Endoscopic Ultrasound-guided Interventions Research Articles

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V - EUS-Guided Therapeutic Interventions (short version).

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation (short version; the long version is published online).

Endoscopic ultrasound-guided interventions in special situations

Endoscopic ultrasound (EUS) was introduced in 1982 and has since become a popular advanced procedure for diagnosis and therapeutic intervention. Initially, EUS was most commonly used for the diagnosis of pancreatobiliary diseases and tissue acquisition. EUS was first used for guided cholangiography in 1996, followed by EUS-guided biliary drainage in 2001. Advancements in equipment and endoscopic accessories have led to an expansion of EUS-guided procedures, which now include EUS-guided drainage of intra-abdominal abscesses or collections, intra-vascular treatment of refractory variceal and nonvariceal bleeding, transmural pancreatic drainage, common bile duct stone clearance, enteral feeding tube placement and entero-enteric anastomosis. Patients with surgically altered upper gastrointestinal anatomies have greatly benefited from EUS also. This systematic review describes and discusses EUS procedures performed in uncommon diseases and conditions, as well as applications on more vulnerable patients such as young children and pregnant women. In these cases, routine approaches do not always apply, and thus may require the use of innovative and unconventional techniques. Increased knowledge of such special applications will help increase the success rates of these procedures and provide a foundation for additional advances and utilizations of the technique.

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V.

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation in clinical practice (long version).

Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses.

Pancreatic tumor is one of the most difficult diseases to diagnose and treat because of its anatomical location and characteristics. Recently, there have been several innovative trials on the treatment of pancreatic tumors using endoscopic ultrasound (EUS) because it allows selective access to the difficult to reach target organ along the gastrointestinal tract and can differentiate vessels by color Doppler. Among these trials, several have investigated EUS-guided ethanol lavage with or without paclitaxel for pancreatic cystic tumors. These studies show a 33% to 79% complete resolution rate with a favorable safety profile. Compared to EUS-guided ethanol lavage for pancreatic cystic tumors, EUS-guided radiofrequency ablation is considered a less invasive treatment method for pancreatic cancer. Although there are still several difficulties and concerns about complications, one clinical study reported 72.8% feasibility with favorable safety, and therefore, we anticipate the results of ongoing studies with these new less invasive techniques.

Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review.

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.

Endoscopic Ultrasound-Guided Treatment beyond Drainage: Hemostasis, Anastomosis, and Others.

Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.

Endoscopic ultrasound-guided treatment of visceral artery pseudoaneurysm

A 73-year-old woman with peripheral vascular disease underwent investigation for abdominal pain. Computed tomography (CT) demonstrated a visceral pseudoaneurysm (Fig. 1a, arrow) and coeliac artery stenosis with collateral filling of the hepatic artery via the gastroduodenal artery. There was no history of trauma or pancreatitis. Selective angiography on two occasions was unsuccessful in embolizing the pseudoaneurysm. Following a multidisciplinary review, endoscopic ultrasound (US) was performed and demonstrated the lesion clearly (Fig. 1b). A mixture of histoacryl glue and lipiodol was injected directly into the lesion (Fig. 1c, d). On completion of the procedure, the aneurysm was visualized according to the acoustic shadow cast by the glue (Fig. 1e). A follow-up CT angiogram 6 weeks later demonstrated the almost complete resolution of the lesion. Figure 1 (a) Computed tomography shows a visceral pseudoaneurysm (arrow) and coeliac artery stenosis with collateral filling of the hepatic artery via the gastroduodenal artery. (b) Endoscopic ultrasound (US) demonstrates the lesion clearly. (c, d) A mixture of ... Angiographic embolization successfully treats the majority of visceral pseudoaneurysms.1,2 Occasionally, endoluminal stents3 and percutaneous injection4 have been used after failed embolization. Endoscopic US provides an alternative minimally invasive method of contemporary treatment.5

Pancreatic cancer: an endoscopic perspective

Pancreatic cancer continues to be a diagnostic and therapeutic challenge. The advent of endoscopic ultrasound-guided interventions have brought about a paradigm shift in the endoscopic approach to diagnosis, treatment and palliation of this common malignancy. The last decade has witnessed significant advances in techniques of endoscopic biliary drainage, endoluminal stenting, celiac plexus neurolysis and image-guided radiation therapy, which have transformed the scope of palliation in pancreatic cancer. Moreover, endoscopic ultrasound-aided intratumoral delivery of fiducials, radioisotopes and chemotherapeutic agents have shown promising results and warrant further investigation. This review summarizes the recent advances in endoscopic applications for the management of pancreatic neoplasms.

The evolution of endoscopic ultrasound: improved imaging, higher accuracy for fine needle aspiration and the reality of endoscopic ultrasound-guided interventions

Endoscopic ultrasound (EUS) is one of the fastest growing areas within gastrointestinal endoscopy. Although the growth in the United States has been steady, EUS is exploding in areas of Asia and Eastern Europe. As utilization of EUS is increasing, so is the evolution of the discipline itself. As a result, it is critically important to periodically review the current state of the art. From its inception, EUS has been primarily utilized for staging cancer, assessment of pancreatic disease and evaluation of submucosal lesions. EUS has evolved and is now dominated by the application of EUS-guided fine needle aspiration cytology (EUS-FNA), and the newest emerging application is EUS-guided interventions. The recent literature is a reflection of these trends, with some articles devoted to the standard applications for EUS, but most of the emphasis is on EUS-FNA and EUS-guided interventions. This current review has important clinical implications, as it contains new information on standard applications for endoscopic ultrasound that should be adopted into clinical practice and also provides a glimpse into the future through EUS-guided interventions.

Komplikationen der Endosonografie und endosonografischer Interventionen – Ergebnisse einer Umfrage an deutschen Zentren

Endoscopic ultrasonography is a widely used technique in Germany and not restricted to highly specialised centres. Complementary to the traditional radial scanners, longitudinally scanning echo endoscopes have gained considerable acceptation. Multicentre data on the complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions at German centres do not exist. From 2004 to 2006 all German centres performing endoscopic ultrasonography were surveyed and asked to report on their complications. From 1991 to 2006 100 604 endosonographic procedures had been performed in 67 centres (85,084 diagnostic endosonographies without any intervention, 13,223 endoscopic ultrasound-guided finde-needle aspiration biopsies, 2297 endoscopic ultrasound-guided therapeutic interventions). 38 centres reported on 104 complications, of which 88 were considered to be severe (overall complication rate 0.1 %). Complications of diagnostic endoscopic ultrasound occurred at a rate of 0.034 %, almost all of them were duodenal and oesophageal perforations. There had been complications in 0.29 % of all endoscopic ultrasound-guided fine-needle aspiration biopsies and subsequent to 1.61 % of all endoscopic ultrasound-guided therapeutic interventions. The overall mortality of non-interventional and interventional endosonographic procedures was 0.01 %. Under the specific circumstances in Germany, endoscopic ultrasound, both conventional and interventional, was confirmed to be a safe diagnostic and therapeutic technique. In future, the prospective assessment of complications should become an essential part of quality management of endoscopic ultrasound.