[Therapeutic endoscopic ultrasound: current indications and future perspectives.]

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.