean of 1.3 EUS sessions, including 2 cases with active bleeding. Rebleeding occurred in 16% of cases and no procedure-related adverse events were reported[233] (LE III). EUS-guided coil embolization and CYA injection are both effective for gastric varices treatment in patients with cirrhosis (LE IIb). While both sclerotherapy and embolization monotherapy present a high complication rate, combined coil embolization and CYA injection seems to be safe and effective in patients with gastric varices (LE III).

CONCLUSION

Several EUS-guided treatments are now available in endosonographer’s armamentarium. The usefulness of EUS-GD of PFCs and of EUS-CPN has been well established in studies with high LE. Other techniques including EUS-guided biliary drainage have been tested only in studies with medium-low LE and thus should still be performed either in referral centers by experienced endosonographers or in investigational/research settings. Well-designed RCTs are warranted to further elucidate the safety and benefits of EUS-guided treatments in comparison to the standards of care.

Footnotes

P- Reviewers: Chatterjee S, Gornals JB, Tellez-Avila F S- Editor: Zhai HH L- Editor: A E- Editor: Zhang DN

References
1.  Fusaroli P, Vallar R, Togliani T, Khodadadian E, Caletti G. Scientific publications in endoscopic ultrasonography: a 20-year global survey of the literature. Endoscopy. 2002;34:451-456.  [PubMed]  [DOI]
2.  Fusaroli P, Kypreos D, Alma Petrini CA, Caletti G. Scientific publications in endoscopic ultrasonography: changing trends in the third millennium. J Clin Gastroenterol. 2011;45:400-404.  [PubMed]  [DOI]
3.  Fusaroli P, Kypraios D, Eloubeidi MA, Caletti G. Levels of evidence in endoscopic ultrasonography: a systematic review. Dig Dis Sci. 2012;57:602-609.  [PubMed]  [DOI]
4.  Fusaroli P, Kypraios D, Caletti G, Eloubeidi MA. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol. 2012;18:4243-4256.  [PubMed]  [DOI]
5.  Eccles M, Rousseau N, Freemantle N. Updating evidence-based clinical guidelines. J Health Serv Res Policy. 2002;7:98-103.  [PubMed]  [DOI]
6.  Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60:1449-1472.  [PubMed]  [DOI]
7.  Fabbri C, Luigiano C, Maimone A, Polifemo AM, Tarantino I, Cennamo V. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. World J Gastrointest Endosc. 2012;4:479-488.  [PubMed]  [DOI]
8.  Binmoeller KF, Soehendra N. Endoscopic ultrasonography in the diagnosis and treatment of pancreatic pseudocysts. Gastrointest Endosc Clin N Am. 1995;5:805-816.  [PubMed]  [DOI]
9.  Pfaffenbach B, Langer M, Stabenow-Lohbauer U, Lux G. [Endosonography controlled transgastric drainage of pancreatic pseudocysts]. Dtsch Med Wochenschr. 1998;123:1439-1442.  [PubMed]  [DOI]
10.  Giovannini M, Pesenti C, Rolland AL, Moutardier V, Delpero JR. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy. 2001;33:473-477.  [PubMed]  [DOI]
11.  Norton ID, Clain JE, Wiersema MJ, DiMagno EP, Petersen BT, Gostout CJ. Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients. Mayo Clin Proc. 2001;76:794-798.  [PubMed]  [DOI]
12.  Vosoghi M, Sial S, Garrett B, Feng J, Lee T, Stabile BE, Eysselein VE. EUS-guided pancreatic pseudocyst drainage: review and experience at Harbor-UCLA Medical Center. MedGenMed. 2002;4:2.  [PubMed]  [DOI]
13.  Enya M, Yasuda I, Tomita E, Shirakami Y, Otsuji K, Shinoda T, Moriwaki H. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts using a large-channel echoendoscope and a conventional polypectomy snare. Dig Endosc. 2003;15:323-328.  [PubMed]  [DOI]
14.  Hookey LC, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Devière J. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006;63:635-643.  [PubMed]  [DOI]
15.  Krüger M, Schneider AS, Manns MP, Meier PN. Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access. Gastrointest Endosc. 2006;63:409-416.  [PubMed]  [DOI]
16.  Azar RR, Oh YS, Janec EM, Early DS, Jonnalagadda SS, Edmundowicz SA. Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope. Gastrointest Endosc. 2006;63:688-692.  [PubMed]  [DOI]
17.  Antillon MR, Shah RJ, Stiegmann G, Chen YK. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc. 2006;63:797-803.  [PubMed]  [DOI]
18.  Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, De La Rue SA, de Lange E, Bassignani M, Gay S, Adams RB. Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy. 2006;38:355-359.  [PubMed]  [DOI]
19.  Ahlawat SK, Charabaty-Pishvaian A, Jackson PG, Haddad NG. Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients. JOP. 2006;7:616-624.  [PubMed]  [DOI]
20.  Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, Devière J. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc. 2007;65:609-619.  [PubMed]  [DOI]
21.  Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses. Scand J Gastroenterol. 2007;42:524-529.  [PubMed]  [DOI]
22.  Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA, Blakely J, Canon CL. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc. 2007;66:1107-1119.  [PubMed]  [DOI]
23.  Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. Arq Gastroenterol. 2008;45:17-21.  [PubMed]  [DOI]
24.  Ardengh JC, Coelho DE, Coelho JF, de Lima LF, dos Santos JS, Módena JL. Single-step EUS-guided endoscopic treatment for sterile pancreatic collections: a single-center experience. Dig Dis. 2008;26:370-376.  [PubMed]  [DOI]
25.  Varadarajulu S, Lopes TL, Wilcox CM, Drelichman ER, Kilgore ML, Christein JD. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc. 2008;68:649-655.  [PubMed]  [DOI]
26.  Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68:1102-1111.  [PubMed]  [DOI]
27.  Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc. 2008;68:656-666.  [PubMed]  [DOI]
28.  Barthet M, Lamblin G, Gasmi M, Vitton V, Desjeux A, Grimaud JC. Clinical usefulness of a treatment algorithm for pancreatic pseudocysts. Gastrointest Endosc. 2008;67:245-252.  [PubMed]  [DOI]
29.  Talreja JP, Shami VM, Ku J, Morris TD, Ellen K, Kahaleh M. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc. 2008;68:1199-1203.  [PubMed]  [DOI]
30.  Park DH, Lee SS, Moon SH, Choi SY, Jung SW, Seo DW, Lee SK, Kim MH. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842-848.  [PubMed]  [DOI]
31.  Yasuda I, Iwata K, Mukai T, Iwashita T, Moriwaki H. EUS-guided pancreatic pseudocyst drainage. Dig Endosc. 2009;21 Suppl 1:S82-S86.  [PubMed]  [DOI]
32.  Itoi T, Itokawa F, Tsuchiya T, Kawai T, Moriyasu F. EUS-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique. Dig Endosc. 2009;21 Suppl 1:S53-S56.  [PubMed]  [DOI]
33.  Varadarajulu S, Trevino JM, Christein JD. EUS for the management of peripancreatic fluid collections after distal pancreatectomy. Gastrointest Endosc. 2009;70:1260-1265.  [PubMed]  [DOI]
34.  Ang TL, Teo EK, Fock KM. Endoscopic drainage and endoscopic necrosectomy in the management of symptomatic pancreatic collections. J Dig Dis. 2009;10:213-224.  [PubMed]  [DOI]
35.  Ahn JY, Seo DW, Eum J, Song TJ, Moon SH, Park do H, Lee SS, Lee SK, Kim MH. Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety. Gut Liver. 2010;4:524-529.  [PubMed]  [DOI]
36.  Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci. 2011;56:902-908.  [PubMed]  [DOI]
37.  Sadik R, Kalaitzakis E, Thune A, Hansen J, Jönson C. EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses. World J Gastroenterol. 2011;17:499-505.  [PubMed]  [DOI]
38.  Will U, Wanzar C, Gerlach R, Meyer F. Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses - treatment algorithm in a large single-center study. Ultraschall Med. 2011;32:176-183.  [PubMed]  [DOI]
39.  Seicean A, Stan-Iuga R, Badea R, Tantau M, Mocan T, Seicean R, Iancu C, Pascu O. The safety of endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopic control: a single tertiary center experience. J Gastrointestin Liver Dis. 2011;20:39-45.  [PubMed]  [DOI]
40.  Heinzow HS, Meister T, Pfromm B, Lenze F, Domschke W, Ullerich H. Single-step versus multi-step transmural drainage of pancreatic pseudocysts: the use of cystostome is effective and timesaving. Scand J Gastroenterol. 2011;46:1004-1013.  [PubMed]  [DOI]
41.  Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol. 2011;26:1504-1508.  [PubMed]  [DOI]
42.  Varadarajulu S, Phadnis MA, Christein JD, Wilcox CM. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc. 2011;74:74-80.  [PubMed]  [DOI]
43.  Varadarajulu S, Wilcox CM, Christein JD. EUS-guided therapy for management of peripancreatic fluid collections after distal pancreatectomy in 20 consecutive patients. Gastrointest Endosc. 2011;74:418-423.  [PubMed]  [DOI]
44.  Zheng M, Qin M. Endoscopic ultrasound guided transgastric stenting for the treatment of traumatic pancreatic pseudocyst. Hepatogastroenterology. 2011;58:1106-1109.  [PubMed]  [DOI]
45.  Voermans RP, Ponchon T, Schumacher B, Fumex F, Bergman JJ, Larghi A, Neuhaus H, Costamagna G, Fockens P. Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial. Gastrointest Endosc. 2011;74:1285-1293.  [PubMed]  [DOI]
46.  Mangiavillano B, Arcidiacono PG, Masci E, Mariani A, Petrone MC, Carrara S, Testoni S, Testoni PA. Single-step versus two-step endo-ultrasonography-guided drainage of pancreatic pseudocyst. J Dig Dis. 2012;13:47-53.  [PubMed]  [DOI]
47.  Seewald S, Ang TL, Richter H, Teng KY, Zhong Y, Groth S, Omar S, Soehendra N. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. Dig Endosc. 2012;24:36-41.  [PubMed]  [DOI]
48.  Itoi T, Binmoeller KF, Shah J, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75:870-876.  [PubMed]  [DOI]
49.  Puri R, Mishra SR, Thandassery RB, Sud R, Eloubeidi MA. Outcome and complications of endoscopic ultrasound guided pancreatic pseudocyst drainage using combined endoprosthesis and naso-cystic drain. J Gastroenterol Hepatol. 2012;27:722-727.  [PubMed]  [DOI]
50.  Fabbri C, Luigiano C, Cennamo V, Polifemo AM, Barresi L, Jovine E, Traina M, D’Imperio N, Tarantino I. Endoscopic ultrasound-guided transmural drainage of infected pancreatic fluid collections with placement of covered self-expanding metal stents: a case series. Endoscopy. 2012;44:429-433.  [PubMed]  [DOI]
51.  Rasmussen DN, Hassan H, Vilmann P. Only few severe complications after endoscopic ultrasound guided drainage of pancreatic pseudocysts. Dan Med J. 2012;59:A4406.  [PubMed]  [DOI]
52.  Khashab MA, Lennon AM, Singh VK, Kalloo AN, Giday SA. Endoscopic ultrasound (EUS)-guided pseudocyst drainage as a one-step procedure using a novel multiple-wire insertion technique (with video). Surg Endosc. 2012;26:3320-3323.  [PubMed]  [DOI]
53.  Penn DE, Draganov PV, Wagh MS, Forsmark CE, Gupte AR, Chauhan SS. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc. 2012;76:679-684.  [PubMed]  [DOI]
54.  Weilert F, Binmoeller KF, Shah JN, Bhat YM, Kane S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy. 2012;44:780-783.  [PubMed]  [DOI]
55.  Rana SS, Bhasin DK, Rao C, Gupta R, Singh K. Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis. Dig Endosc. 2013;25:47-52.  [PubMed]  [DOI]
56.  Binmoeller KF, Weilert F, Shah JN, Bhat YM, Kane S. Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience. Surg Endosc. 2013;27:1835-1839.  [PubMed]  [DOI]
57.  Nan G, Siyu S, Xiang L, Sheng W, Guoxin W. Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst. Gastroenterol Res Pract. 2013;2013:785483.  [PubMed]  [DOI]
58.  Kato S, Katanuma A, Maguchi H, Takahashi K, Osanai M, Yane K, Kim T, Kaneko M, Takaki R, Matsumoto K. Efficacy, Safety, and Long-Term Follow-Up Results of EUS-Guided Transmural Drainage for Pancreatic Pseudocyst. Diagn Ther Endosc. 2013;2013:924291.  [PubMed]  [DOI]
59.  Künzli HT, Timmer R, Schwartz MP, Witteman BJ, Weusten BL, van Oijen MG, Siersema PD, Vleggaar FP. Endoscopic ultrasonography-guided drainage is an effective and relatively safe treatment for peripancreatic fluid collections in a cohort of 108 symptomatic patients. Eur J Gastroenterol Hepatol. 2013;25:958-963.  [PubMed]  [DOI]
60.  Siddiqui AA, Dewitt JM, Strongin A, Singh H, Jordan S, Loren DE, Kowalski T, Eloubeidi MA. Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain. Gastrointest Endosc. 2013;78:589-595.  [PubMed]  [DOI]
61.  Rische S, Riecken B, Degenkolb J, Kayser T, Caca K. Transmural endoscopic necrosectomy of infected pancreatic necroses and drainage of infected pseudocysts: a tailored approach. Scand J Gastroenterol. 2013;48:231-240.  [PubMed]  [DOI]
62.  Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583-90.e1.  [PubMed]  [DOI]
63.  Singhal S, Rotman SR, Gaidhane M, Kahaleh M. Pancreatic Fluid Collection Drainage by Endoscopic Ultrasound: An Update. Clin Endosc. 2013;46:506-514.  [PubMed]  [DOI]
64.  Perez-Miranda M, Vila JJ, De la Serna-Higuera C. Endoscopic ultrasound. Endoscopy. 2013;45:300-304.  [PubMed]  [DOI]
65.  Panamonta N, Ngamruengphong S, Kijsirichareanchai K, Nugent K, Rakvit A. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol. 2012;24:1355-1362.  [PubMed]  [DOI]
66.  Desilets DJ, Banerjee S, Barth BA, Bhat YM, Gottlieb KT, Maple JT, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL. New devices and techniques for management of pancreatic fluid collections. Gastrointest Endosc. 2013;77:835-838.  [PubMed]  [DOI]
67.  Téllez-Ávila FI, Villalobos-Garita A, Ramírez-Luna MÁ. Use of a novel covered self-expandable metal stent with an anti-migration system for endoscopic ultrasound-guided drainage of a pseudocyst. World J Gastrointest Endosc. 2013;5:297-299.  [PubMed]  [DOI]
68.  Gornals JB, De la Serna-Higuera C, Sánchez-Yague A, Loras C, Sánchez-Cantos AM, Pérez-Miranda M. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc. 2013;27:1428-1434.  [PubMed]  [DOI]
69.  Haghshenasskashani A, Laurence JM, Kwan V, Johnston E, Hollands MJ, Richardson AJ, Pleass HC, Lam VW. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011;25:3724-3730.  [PubMed]  [DOI]
70.  Seewald S, Groth S, Omar S, Imazu H, Seitz U, de Weerth A, Soetikno R, Zhong Y, Sriram PV, Ponnudurai R. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. 2005;62:92-100.  [PubMed]  [DOI]
71.  Charnley RM, Lochan R, Gray H, O’Sullivan CB, Scott J, Oppong KE. Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy. 2006;38:925-928.  [PubMed]  [DOI]
72.  Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc. 2007;66:909-916.  [PubMed]  [DOI]
73.  Hocke M, Will U, Gottschalk P, Settmacher U, Stallmach A. Transgastral retroperitoneal endoscopy in septic patients with pancreatic necrosis or infected pancreatic pseudocysts. Z Gastroenterol. 2008;46:1363-1368.  [PubMed]  [DOI]
74.  Schrover IM, Weusten BL, Besselink MG, Bollen TL, van Ramshorst B, Timmer R. EUS-guided endoscopic transgastric necrosectomy in patients with infected necrosis in acute pancreatitis. Pancreatology. 2008;8:271-276.  [PubMed]  [DOI]
75.  Mathew A, Biswas A, Meitz KP. Endoscopic necrosectomy as primary treatment for infected peripancreatic fluid collections (with video). Gastrointest Endosc. 2008;68:776-782.  [PubMed]  [DOI]
76.  Escourrou J, Shehab H, Buscail L, Bournet B, Andrau P, Moreau J, Fourtanier G. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg. 2008;248:1074-1080.  [PubMed]  [DOI]
77.  Jürgensen C, Neser F, Boese-Landgraf J, Schuppan D, Stölzel U, Fritscher-Ravens A. Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary? Surg Endosc. 2012;26:1359-1363.  [PubMed]  [DOI]
78.  Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, van Eijck CH, Fockens P, Hazebroek EJ, Nijmeijer RM. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053-1061.  [PubMed]  [DOI]
79.  Will U, Wanzar I, Meyer F. Endoscopic necrosectomy--a feasible and safe alternative treatment option for infected pancreatic necroses in severe Acute pancreatitis: preliminary results of 18 patients in an ongoing single-center prospective observational study. Pancreas. 2012;41:652-655.  [PubMed]  [DOI]
80.  Yamamoto N, Isayama H, Kawakami H, Sasahira N, Hamada T, Ito Y, Takahara N, Uchino R, Miyabayashi K, Mizuno S. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc. 2013;77:809-814.  [PubMed]  [DOI]
81.  Hritz I, Fejes R, Székely A, Székely I, Horváth L, Sárkány A, Altorjay A, Madácsy L. Endoscopic transluminal pancreatic necrosectomy using a self-expanding metal stent and high-flow water-jet system. World J Gastroenterol. 2013;19:3685-3692.  [PubMed]  [DOI]
82.  Yasuda I, Nakashima M, Iwai T, Isayama H, Itoi T, Hisai H, Inoue H, Kato H, Kanno A, Kubota K. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy. 2013;45:627-634.  [PubMed]  [DOI]
83.  Ang TL, Kwek AB, Tan SS, Ibrahim S, Fock KM, Teo EK. Direct endoscopic necrosectomy: a minimally invasive endoscopic technique for the treatment of infected walled-off pancreatic necrosis and infected pseudocysts with solid debris. Singapore Med J. 2013;54:206-211.  [PubMed]  [DOI]
84.  Sarkaria S, Sethi A, Rondon C, Lieberman M, Srinivasan I, Weaver K, Turner BG, Sundararajan S, Berlin D, Gaidhane M. Pancreatic necrosectomy using covered esophageal stents: a novel approach. J Clin Gastroenterol. 2014;48:145-152.  [PubMed]  [DOI]
85.  Binmoeller KF, Nguyen-Tang T. Endoscopic ultrasound-guided anterograde cholangiopancreatography. J Hepatobiliary Pancreat Sci. 2011;18:319-331.  [PubMed]  [DOI]
86.  Bories E, Pesenti C, Caillol F, Lopes C, Giovannini M. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy. 2007;39:287-291.  [PubMed]  [DOI]
87.  Maranki J, Hernandez AJ, Arslan B, Jaffan AA, Angle JF, Shami VM, Kahaleh M. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy. 2009;41:532-538.  [PubMed]  [DOI]
88.  Brauer BC, Chen YK, Fukami N, Shah RJ. Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). Gastrointest Endosc. 2009;70:471-479.  [PubMed]  [DOI]
89.  Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Takasawa O, Koshita S, Kanno Y. Endosonography-guided biliary drainage in cases with difficult transpapillary endoscopic biliary drainage. Dig Endosc. 2009;21:239-244.  [PubMed]  [DOI]
90.  Kim YS, Gupta K, Mallery S, Li R, Kinney T, Freeman ML. Endoscopic ultrasound rendezvous for bile duct access using a transduodenal approach: cumulative experience at a single center. A case series. Endoscopy. 2010;42:496-502.  [PubMed]  [DOI]
91.  Fabbri C, Luigiano C, Fuccio L, Polifemo AM, Ferrara F, Ghersi S, Bassi M, Billi P, Maimone A, Cennamo V. EUS-guided biliary drainage with placement of a new partially covered biliary stent for palliation of malignant biliary obstruction: a case series. Endoscopy. 2011;43:438-441.  [PubMed]  [DOI]
92.  Park do H, Jang JW, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc. 2011;74:1276-1284.  [PubMed]  [DOI]
93.  Hara K, Yamao K, Niwa Y, Sawaki A, Mizuno N, Hijioka S, Tajika M, Kawai H, Kondo S, Kobayashi Y. Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction. Am J Gastroenterol. 2011;106:1239-1245.  [PubMed]  [DOI]
94.  Komaki T, Kitano M, Sakamoto H, Kudo M. Endoscopic ultrasonography-guided biliary drainage: evaluation of a choledochoduodenostomy technique. Pancreatology. 2011;11 Suppl 2:47-51.  [PubMed]  [DOI]
95.  Ramírez-Luna MA, Téllez-Ávila FI, Giovannini M, Valdovinos-Andraca F, Guerrero-Hernández I, Herrera-Esquivel J. Endoscopic ultrasound-guided biliodigestive drainage is a good alternative in patients with unresectable cancer. Endoscopy. 2011;43:826-830.  [PubMed]  [DOI]
96.  Shah JN, Marson F, Weilert F, Bhat YM, Nguyen-Tang T, Shaw RE, Binmoeller KF. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc. 2012;75:56-64.  [PubMed]  [DOI]
97.  Iwashita T, Lee JG, Shinoura S, Nakai Y, Park DH, Muthusamy VR, Chang KJ. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy. 2012;44:60-65.  [PubMed]  [DOI]
98.  Dhir V, Bhandari S, Bapat M, Maydeo A. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc. 2012;75:354-359.  [PubMed]  [DOI]
99.  Artifon EL, Aparicio D, Paione JB, Lo SK, Bordini A, Rabello C, Otoch JP, Gupta K. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol. 2012;46:768-774.  [PubMed]  [DOI]
100.  Song TJ, Hyun YS, Lee SS, Park do H, Seo DW, Lee SK, Kim MH. Endoscopic ultrasound-guided choledochoduodenostomies with fully covered self-expandable metallic stents. World J Gastroenterol. 2012;18:4435-4440.  [PubMed]  [DOI]
101.  Kim TH, Kim SH, Oh HJ, Sohn YW, Lee SO. Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction. World J Gastroenterol. 2012;18:2526-2532.  [PubMed]  [DOI]
102.  Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, Abadia MA, Pérez-Millán A, González-Huix F, Gornals J, Iglesias-Garcia J, De la Serna C, Aparicio JR. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc. 2012;76:1133-1141.  [PubMed]  [DOI]
103.  Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Koshita S, Kanno Y, Ogawa T, Masu K, Hashimoto S. Metallic stent deployment in endosonography-guided biliary drainage: long-term follow-up results in patients with bilio-enteric anastomosis. Dig Endosc. 2012;24:457-461.  [PubMed]  [DOI]
104.  Hara K, Yamao K, Hijioka S, Mizuno N, Imaoka H, Tajika M, Kondo S, Tanaka T, Haba S, Takeshi O. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy. 2013;45:392-396.  [PubMed]  [DOI]
105.  Park do H, Jeong SU, Lee BU, Lee SS, Seo DW, Lee SK, Kim MH. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc. 2013;78:91-101.  [PubMed]  [DOI]
106.  Kawakubo K, Isayama H, Sasahira N, Nakai Y, Kogure H, Hamada T, Miyabayashi K, Mizuno S, Sasaki T, Ito Y. Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes. Surg Endosc. 2013;27:3437-3443.  [PubMed]  [DOI]
107.  Dhir V, Bhandari S, Bapat M, Joshi N, Vivekanandarajah S, Maydeo A. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J. 2013;1:103-108.  [PubMed]  [DOI]
108.  Khashab MA, Valeshabad AK, Modayil R, Widmer J, Saxena P, Idrees M, Iqbal S, Kalloo AN, Stavropoulos SN. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc. 2013;78:734-741.  [PubMed]  [DOI]
109.  Gornals JB, Moreno R, Castellote J, Loras C, Barranco R, Catala I, Xiol X, Fabregat J, Corbella X. Single-session endosonography and endoscopic retrograde cholangiopancreatography for biliopancreatic diseases is feasible, effective and cost beneficial. Dig Liver Dis. 2013;45:578-583.  [PubMed]  [DOI]
110.  Gupta K, Perez-Miranda M, Kahaleh M, Artifon EL, Itoi T, Freeman ML, de-Serna C, Sauer B, Giovannini M. Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol. 2014;48:80-87.  [PubMed]  [DOI]
111.  Dhir V, Artifon EL, Gupta K, Vila JJ, Maselli R, Frazao M, Maydeo A. Multicenter study on endoscopic ultrasound-guided expandable biliary metal stent placement: choice of access route, direction of stent insertion, and drainage route. Dig Endosc. 2014;26:430-435.  [PubMed]  [DOI]
112.  Kawakubo K, Isayama H, Kato H, Itoi T, Kawakami H, Hanada K, Ishiwatari H, Yasuda I, Kawamoto H, Itokawa F. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci. 2014;21:328-334.  [PubMed]  [DOI]
113.  Kahaleh M, Artifon EL, Perez-Miranda M, Gupta K, Itoi T, Binmoeller KF, Giovannini M. Endoscopic ultrasonography guided biliary drainage: summary of consortium meeting, May 7th, 2011, Chicago. World J Gastroenterol. 2013;19:1372-1379.  [PubMed]  [DOI]
114.  Will U, Fueldner F, Thieme AK, Goldmann B, Gerlach R, Wanzar I, Meyer F. Transgastric pancreatography and EUS-guided drainage of the pancreatic duct. J Hepatobiliary Pancreat Surg. 2007;14:377-382.  [PubMed]  [DOI]
115.  Tessier G, Bories E, Arvanitakis M, Hittelet A, Pesenti C, Le Moine O, Giovannini M, Devière J. EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc. 2007;65:233-241.  [PubMed]  [DOI]
116.  Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc. 2007;65:224-230.  [PubMed]  [DOI]
117.  Barkay O, Sherman S, McHenry L, Yoo BM, Fogel EL, Watkins JL, DeWitt J, Al-Haddad MA, Lehman GA. Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. Gastrointest Endosc. 2010;71:1166-1173.  [PubMed]  [DOI]
118.  Ergun M, Aouattah T, Gillain C, Gigot JF, Hubert C, Deprez PH. Endoscopic ultrasound-guided transluminal drainage of pancreatic duct obstruction: long-term outcome. Endoscopy. 2011;43:518-525.  [PubMed]  [DOI]
119.  Kurihara T, Itoi T, Sofuni A, Itokawa F, Moriyasu F. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc. 2013;25 Suppl 2:109-116.  [PubMed]  [DOI]
120.  Fujii LL, Topazian MD, Abu Dayyeh BK, Baron TH, Chari ST, Farnell MB, Gleeson FC, Gostout CJ, Kendrick ML, Pearson RK. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc. 2013;78:854-864.e1.  [PubMed]  [DOI]
121.  Baron TH, Topazian MD. Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc. 2007;65:735-737.  [PubMed]  [DOI]
122.  Kwan V, Eisendrath P, Antaki F, Le Moine O, Devière J. EUS-guided cholecystenterostomy: a new technique (with videos). Gastrointest Endosc. 2007;66:582-586.  [PubMed]  [DOI]
123.  Lee SS, Park do H, Hwang CY, Ahn CS, Lee TY, Seo DW, Lee SK, Kim MW. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc. 2007;66:1008-1012.  [PubMed]  [DOI]
124.  Takasawa O, Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Obana T. Endosonography-guided gallbladder drainage for acute cholecystitis following covered metal stent deployment. Dig Endosc. 2009;21:43-47.  [PubMed]  [DOI]
125.  Kamata K, Kitano M, Komaki T, Sakamoto H, Kudo M. Transgastric endoscopic ultrasound (EUS)-guided gallbladder drainage for acute cholecystitis. Endoscopy. 2009;41 Suppl 2:E315-E316.  [PubMed]  [DOI]
126.  Kamata K, Kitano M, Kudo M, Imai H, Sakamoto H, Komaki T. Endoscopic ultrasound (EUS)-guided transluminal endoscopic removal of gallstones. Endoscopy. 2010;42 Suppl 2:E331-E332.  [PubMed]  [DOI]
127.  Song TJ, Park do H, Eum JB, Moon SH, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video). Gastrointest Endosc. 2010;71:634-640.  [PubMed]  [DOI]
128.  Súbtil JC, Betes M, Muñoz-Navas M. Gallbladder drainage guided by endoscopic ultrasound. World J Gastrointest Endosc. 2010;2:203-209.  [PubMed]  [DOI]
129.  Itoi T, Itokawa F, Kurihara T. Endoscopic ultrasonography-guided gallbladder drainage: actual technical presentations and review of the literature (with videos). J Hepatobiliary Pancreat Sci. 2011;18:282-286.  [PubMed]  [DOI]
130.  Jang JW, Lee SS, Park do H, Seo DW, Lee SK, Kim MH. Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy. Gastrointest Endosc. 2011;74:176-181.  [PubMed]  [DOI]
131.  Jang JW, Lee SS, Song TJ, Hyun YS, Park do H, Seo DW, Lee SK, Kim MH, Yun SC. Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology. 2012;142:805-811.  [PubMed]  [DOI]
132.  Itoi T, Binmoeller K, Itokawa F, Umeda J, Tanaka R. Endoscopic ultrasonography-guided cholecystogastrostomy using a lumen-apposing metal stent as an alternative to extrahepatic bile duct drainage in pancreatic cancer with duodenal invasion. Dig Endosc. 2013;25 Suppl 2:137-141.  [PubMed]  [DOI]
133.  de la Serna-Higuera C, Pérez-Miranda M, Gil-Simón P, Ruiz-Zorrilla R, Diez-Redondo P, Alcaide N, Sancho-del Val L, Nuñez-Rodriguez H. EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointest Endosc. 2013;77:303-308.  [PubMed]  [DOI]
134.  Widmer J, Alvarez P, Gaidhane M, Paddu N, Umrania H, Sharaiha R, Kahaleh M. Endoscopic ultrasonography-guided cholecystogastrostomy in patients with unresectable pancreatic cancer using anti-migratory metal stents: A new approach. Dig Endosc. 2013;Epub ahead of print.  [PubMed]  [DOI]
135.  Attwell AR, McIntyre RC, Antillon MR, Chen YK. EUS-guided drainage of a diverticular abscess as an adjunct to surgical therapy. Gastrointest Endosc. 2003;58:612-616.  [PubMed]  [DOI]
136.  Giovannini M, Bories E, Moutardier V, Pesenti C, Guillemin A, Lelong B, Delpéro JR. Drainage of deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy. 2003;35:511-514.  [PubMed]  [DOI]
137.  Seewald S, Brand B, Omar S, Yasuda I, Seitz U, Mendoza G, Holzmann T, Groth S, Thonke F, Soehendra N. EUS-guided drainage of subphrenic abscess. Gastrointest Endosc. 2004;59:578-580.  [PubMed]  [DOI]
138.  Seewald S, Imazu H, Omar S, Groth S, Seitz U, Brand B, Zhong Y, Sikka S, Thonke F, Soehendra N. EUS-guided drainage of hepatic abscess. Gastrointest Endosc. 2005;61:495-498.  [PubMed]  [DOI]
139.  Kahaleh M, Wang P, Shami VM, Tokar J, Yeaton P. Drainage of gallbladder fossa fluid collections with endoprosthesis placement under endoscopic ultrasound guidance: a preliminary report of two cases. Endoscopy. 2005;37:393-396.  [PubMed]  [DOI]
140.  Lee DH, Cash BD, Womeldorph CM, Horwhat JD. Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage. Gastrointest Endosc. 2006;64:631-634.  [PubMed]  [DOI]
141.  Jah A, Jamieson N, Huguet E, Griffiths W, Carroll N, Praseedom R. Endoscopic ultrasound-guided drainage of an abdominal fluid collection following Whipple’s resection. World J Gastroenterol. 2008;14:6867-6868.  [PubMed]  [DOI]
142.  Shami VM, Talreja JP, Mahajan A, Phillips MS, Yeaton P, Kahaleh M. EUS-guided drainage of bilomas: a new alternative? Gastrointest Endosc. 2008;67:136-140.  [PubMed]  [DOI]
143.  Ang TL, Seewald S, Teo EK, Fock KM, Soehendra N. EUS-guided drainage of ruptured liver abscess. Endoscopy. 2009;41 Suppl 2:E21-E22.  [PubMed]  [DOI]
144.  Piraka C, Shah RJ, Fukami N, Chathadi KV, Chen YK. EUS-guided transesophageal, transgastric, and transcolonic drainage of intra-abdominal fluid collections and abscesses. Gastrointest Endosc. 2009;70:786-792.  [PubMed]  [DOI]
145.  Noh SH, Park do H, Kim YR, Chun Y, Lee HC, Lee SO, Lee SS, Seo DW, Lee SK, Kim MH. EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos). Gastrointest Endosc. 2010;71:1314-1319.  [PubMed]  [DOI]
146.  Puri R, Eloubeidi MA, Sud R, Kumar M, Jain P. Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance. J Gastroenterol Hepatol. 2010;25:1416-1419.  [PubMed]  [DOI]
147.  Itoi T, Ang TL, Seewald S, Tsuji S, Kurihara T, Tanaka R, Itokawa F. Endoscopic ultrasonography-guided drainage for tuberculous liver abscess drainage. Dig Endosc. 2011;23 Suppl 1:158-161.  [PubMed]  [DOI]
148.  Decker C, Varadarajulu S. EUS-guided drainage of an intra-abdominal abscess after liver transplantation. Gastrointest Endosc. 2011;73:1056-1058.  [PubMed]  [DOI]
149.  Gupta T, Lemmers A, Tan D, Ibrahim M, Le Moine O, Devière J. EUS-guided transmural drainage of postoperative collections. Gastrointest Endosc. 2012;76:1259-1265.  [PubMed]  [DOI]
150.  Ulla-Rocha JL, Vilar-Cao Z, Sardina-Ferreiro R. EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery. Therap Adv Gastroenterol. 2012;5:95-102.  [PubMed]  [DOI]
151.  Varadarajulu S. Endoscopic ultrasound-guided drainage of a pelvic abscess via a J-pouch. Endoscopy. 2012;44 Suppl 2 UCTN:E92-E93.  [PubMed]  [DOI]
152.  Knuth J, Krakamp B, Heiss MM, Bulian DR. Transrectal ultrasound-guided endoscopic drainage and vacuum therapy of pelvic abscesses: an alternative to (computed tomography-guided) percutaneous drainage. Endoscopy. 2013;45 Suppl 2 UCTN:E3-E4.  [PubMed]  [DOI]
153.  Ramesh J, Bang JY, Trevino J, Varadarajulu S. Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol. 2013;28:620-625.  [PubMed]  [DOI]
154.  Luigiano C, Togliani T, Cennamo V, Maimone A, Polifemo AM, Pilati S, Fabbri C. Transrectal endoscopic ultrasound-guided drainage of pelvic abscess with placement of a fully covered self-expandable metal stent. Endoscopy. 2013;45 Suppl 2 UCTN:E245-E246.  [PubMed]  [DOI]
155.  Penman ID, Rösch T. EUS 2008 Working Group document: evaluation of EUS-guided celiac plexus neurolysis/block (with video). Gastrointest Endosc. 2009;69:S28-S31.  [PubMed]  [DOI]
156.  Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci. 2009;54:2330-2337.  [PubMed]  [DOI]
157.  Kaufman M, Singh G, Das S, Concha-Parra R, Erber J, Micames C, Gress F. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol. 2010;44:127-134.  [PubMed]  [DOI]
158.  Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29:3541-3546.  [PubMed]  [DOI]
159.  Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;CD007519.  [PubMed]  [DOI]
160.  LeBlanc JK, Al-Haddad M, McHenry L, Sherman S, Juan M, McGreevy K, Johnson C, Howard TJ, Lillemoe KD, DeWitt J. A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two? Gastrointest Endosc. 2011;74:1300-1307.  [PubMed]  [DOI]
161.  Téllez-Ávila FI, Romano-Munive AF, Herrera-Esquivel Jde J, Ramírez-Luna MA. Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. Endosc Ultrasound. 2013;2:153-156.  [PubMed]  [DOI]
162.  Doi S, Yasuda I, Kawakami H, Hayashi T, Hisai H, Irisawa A, Mukai T, Katanuma A, Kubota K, Ohnishi T. Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy. 2013;45:362-369.  [PubMed]  [DOI]
163.  Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999;94:900-905.  [PubMed]  [DOI]
164.  Santosh D, Lakhtakia S, Gupta R, Reddy DN, Rao GV, Tandan M, Ramchandani M, Guda NM. Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis. Aliment Pharmacol Ther. 2009;29:979-984.  [PubMed]  [DOI]
165.  LeBlanc JK, DeWitt J, Johnson C, Okumu W, McGreevy K, Symms M, McHenry L, Sherman S, Imperiale T. A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain. Gastrointest Endosc. 2009;69:835-842.  [PubMed]  [DOI]
166.  Stevens T, Costanzo A, Lopez R, Kapural L, Parsi MA, Vargo JJ. Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2012;10:186-91, 191.e1.  [PubMed]  [DOI]
167.  Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44:656-662.  [PubMed]  [DOI]
168.  Gunaratnam NT, Sarma AV, Norton ID, Wiersema MJ. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc. 2001;54:316-324.  [PubMed]  [DOI]
169.  Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol. 2001;96:409-416.  [PubMed]  [DOI]
170.  Tran QN, Urayama S, Meyers FJ. Endoscopic ultrasound-guided celiac plexus neurolysis for pancreatic cancer pain: a single-institution experience and review of the literature. J Support Oncol. 2006;4:460-42, 464; discussion 460-42.  [PubMed]  [DOI]
171.  Ramirez-Luna MA, Chavez-Tapia NC, Franco-Guzman AM, Garcia-Saenz-de Sicilia M, Tellez-Avila FI. Endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. Rev Gastroenterol Mex. 2008;73:63-67.  [PubMed]  [DOI]
172.  Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, de la Mora JG, Gleeson FC, Pearson RK, Pelaez MC. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008;103:98-103.  [PubMed]  [DOI]
173.  O’Toole TM, Schmulewitz N. Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series. Endoscopy. 2009;41:593-597.  [PubMed]  [DOI]
174.  Sahai AV, Lemelin V, Lam E, Paquin SC. Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol. 2009;104:326-329.  [PubMed]  [DOI]
175.  Sakamoto H, Kitano M, Kamata K, Komaki T, Imai H, Chikugo T, Takeyama Y, Kudo M. EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle. Am J Gastroenterol. 2010;105:2599-2606.  [PubMed]  [DOI]
176.  Iwata K, Yasuda I, Enya M, Mukai T, Nakashima M, Doi S, Iwashita T, Tomita E, Moriwaki H. Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis. Dig Endosc. 2011;23:140-145.  [PubMed]  [DOI]
177.  Ascunce G, Ribeiro A, Reis I, Rocha-Lima C, Sleeman D, Merchan J, Levi J. EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video). Gastrointest Endosc. 2011;73:267-274.  [PubMed]  [DOI]
178.  Wiechowska-Kozłowska A, Boer K, Wójcicki M, Milkiewicz P. The efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis for treatment of pain in patients with pancreatic cancer. Gastroenterol Res Pract. 2012;2012:503098.  [PubMed]  [DOI]
179.  Wang KX, Jin ZD, Du YQ, Zhan XB, Zou DW, Liu Y, Wang D, Chen J, Xu C, Li ZS. EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study. Gastrointest Endosc. 2012;76:945-952.  [PubMed]  [DOI]
180.  Leblanc JK, Rawl S, Juan M, Johnson C, Kroenke K, McHenry L, Sherman S, McGreevy K, Al-Haddad M, Dewitt J. Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol. Diagn Ther Endosc. 2013;2013:327036.  [PubMed]  [DOI]
181.  Seicean A, Cainap C, Gulei I, Tantau M, Seicean R. Pain palliation by endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer. J Gastrointestin Liver Dis. 2013;22:59-64.  [PubMed]  [DOI]
182.  Ho KY, Brugge WR. EUS 2008 Working Group document: evaluation of EUS-guided pancreatic-cyst ablation. Gastrointest Endosc. 2009;69:S22-S27.  [PubMed]  [DOI]
183.  DeWitt J, McGreevy K, Schmidt CM, Brugge WR. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: a randomized, double-blind study. Gastrointest Endosc. 2009;70:710-723.  [PubMed]  [DOI]
184.  DeWitt J, DiMaio CJ, Brugge WR. Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation. Gastrointest Endosc. 2010;72:862-866.  [PubMed]  [DOI]
185.  Oh HC, Seo DW, Lee TY, Kim JY, Lee SS, Lee SK, Kim MH. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc. 2008;67:636-642.  [PubMed]  [DOI]
186.  Oh HC, Seo DW, Song TJ, Moon SH, Park do H, Soo Lee S, Lee SK, Kim MH, Kim J. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology. 2011;140:172-179.  [PubMed]  [DOI]
187.  Gan SI, Thompson CC, Lauwers GY, Bounds BC, Brugge WR. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc. 2005;61:746-752.  [PubMed]  [DOI]
188.  Oh HC, Seo DW, Kim SC, Yu E, Kim K, Moon SH, Park do H, Lee SS, Lee SK, Kim MH. Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention? Scand J Gastroenterol. 2009;44:242-247.  [PubMed]  [DOI]
189.  DiMaio CJ, DeWitt JM, Brugge WR. Ablation of pancreatic cystic lesions: the use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas. 2011;40:664-668.  [PubMed]  [DOI]
190.  Oh HC, Seo DW, Kim SC. Portal vein thrombosis after EUS-guided pancreatic cyst ablation. Dig Dis Sci. 2012;57:1965-1967.  [PubMed]  [DOI]
191.  Levy MJ, Thompson GB, Topazian MD, Callstrom MR, Grant CS, Vella A. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc. 2012;75:200-206.  [PubMed]  [DOI]
192.  Jürgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stölzel U. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63:1059-1062.  [PubMed]  [DOI]
193.  Muscatiello N, Nacchiero M, Della Valle N, Di Terlizzi F, Verderosa G, Salcuni A, Macarini L, Cignarelli M, Castriota M, D’Agnessa V. Treatment of a pancreatic endocrine tumor by ethanol injection (PEI) guided by endoscopic ultrasound. Endoscopy. 2008;40 Suppl 2:E83.  [PubMed]  [DOI]
194.  Deprez PH, Claessens A, Borbath I, Gigot JF, Maiter D. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroenterol Belg. 2008;71:333-337.  [PubMed]  [DOI]
195.  Vleggaar FP, Bij de Vaate EA, Valk GD, Leguit RJ, Siersema PD. Endoscopic ultrasound-guided ethanol ablation of a symptomatic sporadic insulinoma. Endoscopy. 2011;43 Suppl 2 UCTN:E328-E329.  [PubMed]  [DOI]
196.  Barclay RL, Perez-Miranda M, Giovannini M. EUS-guided treatment of a solid hepatic metastasis. Gastrointest Endosc. 2002;55:266-270.  [PubMed]  [DOI]
197.  Günter E, Lingenfelser T, Eitelbach F, Müller H, Ell C. EUS-guided ethanol injection for treatment of a GI stromal tumor. Gastrointest Endosc. 2003;57:113-115.  [PubMed]  [DOI]
198.  Hu YH, Tuo XP, Jin ZD, Liu Y, Guo Y, Luo L. Endoscopic ultrasound (EUS)-guided ethanol injection in hepatic metastatic carcinoma: a case report. Endoscopy. 2010;42 Suppl 2:E256-E257.  [PubMed]  [DOI]
199.  Artifon EL, Lucon AM, Sakai P, Gerhardt R, Srougi M, Takagaki T, Ishioka S, Bhutani MS. EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma. Gastrointest Endosc. 2007;66:1201-1205.  [PubMed]  [DOI]
200.  DeWitt J, Mohamadnejad M. EUS-guided alcohol ablation of metastatic pelvic lymph nodes after endoscopic resection of polypoid rectal cancer: the need for long-term surveillance. Gastrointest Endosc. 2011;74:446-447.  [PubMed]  [DOI]
201.  Wallace MB, Sabbagh LC. EUS 2008 Working Group document: evaluation of EUS-guided tumor ablation. Gastrointest Endosc. 2009;69:S59-S63.  [PubMed]  [DOI]
202.  Chang KJ, Nguyen PT, Thompson JA, Kurosaki TT, Casey LR, Leung EC, Granger GA. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88:1325-1335.  [PubMed]  [DOI]
203.  Hecht JR, Bedford R, Abbruzzese JL, Lahoti S, Reid TR, Soetikno RM, Kirn DH, Freeman SM. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res. 2003;9:555-561.  [PubMed]  [DOI]
204.  Irisawa A, Takagi T, Kanazawa M, Ogata T, Sato Y, Takenoshita S, Ohto H, Ohira H. Endoscopic ultrasound-guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas. 2007;35:189-190.  [PubMed]  [DOI]
205.  Hecht JR, Farrell JJ, Senzer N, Nemunaitis J, Rosemurgy A, Chung T, Hanna N, Chang KJ, Javle M, Posner M. EUS or percutaneously guided intratumoral TNFerade biologic with 5-fluorouracil and radiotherapy for first-line treatment of locally advanced pancreatic cancer: a phase I/II study. Gastrointest Endosc. 2012;75:332-338.  [PubMed]  [DOI]
206.  Chang KJ, Reid T, Senzer N, Swisher S, Pinto H, Hanna N, Chak A, Soetikno R. Phase I evaluation of TNFerade biologic plus chemoradiotherapy before esophagectomy for locally advanced resectable esophageal cancer. Gastrointest Endosc. 2012;75:1139-46.e2.  [PubMed]  [DOI]
207.  Hanna N, Ohana P, Konikoff FM, Leichtmann G, Hubert A, Appelbaum L, Kopelman Y, Czerniak A, Hochberg A. Phase 1/2a, dose-escalation, safety, pharmacokinetic and preliminary efficacy study of intratumoral administration of BC-819 in patients with unresectable pancreatic cancer. Cancer Gene Ther. 2012;19:374-381.  [PubMed]  [DOI]
208.  Arcidiacono PG, Carrara S, Reni M, Petrone MC, Cappio S, Balzano G, Boemo C, Cereda S, Nicoletti R, Enderle MD. Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc. 2012;76:1142-1151.  [PubMed]  [DOI]
209.  Sun S, Xu H, Xin J, Liu J, Guo Q, Li S. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy. 2006;38:399-403.  [PubMed]  [DOI]
210.  Jin Z, Du Y, Li Z, Jiang Y, Chen J, Liu Y. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study. Endoscopy. 2008;40:314-320.  [PubMed]  [DOI]
211.  Chang KJ, Lee JG, Holcombe RF, Kuo J, Muthusamy R, Wu ML. Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer. Nat Clin Pract Gastroenterol Hepatol. 2008;5:107-111.  [PubMed]  [DOI]
212.  Maier W, Henne K, Krebs A, Schipper J. Endoscopic ultrasound-guided brachytherapy of head and neck tumours. A new procedure for controlled application. J Laryngol Otol. 1999;113:41-48.  [PubMed]  [DOI]
213.  Lah JJ, Kuo JV, Chang KJ, Nguyen PT. EUS-guided brachytherapy. Gastrointest Endosc. 2005;62:805-808.  [PubMed]  [DOI]
214.  Martínez-Monge R, Subtil JC, López-Picazo JM. Transoesophageal endoscopic-ultrasonography-guided 125I permanent brachytherapy for unresectable mediastinal lymphadenopathy. Lancet Oncol. 2006;7:781-783.  [PubMed]  [DOI]
215.  Pishvaian AC, Collins B, Gagnon G, Ahlawat S, Haddad NG. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc. 2006;64:412-417.  [PubMed]  [DOI]
216.  Park WG, Yan BM, Schellenberg D, Kim J, Chang DT, Koong A, Patalano C, Van Dam J. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc. 2010;71:513-518.  [PubMed]  [DOI]
217.  Sanders MK, Moser AJ, Khalid A, Fasanella KE, Zeh HJ, Burton S, McGrath K. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc. 2010;71:1178-1184.  [PubMed]  [DOI]
218.  Khashab MA, Kim KJ, Tryggestad EJ, Wild AT, Roland T, Singh VK, Lennon AM, Shin EJ, Ziegler MA, Sharaiha RZ. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc. 2012;76:962-971.  [PubMed]  [DOI]
219.  Majumder S, Berzin TM, Mahadevan A, Pawa R, Ellsmere J, Sepe PS, Larosa SA, Pleskow DK, Chuttani R, Sawhney MS. Endoscopic ultrasound-guided pancreatic fiducial placement: how important is ideal fiducial geometry? Pancreas. 2013;42:692-695.  [PubMed]  [DOI]
220.  Yang J, Abdel-Wahab M, Ribeiro A. EUS-guided fiducial placement before targeted radiation therapy for prostate cancer. Gastrointest Endosc. 2009;70:579-583.  [PubMed]  [DOI]
221.  Yang J, Abdel-Wahab M, Ribeiro A. EUS-guided fiducial placement after radical prostatectomy before targeted radiation therapy for prostate cancer recurrence. Gastrointest Endosc. 2011;73:1302-1305.  [PubMed]  [DOI]
222.  Varadarajulu S, Trevino JM, Shen S, Jacob R. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy. 2010;42:423-425.  [PubMed]  [DOI]
223.  DiMaio CJ, Nagula S, Goodman KA, Ho AY, Markowitz AJ, Schattner MA, Gerdes H. EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos). Gastrointest Endosc. 2010;71:1204-1210.  [PubMed]  [DOI]
224.  Ammar T, Coté GA, Creach KM, Kohlmeier C, Parikh PJ, Azar RR. Fiducial placement for stereotactic radiation by using EUS: feasibility when using a marker compatible with a standard 22-gauge needle. Gastrointest Endosc. 2010;71:630-633.  [PubMed]  [DOI]
225.  Varadarajulu S, Bang JY, Hebert-Magee S. Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle. Gastrointest Endosc. 2012;76:336-343.  [PubMed]  [DOI]
226.  Law JK, Singh VK, Khashab MA, Hruban RH, Canto MI, Shin EJ, Saxena P, Weiss MJ, Pawlik TM, Wolfgang CL. Endoscopic ultrasound (EUS)-guided fiducial placement allows localization of small neuroendocrine tumors during parenchymal-sparing pancreatic surgery. Surg Endosc. 2013;27:3921-3926.  [PubMed]  [DOI]
227.  Trevino JM, Varadarajulu S. Initial experience with the prototype forward-viewing echoendoscope for therapeutic interventions other than pancreatic pseudocyst drainage (with videos). Gastrointest Endosc. 2009;69:361-365.  [PubMed]  [DOI]
228.  Levy MJ, Chak A. EUS 2008 Working Group document: evaluation of EUS-guided vascular therapy. Gastrointest Endosc. 2009;69:S37-S42.  [PubMed]  [DOI]
229.  Fockens P, Meenan J, van Dullemen HM, Bolwerk CJ, Tytgat GN. Dieulafoy’s disease: endosonographic detection and endosonography-guided treatment. Gastrointest Endosc. 1996;44:437-442.  [PubMed]  [DOI]
230.  de Paulo GA, Ardengh JC, Nakao FS, Ferrari AP. Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins. Gastrointest Endosc. 2006;63:396-402; quiz 463.  [PubMed]  [DOI]
231.  Lee YT, Chan FK, Ng EK, Leung VK, Law KB, Yung MY, Chung SC, Sung JJ. EUS-guided injection of cyanoacrylate for bleeding gastric varices. Gastrointest Endosc. 2000;52:168-174.  [PubMed]  [DOI]
232.  Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, Subtil-Inigo JC, Junquera-Florez F, Gornals JB, Repiso-Ortega A, Vila-Costas J, Marcos-Sanchez F, Muñoz-Navas M. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013;78:711-721.  [PubMed]  [DOI]
233.  Binmoeller KF, Weilert F, Shah JN, Kim J. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos). Gastrointest Endosc. 2011;74:1019-1025.  [PubMed]  [DOI]
234.  Levy MJ, Wong Kee Song LM, Farnell MB, Misra S, Sarr MG, Gostout CJ. Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding. Am J Gastroenterol. 2008;103:352-359.  [PubMed]  [DOI]
235.  Gonzalez JM, Giacino C, Pioche M, Vanbiervliet G, Brardjanian S, Ah-Soune P, Vitton V, Grimaud JC, Barthet M. Endoscopic ultrasound-guided vascular therapy: is it safe and effective? Endoscopy. 2012;44:539-542.  [PubMed]  [DOI]
236.  Lahoti S, Catalano MF, Alcocer E, Hogan WJ, Geenen JE. Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler. Gastrointest Endosc. 2000;51:331-333.  [PubMed]  [DOI]
237.  Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, Marcos-Sanchez F, Caunedo-Alvarez A, Ortiz-Moyano C, Gomez-Parra M, Herrerias-Gutierrez JM. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc. 2007;66:402-407.  [PubMed]  [DOI]
238.  Levy MJ, Wong Kee Song LM, Kendrick ML, Misra S, Gostout CJ. EUS-guided coil embolization for refractory ectopic variceal bleeding (with videos). Gastrointest Endosc. 2008;67:572-574.  [PubMed]  [DOI]
239.  Romero-Castro R, Pellicer-Bautista F, Giovannini M, Marcos-Sánchez F, Caparros-Escudero C, Jiménez-Sáenz M, Gomez-Parra M, Arenzana-Seisdedos A, Leria-Yebenes V, Herrerias-Gutiérrez JM. Endoscopic ultrasound (EUS)-guided coil embolization therapy in gastric varices. Endoscopy. 2010;42 Suppl 2:E35-E36.  [PubMed]  [DOI]
240.  Weilert F, Shah JN, Marson FP, Binmoeller KF. EUS-guided coil and glue for bleeding rectal varix. Gastrointest Endosc. 2012;76:915-916.  [PubMed]  [DOI]
241.  Gonzalez JM, Ezzedine S, Vitton V, Grimaud JC, Barthet M. Endoscopic ultrasound treatment of vascular complications in acute pancreatitis. Endoscopy. 2009;41:721-724.  [PubMed]  [DOI]
242.  Roberts KJ, Jones RG, Forde C, Marudanayagam R. Endoscopic ultrasound-guided treatment of visceral artery pseudoaneurysm. HPB (Oxford). 2012;14:489-490.  [PubMed]  [DOI]
243.  Roach H, Roberts SA, Salter R, Williams IM, Wood AM. Endoscopic ultrasound-guided thrombin injection for the treatment of pancreatic pseudoaneurysm. Endoscopy. 2005;37:876-878.  [PubMed]  [DOI]
244.  Chaves DM, Costa FF, Matuguma S, Lera Dos Santos ME, de Moura EG, Maluf Filho F, Sakai P. Splenic artery pseudoaneurysm treated with thrombin injection guided by endoscopic ultrasound. Endoscopy. 2012;44 Suppl 2 UCTN:E99-100.  [PubMed]  [DOI]
245.  Robinson M, Richards D, Carr N. Treatment of a splenic artery pseudoaneurysm by endoscopic ultrasound-guided thrombin injection. Cardiovasc Intervent Radiol. 2007;30:515-517.  [PubMed]  [DOI]
246.  Lameris R, du Plessis J, Nieuwoudt M, Scheepers A, van der Merwe SW. A visceral pseudoaneurysm: management by EUS-guided thrombin injection. Gastrointest Endosc. 2011;73:392-395.  [PubMed]  [DOI]
247.  Gress F, Ciaccia D, Kiel S. Endoscopic ultrasound (EUS) guided celiac plexus block (CB) for management of pain due to chronic pancreatitis (CP): a large single centre experience. Gastrointest Endosc. 1997;45:AB173.  [PubMed]  [DOI]
248.  Mahajan RJ, Nowel W, Theerathron P, Lipscomb A, Hart R, Adams L. Empyema after endoscopic ultrasound guided celiac plexus block (EUS-CPB) in chronic pancreatitis (CP): experience at an academic center [Abstract]. Gastrointest Endosc. 2002;55:AB101.  [PubMed]  [DOI]
249.  Muscatiello N, Panella C, Pietrini L, Tonti P, Ierardi E. Complication of endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2006;38:858.  [PubMed]  [DOI]
250.  Ahmed HM, Friedman SE, Henriques HF, Berk BS. End-organ ischemia as an unforeseen complication of endoscopic-ultrasound-guided celiac plexus neurolysis. Endoscopy. 2009;41 Suppl 2:E218-E219.  [PubMed]  [DOI]
251.  Shin SK, Kweon TD, Ha SH, Yoon KB. Ejaculatory failure after unilateral neurolytic celiac plexus block. Korean J Pain. 2010;23:274-277.  [PubMed]  [DOI]
252.  Lalueza A, López-Medrano F, del Palacio A, Alhambra A, Alvarez E, Ramos A, Pérez A, Lizasoain M, Meije Y, García-Reyne A. Cladosporium macrocarpum brain abscess after endoscopic ultrasound-guided celiac plexus block. Endoscopy. 2011;43 Suppl 2 UCTN:E9-10.  [PubMed]  [DOI]
253.  Gimeno-García AZ, Elwassief A, Paquin SC, Sahai AV. Fatal complication after endoscopic ultrasound-guided celiac plexus neurolysis. Endoscopy. 2012;44 Suppl 2 UCTN:E267.  [PubMed]  [DOI]
254.  Fujii L, Clain JE, Morris JM, Levy MJ. Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis. Endoscopy. 2012;44 Suppl 2 UCTN:E265-E266.  [PubMed]  [DOI]
255.  Mittal MK, Rabinstein AA, Wijdicks EF. Pearls & amp; oy-sters: Acute spinal cord infarction following endoscopic ultrasound-guided celiac plexus neurolysis. Neurology. 2012;78:e57-e59.  [PubMed]  [DOI]
256.  Loeve US, Mortensen MB. Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis. Gastrointest Endosc. 2013;77:151-152.  [PubMed]  [DOI]
257.  Jang HY, Cha SW, Lee BH, Jung HE, Choo JW, Cho YJ, Ju HY, Cho YD. Hepatic and splenic infarction and bowel ischemia following endoscopic ultrasound-guided celiac plexus neurolysis. Clin Endosc. 2013;46:306-309.  [PubMed]  [DOI]