Abstract
In the last decades, endoscopic ultrasound (EUS) has rapidly evolved from a purely diagnostic procedure into a more interventional/therapeutic one. This transformation has been driven by the availability of echoendoscopes with large working channels, allowing the passage not only of needles for tissue acquisition, but also of bigger accessories needed to perform more advanced procedures. Although most of the tools and some of the techniques are still in development, numerous advancements have been made in different procedures, such as EUS-guided drainage of pancreatic fluid collections, of bile and pancreatic ducts, and of the gallbladder and in the creation of gastrointestinal (GI) anastomoses and treatment of GI bleeding. Moreover, accessories to perform EUS-guided loco-regional therapies mainly for pancreatic tumors, such as radio-frequency ablation, laser therapy, tumor injection and implantation have been developed and tested in human studies. All these EUS-guided interventions represent potentially the least invasive and most efficacious therapeutic alternatives to more demolitive surgeries. However, one should keep in mind that technological advancements do not automatically mean favourable treatment outcomes, and procedural safety and success mostly depend on proper patient selection, operator’s skills and expertise, organization of the endoscopic unit, and availability of emergency interventional radiological and surgical support.
Keywords
- Endoscopic ultrasound
- Interventional EUS
- Therapeutic EUS
- Echoendoscopes
- Ultrasound processors
- EUS accessories
- Tumor ablation
- Lumen-apposing metal stent
- Bi-flanged metal stent
- Hepatico-gastrostomy
- Choledochoduodenostomy
- Pancreatic fluid collection drainage
- Gallbladder drainage
- Intratumoral injection
- Intratumoral implantation
- EUS fiducials
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Rimbaș, M., Larghi, A. (2020). Equipment and Accessories for Therapeutic Endoscopic Ultrasound. In: Kalaitzakis, E., Vilmann, P., Bhutani, M. (eds) Therapeutic Endoscopic Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-030-28964-5_1
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