Therapeutic endoscopic ultrasound

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopic Imaging

Background:

• Endoscopic ultrasound (EUS) has evolved significantly over 30 years.
• Therapeutic EUS (TEUS) is increasingly recognized for its efficacy and patient tolerance compared to conventional approaches.
• TEUS enables diverse procedures like drainage and anastomoses.

Purpose of the Study:

• To review the advancements and applications of therapeutic endoscopic ultrasound (TEUS).
• To outline the critical steps, indications, and contraindications for TEUS procedures.
• To discuss the training pathway and complexity progression in TEUS.

Main Methods:

• Review of therapeutic endoscopic ultrasound (TEUS) procedures.
• Analysis of critical steps including needle access, guidewire placement, fistula creation, and stent deployment.
• Examination of indications, contraindications, and training requirements for TEUS.

Main Results:

• TEUS demonstrates superior efficacy and tolerability over percutaneous or surgical methods.
• Successful TEUS applications include gallbladder, pancreatic duct, and biliary drainage, alongside gastrointestinal anastomoses.
• Contraindications include hemodynamic instability, uncorrectable coagulopathy, large ascites, or failed access.

Conclusions:

• Therapeutic EUS is a valuable tool in minimally invasive therapy, impacting daily clinical practice.
• Mastery of basic TEUS procedures is essential before advancing to more complex interventions.
• Proficiency in ERCP and diagnostic EUS is a prerequisite for TEUS training.