Advances in digestive ultrasound endoscopy technology

In recent years, the development of endoscopic ultrasound (EUS) technology has been very rapid, thanks to the technological advances brought about by the development of EUS equipment. This presentation will share information on EUS drainage, EUS ablation, and EUS anastomosis.

I. EUS Drainage

EUS drainage mainly includes: pancreatic duct drainage, biliary drainage, gallbladder drainage, and pseudocyst drainage. After pancreatic duct obstruction, if surgery is inconvenient, pancreatic duct drainage should be performed. EUS pancreatic duct drainage is mainly divided into retrograde drainage and antegrade drainage. Antegrade drainage is more commonly used and can be further divided into drainage via the papilla or pancreaticojejunostomy and transmural drainage. The success rate of pancreatic duct drainage is approximately 80%, and it is recommended for patients with pancreatic duct obstruction after ERCP failure; biliary drainage can be classified into four categories: EUS-AG, EUS-RV, EUS-HGS, and EUS-CDS, depending on the site of biliary puncture drainage. Biliary drainage can significantly reduce serum bilirubin levels. Recent studies have shown that simultaneous drainage of the duodenum and biliary tract results in shorter hospital stays and does not increase the incidence of complications. Compared with ERCP-BD, EUS-BD has a lower reintervention rate and similar safety and effectiveness. Regarding gallbladder drainage, EUS-GBD is comparable to LC in treating acute cholecystitis. EUS-GBD can serve as an alternative to LC for patients who are not suitable for cholecystectomy. For pseudocyst drainage, the interventional EUS guidelines indicate that drainage should be performed for pseudocysts that persist for 4–6 weeks or more, have mature cyst walls, are ≥6 cm in size, and cause symptoms or complications.

A meta-analysis concluded that endoscopic ultrasound-guided peripancreatic fluid collections metal stents are superior to plastic stents. Factors influencing advanced treatment of peripancreatic fluid collections include: cysts ≥10 cm, spread to the paracolic region, and ≥30% solid necrosis. Patients with these three factors should consider early endoscopic intervention after LAMS drainage.

II. EUS Ablation

Indications for EUS ablation include: (1) pathologically confirmed late-stage pancreatic cancer without distant metastasis and unresectable by surgery; (2) adenoneuroendocrine tumors >1 cm in diameter; (3) pancreatic cystic tumors. Paclitaxel combined with absolute ethanol ablation of PCNs guided by EUS is safe and effective. Indications for EUS-guided absolute ethanol ablation include: (1) patients with benign functional insulinomas; (2) patients unwilling to undergo surgery or laparoscopy; (3) patients who cannot tolerate surgery. In addition, EUS-RFA is safe and effective for treating pNETs. EUS-RFA is a reasonable and feasible approach for smaller pNETs, regardless of whether they are functional or not. EUS-guided cryoablation is a reliable adjuvant treatment for locally advanced PDAC, but further research is still needed.

III. EUS Anastomosis

As a novel procedure, indications for EUS anastomosis include: patients with gastric outlet obstruction who are not suitable for surgery, who are not suitable for endoscopic intestinal metal stent placement, who have failed endoscopic intestinal metal stent placement, or who refuse surgery. EUS anastomosis performed according to standardized clinical assessment and management protocols has achieved high technical and clinical success rates and low adverse event rates. Postoperative patient recovery time, eating time, and hospital stay are shorter and safer, which is superior to L-GE.

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