New frontiers in therapeutic EUS: dreams, style exercises or actual possibilities

The term therapeutic endoscopic ultrasound (EUS) refers to direct ultrasound guided placement of pharmaceuticals, devices and biological agents for the purpose of treating a disease or symptoms. The vast majority of EUS procedures in the world are performed for diagnostic purposes, although these lead directly to therapeutic decisions such as whether to treat diseases by local (including endoscopic) resection, surgery or chemotherapy. EUS imaging is providing directions for therapies in different conditions, such as 1) gastrointestinal (GI) diseases including luminal GI malignancies, 2) management of pancreatic pain by performing the celiac plexus block, 3) drainage of obstructed biliary and pancreatic ducts when standard ERCP methods have failed, and 4) lesions surrounding the gut wall, including adjacent organs (pancreas liver, etc) and mediastinum (e.g. non-small cell lung cancer staging). Experimental promising EUS applications include delivery of cytotoxic agents such as chemotherapy, gene therapy, and radioactive seeds. This article will review the diagnostic and therapeutic role of EUS in gastrointestinal as well as extra-intestinal diseases.