Gastroenterologie
a hepatologie

Therapeutic endosonography – current position

Martin Kliment ^{Orcid.org  1}

+ Affiliation
¹ Gastroenterologie und Hepatologie, Klinik für Innere Medizin, Vivantes Klinikum Spandau, Berlin, Germany 2 Research Institute AGEL, Digestive Disease Center, Vitkovice Hospital, Ostrava, Czech Republic

Summary

Technological advances in echoendoscopes and their accessories has contributed to the continuing employment of therapeutic endosonography (EUS). EUS-guided therapy can be divided into EUS-guided drainage/anastomosis therapy and EUS-guided injection therapy. EUS-guided transmural drainage of pancreatic fluid collections and EUS-guided coeliac plexus neurolysis are now well established therapeutic techniques. Another technically and clinically effective procedure is EUS-guided drainage of abdominal (non-pancreatic) and pelvic collections adjacent to the gastric, duodenal and rectal wall (periproctal, hepatal, and subphrenic abscesses), although the data regarding these procedures are limited. EUS-guided biliary drainage/anastomosis (EUS-hepaticogastrostomy and EUS-choledocholduodenostomy) in the hands of an experienced interventional endoscopist with the support of an interventional radiologist and a surgeon is an alternative to percutaneous transhepatic biliary drainage. EUS-guided pancreaticogastrostomy is more technically challenging and has higher complication rates. In the case of conventional bile duct or pancreatic duct cannulation failure, the EUS-guided rendezvous technique is an option for achieving successful cannulation. EUS-guided antitumorous therapy including EUS-alcohol ablation of pancreatic cystic neoplasia is currently the object of ongoing clinical studies. Potential uses of therapeutic EUS in the future could be EUS-guided vascular therapy and EUS-guided gastroenteroanastomosis. The aim of this article is to provide up-to-date information on the current position of therapeutic EUS in clinical practice using evidence-based data in the literature.

Keywords

endosopic pseudocystogastrostomy, endosonography, endoscopic ultrasound-guided therapy

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