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Endo-hepatology
Key points Endo-hepatology has emerged as a new subspecialty in GI endoscopy, leveraging the strength of endoscopy and EUS in the diagnosis, prognosis, and treatment of patients with liver disease. EUS-shear-wave elastography (SWE) can quantitatively assess liver stiffness in both…
Endoscopic ultrasonography-guided vascular interventions
Key points EUS-guided glue-coil therapy is a safe and effective method for treatment of or primary prophylaxis for gastric variceal bleeding. Combining coil implantation with glue injection is more effective than monotherapy. Attention should be paid to the varied polymerization…
EUS-guided pancreatic cyst chemoablation, EUS-guided radiofrequency ablation, and EUS-guided fine-needle injection
Key points EUS-guided pancreatic chemoablation has emerged as an innovative, promising, and minimally invasive approach for the treatment of appropriately selected neoplastic type pancreatic cysts. When performed at expert centers, the treatment response appears durable in majority of patients at…
EUS-guided bowel anastomosis
Key points An anastomosis can be established between the stomach and the jejunum under endoscopic ultrasound (EUS)-guidance in patients with gastric outlet obstruction. A lumen-apposing metal stent (LAMS) can be deployed either directly or via assisted-techniques using fluoroscopic and sonographic…
Endoscopic ultrasonography-guided celiac plexus interventions and fiducial placement
Key points Endoscopic ultrasonography (EUS)-guided celiac plexus interventions consist of the injection of neurolytic agents or steroids into ganglia to produce neurolysis or temporary block. Celiac plexus block or neurolysis is the most common EUS-guided intervention in current practice. Significant…
Endoscopic ultrasonography-guided gallbladder drainage
Key points In patients who are unfit for surgery, percutaneous drainage, endoscopic transpapillary drainage and EUS-guided drainage are all effective and safe alternative procedures to cholecystectomy EUS-guided drainage is preferred over percutaneous technique due to similar rates of technical success…
Endoscopic ultrasonography-guided drainage of the biliary-pancreatic ductal systems
Key points Endoscopic ultrasonography-guided biliary drainage (EUS-BD) is now generally preferred over percutaneous methods in patients with biliary obstruction and failed biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP), and should be considered in those with an inaccessible papilla. EUS-BD is…
EUS-guided drainage of pancreatic and intraabdominal fluid collections and pelvic abscesses
Key points Recognition of different types of pancreatic fluid collections is crucial for appropriate management. EUS-guided drainage is the treatment of choice in the management of pancreatic pseudocysts, with clinical outcomes comparable to surgical cystogastrostomy. The management of walled-off necrosis…
Cytology primer for endosonographers
Key points Communication between the endosonographer and the cytopathologist is the key to a successful EUS FNA service. A cytopathology service should be involved early in the planning process for establishing an EUS-guided tissue acquisition service. Using an algorithmic approach…