|Year : 2016 | Volume
| Issue : 3 | Page : 143-148
European federation of societies for ultrasound in medicine and biology guidelines 2015 on interventional endoscopic ultrasound
Christoph F Dietrich1, Pietro Fusaroli2, Christian Jenssen3
1 Department of Medicine, Caritas-Krankenhaus Bad Mergentheim, Uhlandstr, Bad Mergentheim, Germany
2 Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Hospital of Imola, Bologna, Italy
3 Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg, Germany
|Date of Submission||01-Feb-2016|
|Date of Acceptance||05-Mar-2016|
|Date of Web Publication||13-Jun-2016|
Christoph F Dietrich
Department of Medicine, Caritas-Krankenhaus Bad Mergentheim, Med. Klinik 2, Caritaskrankenhaus Bad Mergentheim, Uhlandstr 7, D-97980 Bad Mergentheim
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dietrich CF, Fusaroli P, Jenssen C. European federation of societies for ultrasound in medicine and biology guidelines 2015 on interventional endoscopic ultrasound. Endosc Ultrasound 2016;5:143-8
|How to cite this URL:|
Dietrich CF, Fusaroli P, Jenssen C. European federation of societies for ultrasound in medicine and biology guidelines 2015 on interventional endoscopic ultrasound. Endosc Ultrasound [serial online] 2016 [cited 2020 Feb 25];5:143-8. Available from: http://www.eusjournal.com/text.asp?2016/5/3/143/183968
The recently published guidelines of the European Federation of societies for ultrasound in medicine and biology (EFSUMB) on interventional ultrasound (INVUS)-guided procedures , summarize the intended interdisciplinary and multiprofessional approach. A foreword, an introduction, the aims of EFSUMB guidelines on INVUS  as well as a guide to the EFSUMB website  have been published. Over the last 10 years, EFSUMB has published guidelines and recommendations on the use of different ultrasound techniques. Contrast enhanced ultrasound (CEUS) guidelines were first introduced by EFSUMB in 2004, updated in 2008, 2011, and 2012., In addition, an introduction into dynamic CEUS for quantification of tumor perfusion was published as well. EFSUMB elastography guidelines were introduced in 2013, followed by guidelines of the World Federation of Ultrasound in Medicine and Biology 2 years later.,, Those guidelines on CEUS and elastography included recommendations and comments on the emerging endoscopic ultrasound (EUS)-guided applications of these techniques. We also refer to the currently published textbook on INVUS, which was also a motivation for more evidence-based recommendations., The EFSUMB activities could guide an approach to our societies, the Euro EUS Scientific Committee, Asia Pacific EUS Task Force and Latin American Chapter of EUS and their respective journal, EUS, to prepare and publish not only high-value reviews ,,,, but also guidelines.,,
| Interventional Ultrasound Guidelines|| |
The recently published guidelines consist of six main parts that are published in Ultraschall in der Medizin/European Journal of Ultrasound:,,,,,,,,
- Part I: General aspects
- Part II: Abdominal diagnostic procedures
- Part III: Abdominal treatment procedures using the transcutaneous approach
- Part IV: EUS-guided interventions: General aspects and EUS-guided sampling
- Part V: EUS-guided therapeutic interventions
- Part VI: Ultrasound-guided vascular interventions.
Part I: General aspects
This part deals with general principles that are important and relevant for all kind of INVUS procedures, diagnostic, as well as therapeutic: B-mode imaging and the use of CEUS in INVUS procedures, guiding techniques including fusion imaging, patient information, informed consent and patient preparation, local anesthesia and sedation, hygiene management, puncture routes and accessing techniques, how to reduce and/or eliminate complications, and finally how INVUS is organized locally.,
Part II: Abdominal diagnostic procedures using the transcutaneous approach
This part deals with the workup both in clinical terms and in imaging, prior to the use of an interventional procedure to either diagnose or treat an abnormality. The section is divided into both an organ-specific discussion as well as targeting particular “niche” areas that will concern readers of the guidelines. All imaging modalities play a role in the workup of these patients, and not always will an ultrasound-guided procedure be the most appropriate imaging tool. This is clearly detailed with an evidence-based assessment of the diagnostic route and the final imaging approach to resolve the clinical situation.,
Part III: Abdominal treatment procedures using the transcutaneous approach
Therapeutic abscess drainage and the drainage of pancreatic pseudocysts, interventional tumor ablation techniques, interventional treatments for cysts in general, and specifically parasitic diseases (PAIR for echinococcosis), enrich our daily practice., Hence, do established therapeutic procedures such as percutaneous transhepatic cholangiography and drainage, percutaneous endoscopic gastrostomy, percutaneous ultrasound-guided gastrostomy, biliary and urinary bladder drainage, and nephrostomy. Symptom-oriented palliative care interventions are an important issue that concludes the chapter.
Part IV: Endoscopic ultrasound-guided interventions: General aspects and endoscopic ultrasound-guided sampling
EUS is now widely regarded as one of the supreme disciplines in endoscopy. Initial enthusiasm over the diagnostic results obtained with 360° cross-sectional radial scanning has settled to a more realistic level, particularly since the advent of computed tomography and magnetic resonance imaging technologies. EUS has made “hidden places” accessible for diagnostic and therapeutic interventions. EUS-guided sampling was introduced in the early 1990s  and 20 years later was proclaimed to have afforded a “disruptive innovation effect” for pancreatic pathology. It combines most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract with safe and effective tissue acquisition using fine needles of 25–19 gauge. The fourth part of the guidelines deals with indications and clinical impact of EUS-guided sampling and tries to balance advantages and drawbacks in comparison with image-guided percutaneous biopsy. Needle choice and biopsy technique, as well as specimen processing, are crucial for success,, and therefore evidence-based recommendations are given for almost all steps of EUS-guided sampling as well as for safe performance. The first international guidelines on EUS-guided sampling were published in 2011 and 2012 by the European Society of Gastrointestinal Endoscopy., In the approximately 5 years since the preparation of these ground-breaking guidelines, scientific literature in EUS-guided sampling has expanded dramatically. The recommendations of the EFSUMB guidelines are now based on 21 meta-analyses describing the performance of EUS-guided sampling in solid and cystic pancreatic lesions, biliary strictures, and masses and mediastinal lymph nodes. The majority of those meta-analyses (15 out of 21) and more than 50% of all available studies on EUS-guided sampling (1570 out of 3014 papers) have been published in the years from 2012 to 2015. High-quality evidence (randomized controlled studies, systematic reviews and meta-analyses, guidelines) has been published in the last 4 years, for example, comparing the diagnostic efficiency of fine needles of various diameters, evaluating the impact of on-site cytology and of molecular analyses, and describing the occurrence and outcome of atypical findings in EUS-guided sampling of solid pancreatic lesions.,,,,, Studies demonstrating a very high diagnostic efficacy of 25 gauge aspiration needles for diagnosis of solid pancreatic neoplasms as well as the emergence of new types of “histology needles” have broadened the opportunities of EUS-guided sampling., Recently, the role of on-site cytology has been questioned by several studies showing an incremental yield of combining smear cytology with cell block or tissue core assessment and molecular studies in terms of diagnostic yield and accuracy as well as by two multicenter randomized studies showing equal results of on-site cytopathologist-guided sampling and of performing a standardized number of needle passes in solid pancreatic tumors., Prompted by the advent of personalized, targeted treatments in visceral oncology, a paradigm shift has occurred onto cytopathological and molecular subtyping of EUS-samples from various neoplasms.,, These recent developments are reflected by up-to-date recommendations on needle choice, cell-block and tissue core preparations, the role of on-site cytopathological assessment as well as on using a complimentary approach combining cytopathological, and histopathological assessment of samples. Evidence was added also in the important field of guidance and targeting of EUS-guided sampling by advanced endosonographic tools for tissue characterization (real-time elastography and contrast-enhanced EUS). Acknowledging significant variations in practice and outcome between examiners and EUS centers worldwide,, quality indicators are suggested to be implemented in clinical practice to allow for performance monitoring and benchmarking of EUS-guided sampling techniques. Based on an analysis of data regarding the reporting and reliability of cytopathology in EUS-guided sampling, the guideline recommends to use a standardized and validated classification system for cytopathology reporting. An addendum on important terms used in the literature of EUS-guided sampling provides further details of the 55 evidence-based recommendations in the guidelines on EUS-guided sampling.
The EFSUMB guidelines emphasize that by the combination of fine needle aspiration using curved linear-array instruments, and the use of Doppler, contrast-enhanced EUS,,, and elastography, EUS has finally become a state-of-the-art, minimally invasive alternative to exploratory surgery in many situations not only for diagnostic, but also for therapeutic purposes.
Part V: Endoscopic ultrasound-guided therapeutic interventions
The fifth part of the EFSUMB guidelines deals with the therapeutic interventions that can be provided by the means of EUS guidance. EUS-guided therapeutic techniques are compared with their percutaneous alternatives to help the clinician choose the most appropriate solutions for challenging therapeutic problems.
The two most established techniques are EUS-guided celiac plexus neurolysis and pseudocyst drainage. They were described soon after the introduction of EUS-guided fine needle aspiration , and since then have been investigated in numerous research trials.,,,,, The expert panel found high levels of evidence in the literature to demonstrate the superiority of both techniques versus a percutaneous approach. On the other hand, the effectiveness of EUS-guided celiac plexus block injecting anesthetic and steroid drugs instead of absolute alcohol for the treatment of pain in patients with chronic pancreatitis is still debated.,
EUS-guided drainage of the biliary duct and the gallbladder has become a valid alternative to percutaneous drainage after failed attempts with endoscopic retrograde cholangiopancreatography. However, several technical aspects and its safety profile are still debated. The advent of lumen-apposing metals stents has significantly simplified the EUS-guided approach and probably has opened a new era of EUS-guided interventions on the biliary tree.,,,,, However, EUS-guided drainage of the pancreatic duct to relieve pain in patients with ductal obstruction has been reported in a limited number of patients with uncertain balance between clinical outcome and side effects.,
EUS-guided vascular interventions are rapidly expanding, comprising treatment of bleeding in patients with portal hypertension, treatment of nonvariceal bleeding and pseudo-aneurysms as well as new indications such as portal vein pressure measurement.,,, As far as treatment of extra-esophageal and fundal varies is concerned, significant advantages have been reported using a forward view echoendoscope specifically developed for EUS-guided therapies. It combines the advantages of a frontal endoscopic view with a forward viewing ultrasound beam that allows for a straight approach onto target lesions.,
Finally, EUS-guided tumor therapy has attracted a lot of interest in recent years. In particular, EUS-guided ethanol injection for the treatment of pancreatic cysts and neuroendocrine tumors, EUS-guided radiofrequency ablation for inoperable pancreatic tumors and EUS-guided injection of anti-tumoral agents were reported.,,,,, However, positive results are still lacking both in terms of safety and efficacy. As a result, EUS-guided tumor therapy should still be considered investigational.
Part VI: Ultrasound-guided vascular interventions
Evidence-based recommendations support the use of ultrasound to guide ultrasound procedures and to detect complications of vascular access and US-guided treatment of arterial pseudoaneurysms.
| Other Ultrasound-Guided Interventions|| |
Other US-guided interventions have been reported ,, but are not the topic of this editorial.
| References|| |
Lorentzen T, Nolsøe CP, Ewertsen C, et al.
EFSUMB guidelines on interventional ultrasound (INVUS), part I. General aspects (long Version). Ultraschall Med
Lorentzen T, Nolsøe CP, Ewertsen C, et al.
EFSUMB guidelines on interventional ultrasound (INVUS), part I. General aspects (Short Version). Ultraschall Med
Lutz HT. Foreword. Ultraschall Med
Dietrich CF, Lorentzen T, Sidhu PS, et al
. An introduction to the EFSUMB guidelines on interventional ultrasound (INVUS). Ultraschall Med
Dietrich CF. EFSUMB guidelines 2015 on interventional ultrasound. Med Ultrason
Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason
Albrecht T, Blomley M, Bolondi L, et al.
Guidelines for the use of contrast agents in ultrasound. January 2004. Ultraschall Med
Claudon M, Cosgrove D, Albrecht T, et al.
Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – Update 2008. Ultraschall Med
Piscaglia F, Nolsøe C, Dietrich CF, et al.
The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall Med
Claudon M, Dietrich CF, Choi BI, et al.
Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – Update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med
Claudon M, Dietrich CF, Choi BI, et al.
Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – Update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol
Dietrich CF, Averkiou MA, Correas JM, et al
. An EFSUMB introduction into dynamic contrast-enhanced ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall Med
Bamber J, Cosgrove D, Dietrich CF, et al.
EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med
Cosgrove D, Piscaglia F, Bamber J, et al.
EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med
Shiina T, Nightingale KR, Palmeri ML, et al.
WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: Basic principles and terminology. Ultrasound Med Biol
Barr RG, Nakashima K, Amy D, et al.
WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: Breast. Ultrasound Med Biol
Ferraioli G, Filice C, Castera L, et al.
WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver. Ultrasound Med Biol
Dietrich CF, Nuernberg D. Interventional Ultrasound. Stuttgart: Thieme Publisher; 2014.
Dietrich CF, Nuernberg D. Interventionelle Sonographie. Stuttgart: Thieme; 2011.
Bhutani MS. Role of endoscopic ultrasound for pancreatic cystic lesions: Past, present, and future! Endosc Ultrasound
Adler DG, Diehl DL. Missed lesions in endoscopic ultrasound. Endosc Ultrasound
Baron TH, DeSimio TM. New ex-vivo
porcine model for endoscopic ultrasound-guided training in transmural puncture and drainage of pancreatic cysts and fluid collections (with videos). Endosc Ultrasound
Konge L, Colella S, Vilmann P, et al
. How to learn and to perform endoscopic ultrasound and endobronchial ultrasound for lung cancer staging: A structured guide and review. Endosc Ultrasound
Dietrich CF, Jenssen C, Arcidiacono PG, et al.
Endoscopic ultrasound: Elastographic lymph node evaluation. Endosc Ultrasound
Ingravallo F, Dietrich CF, Gilja OH, et al
. Guidelines, clinical practice recommendations, position papers and consensus statements: Definition, preparation, role and application. Ultraschall Med
Bolondi L. The appropriate allocation of CEUS in the diagnostic algorithm of liver lesions: A debated issue. Ultraschall Med
Dietrich CF, Lorentzen T, Appelbaum L, et al.
EFSUMB guidelines on interventional ultrasound (INVUS), part III – Abdominal treatment procedures (Long Version). Ultraschall Med
Fusaroli P, Jenssen C, Hocke M, et al.
EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V. Ultraschall Med
2015 [Epub ahead of print].
Jenssen C, Brkljacic B, Hocke M, et al.
EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI. Ultraschall Med
2015 [Epub ahead of print].
Jenssen C, Hocke M, Fusaroli P, et al
. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided interventions: General Aspects and EUS-guided Sampling (Short version). Ultraschall Med
2016;37:157-169; Long version (online): Ultraschall Med
Sidhu PS, Brabrand K, Cantisani V, et al.
EFSUMB guidelines on interventional ultrasound (INVUS), part II. Ultraschall Med
Sidhu PS, Brabrand K, Cantisani V, et al.
EFSUMB guidelines on interventional ultrasound (INVUS), part II. Ultraschall Med
Dietrich CF, Cui XW, Chiorean L, et al
. Local ablative procedures of the liver. Z Gastroenterol
Gottschalk U, Ignee A, Dietrich CF. Ultrasound-guided interventions and description of the equipment. Z Gastroenterol
Gottschalk U, Ignee A, Dietrich CF. Ultrasound guided interventions, part 1, diagnostic procedures. Z Gastroenterol
Nürnberg D, Jenssen C, Cui X, et al
. Ultrasound in palliative care medicine. Z Gastroenterol
Vilmann P, Jacobsen GK, Henriksen FW, et al
. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc
Eltoum IA, Alston EA, Roberson J. Trends in pancreatic pathology practice before and after implementation of endoscopic ultrasound-guided fine-needle aspiration: An example of disruptive innovation effect? Arch Pathol Lab Med
Hocke M, Ignee A, Topalidis T, et al
. Back to the roots – Should gastroenterologists perform their own cytology? Z Gastroenterol
Dietrich CF, Jenssen C. Endoscopic ultrasound-guided sampling in gastroenterology: European society of gastrointestinal endoscopy technical guidelines. Endosc Ultrasound
Dumonceau JM, Polkowski M, Larghi A, et al.
Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy
Polkowski M, Larghi A, Weynand B, et al.
Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) technical guideline. Endoscopy
Madhoun MF, Wani SB, Rastogi A, et al.
The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: A meta-analysis. Endoscopy
Affolter KE, Schmidt RL, Matynia AP, et al
. Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: A systematic review and meta-analysis. Dig Dis Sci
Bang J, Northeved A. A new ultrasonic method for transabdominal amniocentesis. Am J Obstet Gynecol
Hébert-Magee S, Bae S, Varadarajulu S, et al.
The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: A meta-analysis. Cytopathology
Abdelgawwad MS, Alston E, Eltoum IA. The frequency and cancer risk associated with the atypical cytologic diagnostic category in endoscopic ultrasound-guided fine-needle aspiration specimens of solid pancreatic lesions: A meta-analysis and argument for a Bethesda system for reporting cytopathology of the pancreas. Cancer Cytopathol
Fuccio L, Hassan C, Laterza L, et al.
The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: A meta-analysis of prospective studies. Gastrointest Endosc
Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy
Lee LS, Nieto J, Watson RR, et al
. Randomized noninferiority trial comparing diagnostic yield of cytopathologist-guided versus 7 passes for EUS-FNA of pancreatic masses. Dig Endosc
2015 [Epub ahead of print].
Wani S, Mullady D, Early DS, et al.
The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: A prospective multicenter randomized controlled trial. Am J Gastroenterol
Navani N, Brown JM, Nankivell M, et al.
Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for subtyping and genotyping of non-small cell lung cancer: A multicenter study of 774 patients. Am J Respir Crit Care Med
Esterbrook G, Anathhanam S, Plant PK. Adequacy of endobronchial ultrasound transbronchial needle aspiration samples in the subtyping of non-small cell lung cancer. Lung Cancer
Tournoy KG, Carprieaux M, Deschepper E, et al
. Are EUS-FNA and EBUS-TBNA specimens reliable for subtyping non-small cell lung cancer? Lung Cancer
Dumonceau JM, Koessler T, van Hooft JE, et al
. Endoscopic ultrasonography-guided fine needle aspiration: Relatively low sensitivity in the endosonographer population. World J Gastroenterol
DiMaio CJ, Buscaglia JM, Gross SA, et al.
Practice patterns in FNA technique: A survey analysis. World J Gastrointest Endosc
Dietrich CF, Ignee A, Frey H. Contrast-enhanced endoscopic ultrasound with low mechanical index: A new technique. Z Gastroenterol
Dietrich CF, Jenssen C. Evidence based endoscopic ultrasound. Z Gastroenterol
Dietrich CF, Hocke M, Jenssen C. Interventional endosonography. Ultraschall Med
Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc
Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc
Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol
Levy MJ, Topazian MD, Wiersema MJ, et al.
Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am J Gastroenterol
Wyse JM, Carone M, Paquin SC, et al
. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol
LeBlanc JK, Al-Haddad M, McHenry L, et al.
Aprospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: One injection or two? Gastrointest Endosc
Akshintala VS, Saxena P, Zaheer A, et al.
Acomparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc
Varadarajulu S, Bang JY, Phadnis MA, et al
. Endoscopic transmural drainage of peripancreatic fluid collections: Outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg
Puli SR, Reddy JB, Bechtold ML, et al
. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: A meta-analysis and systematic review. Dig Dis Sci
Stevens T, Costanzo A, Lopez R, et al
. Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis. Clin Gastroenterol Hepatol
Wiersema MJ, Sandusky D, Carr R, et al
. Endosonography-guided cholangiopancreatography. Gastrointest Endosc
1996;43(2 Pt 1):102-6.
Giovannini M, Moutardier V, Pesenti C, et al
. Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage. Endoscopy
Will U, Fueldner F, Kern C, et al
. EUS-guided bile duct drainage (EUBD) in 95 patients. Ultraschall Med
Kahaleh M, Artifon EL, Perez-Miranda M, et al.
Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7th
, 2011, Chicago. World J Gastroenterol
Dhir V, Itoi T, Khashab MA, et al.
Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc
Moon JH, Choi HJ, Kim DC, et al.
Anewly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: A feasibility study (with videos). Gastrointest Endosc
Harada N, Kouzu T, Arima M, et al
. Endoscopic ultrasound-guided pancreatography: A case report. Endoscopy
Fujii LL, Topazian MD, Abu Dayyeh BK, et al.
EUS-guided pancreatic duct intervention: Outcomes of a single tertiary-care referral center experience. Gastrointest Endosc
Levy MJ, Wong Kee Song LM, Farnell MB, et al
. Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding. Am J Gastroenterol
Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, et al.
EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: A multicenter study (with videos). Gastrointest Endosc
Lameris R, du Plessis J, Nieuwoudt M, et al
. A visceral pseudoaneurysm: Management by EUS-guided thrombin injection. Gastrointest Endosc
Giday SA, Clarke JO, Buscaglia JM, et al.
EUS-guided portal vein catheterization: A promising novel approach for portal angiography and portal vein pressure measurements. Gastrointest Endosc
Binmoeller KF, Weilert F, Shah JN, et al
. EUS-guided transesophageal treatment of gastric fundal varices with combined coiling and cyanoacrylate glue injection (with videos). Gastrointest Endosc
Fusaroli P, Ceroni L, Caletti G. Forward-view endoscopic ultrasound: A systematic review of diagnostic and therapeutic applications. Endosc Ultrasound
DeWitt J, McGreevy K, Schmidt CM, et al
. EUS-guided ethanol versus saline solution lavage for pancreatic cysts: A randomized, double-blind study. Gastrointest Endosc
Oh HC, Seo DW, Song TJ, et al.
Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology
Jürgensen C, Schuppan D, Neser F, et al
. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc
Chang KJ, Reid T, Senzer N, et al.
Phase I evaluation of TNFerade biologic plus chemoradiotherapy before esophagectomy for locally advanced resectable esophageal cancer. Gastrointest Endosc
Arcidiacono PG, Carrara S, Reni M, et al.
Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer. Gastrointest Endosc
Sun S, Ge N, Wang S, et al
. Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer. Endosc Ultrasound
Dietrich CF, Annema JT, Clementsen P, et al
. Ultrasound techniques in the evaluation of the mediastinum, part I: Endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS) and transcutaneous mediastinal ultrasound (TMUS), introduction into ultrasound techniques. J Thorac Dis
Jenssen C, Annema JT, Clementsen P, et al
. Ultrasound techniques in the evaluation of the mediastinum, part 2: Mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis
Dietrich CF, Mathis G, Cui XW, et al
. Ultrasound of the pleurae and lungs. Ultrasound Med Biol