[Interventional procedures in gastroenterology guided by endoscopic ultrasonography: status and perspectives].

Endoscopic ultrasonography (EUS) was developed as a diagnostic tool, but has rapidly found various therapeutic applications. EUS has been used for drainage of pancreatic pseudocysts, treatment of cystic neoplasms of the pancreas, EUS-guided cholangiopancreatography, localized therapy for pancreatic tumors, and treatment of subepithelial lesions and esophageal and gastric varices. Endosonography allows for safe drainage of fluid collections of various types accessible from the stomach, duodenum, or rectum. The largest experience has been acquired with drainage of pancreatic pseudocysts, whereas there are case reports that describe drainage of hepatic abscess, subphrenic abscesses, pelvic abscesses, bilomas and infected gallbladders. EUS permits precise targeting for delivery of various substances directly into the pancreas, liver, or subepithelial lesions. EUS-guided injection of therapeutic agents has been reported in the treatment of gastrointestinal stromal tumors, insulinomas, hepatic metastases, esophageal cancer, cystic neoplasms of the pancreas, and pancreatic adenocarcinoma. EUS-guided celiac plexus neurolysis has been performed for over a decade now. The utility of EUS in the management of gastrointestinal bleeding has been evaluated in a few small series including esophageal and gastric varices. EUS-guided angiography is a potential alternative to the traditional percutaneous route for access to the vascular system. Despite the fact that the efficacy and safety of therapeutic EUS are evolving, at present therapeutic EUS should be limited to tertiary centers with experienced endoscopists-endosonographers.