Interventional endosonography comes of age: an update on endoscopic ultrasonography-guided drainage and anastomosis procedures.
10.4103/singaporemedj.SMJ-2025-169
- Author:
Tiing Leong ANG
1
;
Christopher Jen Lock KHOR
2
Author Information
1. Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore.
2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
- Publication Type:Review
- Keywords:
Endoscopic ultrasound-guided drainage;
endosonography;
gastric outlet obstruction;
gastrointestinal anastomosis;
walled-off necrosis
- MeSH:
Humans;
Endosonography/methods*;
Drainage/methods*;
Cholangiopancreatography, Endoscopic Retrograde/methods*;
Ultrasonography, Interventional/methods*;
Anastomosis, Surgical/methods*
- From:Singapore medical journal
2025;66(8):420-425
- CountrySingapore
- Language:English
-
Abstract:
Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedures, and other therapeutic procedures. Today, EUS-guided drainage of symptomatic walled-off pancreatic fluid collections is the norm, with endoscopic necrosectomy as an adjunct. For high-risk surgical patients unsuitable for cholecystectomy, EUS-guided gallbladder drainage of acute cholecystitis is an option. Additionally, EUS-guided drainage of obstructed biliary and pancreatic ductal system can be performed as salvage procedures after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Bariatric procedures such as Roux-en-Y gastric bypass alter the gastric anatomy, hindering access to the major papilla. This can be overcome by creating a conduit through the excluded stomach using EUS-directed transgastric ERCP. Gastric outlet obstruction and afferent loop syndrome can be treated using EUS-guided gastrojejunostomy. These therapeutic interventions are a major advancement in the field of interventional EUS, achieving significant clinical impact.
