[Therapeutic endoscopic ultrasound: current indications and future perspectives.] / Ecoendoscopia terapeutica: indicazioni attuali e sviluppi futuri.

Endoscopic ultrasound (EUS) is rapidly evolving from a diagnostic into a mainly therapeutic procedure, similarly to what previously occurred to endoscopic retrograde cholangio-pancreatography (ERCP). The capability to easily access adjacent organs and structures with a minimally invasive approach as well as the availability of dedicated devices are driving this process. Several therapeutic procedures can be performed under EUS-guidance, such as drainage of pancreatic fluid collections, of the biliary system after ERCP failure, of the gallbladder for acute cholecystitis in high-risk surgical patients, as well as endoscopic gastroenteral-anastomosis creation. The introduction of dedicated lumen-apposing metal stents in the latest years has made these procedures technically easier. However, further improvements of stent design will be required in the next future. Moreover, data on long-term efficacy and safety coming from well-designed randomized multicenter controlled trials are still needed to bring EUS-guided procedures to the next level.

Endoscopic ultrasonography and small-bowel endoscopy: Present and future.

Over the last decade, impressive technological advances have occurred in ultrasonography and small-bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device-assisted enteroscopy have quickly become the reference standard for the diagnosis of small-bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up-to-date overview of the latest advances in endoscopic ultrasonography and small-bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.

Endoscopic ultrasound-guided gallbladder drainage: Current status and future prospects.

Early surgical treatment using the laparoscopic approach is generally accepted as the treatment of choice for acute cholecystitis (AC) according to Tokyo Guidelines 2018 (TG2018). If the patient is a poor candidate for surgery because of the presence of advanced malignancy or severe organ failure, this treatment may be too invasive. In such cases, gallbladder drainage is considered an alternative treatment method to surgery. Several drainage methods have been established, such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic transpapillary gallbladder drainage (ETGBD) under endoscopic retrograde cholangiopancreatography (ERCP), including endoscopic naso-gallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS). PTGBD is a well-established procedure that is relatively easily carried out by general clinicians. And ETGBD has been developed as an alternative drainage method. The procedure also calls for guidewire passage across the cystic duct. Therefore, in AC cases who are contraindicated for surgery, PTGBD should be considered before ETGBD, and ETGBD may be considered only in high-volume institutes where expert hands are available, as described in the TG2018. However, there are several limitations to these procedures. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly being done as an alternative method to PTGBD and ETGBD. In this review, the current status and problems of EUS-GBD are reviewed, including technical review and clinical data of previous papers, current indication, long-term outcome, and comparison data with PTGBD or ETGBD, and their future prospects are discussed.

Gastrointestinal Endoscopy Editorial Board top 10 topics: advances in GI endoscopy in 2018.

The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed original endoscopy-related articles published during 2018 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, EMR/submucosal dissection/full-thickness resection, artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen-apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and GI bleeding. This document summarizes these "Top 10" endoscopic advances of 2018.

State of endoscopic ultrasonography in Spain in 2017. / Estado de la ecoendoscopia en España en 2017.

AIM: To understand the current state of endoscopic ultrasonography (EUS) in Spain. METHODS: Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists. RESULTS: Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36). CONCLUSIONS: EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions.

Endoscopic ultrasound (EUS) is now well established as an important tool in clinical practice. From purely diagnostic imaging, it has progressed to include tissue acquisition, which provided the basis for therapeutic procedures. Even as interventional EUS developed, there has been ongoing progress in EUS diagnostic capabilities due to improved imaging systems, better needles for tissue acquisition and development of enhanced imaging functions such as contrast harmonic EUS (CHEUS) and EUS elastography. EUS is well established for differentiation of subepithelial lesions, for T-staging of luminal gastrointestinal and pancreaticobiliary malignancies, for differentiation of benign pancreaticobiliary disorders and for diagnostic tissue acquisition, which can be achieved by EUS-guided fine needle aspiration or by EUS-guided fine needle biopsy using dedicated biopsy needles. This review briefly describes the technique of performing EUS and then discusses its clinical utility in terms of gastrointestinal cancer staging, the evaluation of pancreaticobiliary disorders and tissue acquisition. Enhanced imaging techniques such as CHEUS and EUS elastography are briefly reviewed.

Present status and perspectives of endosonography 2017 in gastroenterology.

Endoscopic ultrasound has become an essential tool in modern gastroenterology and abdominal surgery. Compared with all other endoscopic methods, it has the most potential for innovation and its future looks bright. Thus, we compiled this summary of established and novel applications of endoscopic ultrasound methods to inform the reader about what is already possible and where future developments will lead in improving patient care further. This review is structured in four parts. The first section reports on developments in diagnostic endoscopic ultrasound, the second looks at semi-invasive endoscopic ultrasound, and the third discusses advances in therapeutic endoscopic ultrasound. An overview on the future prospects of endoscopic ultrasound methods concludes this article.

Endoscopic Ultrasound and Related Technologies for the Diagnosis and Treatment of Pancreatic Disease - Research Gaps and Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop.

A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic endoscopic ultrasound (EUS). The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

New Developments in Endoscopic Ultrasound Tissue Acquisition.

Endoscopic ultrasound (EUS)-guided tissue acquisition has greatly evolved since the first EUS-guided fine-needle aspiration was reported nearly 25 years ago. EUS-guided tissue acquisition has become the procedure of choice for sampling of the pancreas, subepithelial lesions, and other structures adjacent to the gastrointestinal tract. This review focuses on recent developments in procedural techniques and needle technologies for EUS-guided tissue acquisition.

Recent Advances in Therapeutic Endosonography for Cancer Treatment.

Therapeutic endosonography (EUS) may play an important role in the management of cancers. EUS-guided fiducial placement has a high success rate and can aid in stereotactic radiotherapy. EUS-guided tumor ablation therapies can help in palliation of locally advanced tumors. EUS-guided antitumor injection seems to be feasible and safe in animals; initial human studies suffer from small sample size and lack of controls. Randomized, controlled trials have not shown benefit over conventional therapy. EUS celiac plexus neurolysis has gained popularity and is performed by interventional endosonographers. Large trials are needed to determine the most appropriate indications and overall usefulness of these therapies.

Future Directions for Endoscopic Ultrasound: Where Are We Heading?

Endoscopic ultrasound (EUS) plays an important role as a diagnostic and therapeutic modality in gastroenterology. New developments have emerged, especially in the last decade, and are being introduced to endoscopists. The ability to readily visualize and access organs in the gastrointestinal tract has allowed endoscopists to perform new interventional procedures. EUS procedures have taken the place of conventional approaches for the treatment of various gastrointestinal diseases, including pancreatic cystic lesions. This article focuses on the advances and future of diagnostic and therapeutic EUS.

Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search.

Radiofrequency ablation (RFA) has been widely used for the treatment of various solid organ malignancies. Over the last decade, endosonographers have gradually shifted the application of RFA from porcine models to humans to treat a spectrum of diseases. RFA is performed in patients with pancreatic carcinoma who are not candidates for surgery. In this paper, we will discuss various indications for RFA, its procedural details and complications. At present, endoscopic ultrasound-guided RFA is gradually incorporated into the management of various diseases and opens a new avenue for disease treatment.

Interventional endoscopic ultrasonography: Where are we headed?

Endoscopic ultrasonography (EUS) is an essential endoscopic tool within the diagnostic and therapeutic armamentarium of gastrointestinal and hepatic diseases. EUS-guided tissue acquisition will develop towards facilitating personalized treatment by obtaining large representative tissue specimens for elaborate immunohistochemical and biomolecular typing of the tumor. Intratumoral or intravascular delivery of drugs potentially offers many advantages over systemic injection. Intratumoral application of radiofrequency ablation and photodynamic therapy show promise but need to be explored further. Appositioning and connecting luminal structures within the gastrointestinal tract using fully covered expandable lumen-apposing stents will expand its indication far beyond the drainage of (infected) fluid collections and EUS-guided gastrojejunostomy is a particularly exciting development that could have significant impact on the management of gastric outlet obstruction.