Endoscopic ultrasonography: Transition towards the future of gastro-intestinal diseases

Abstract

Endoscopic ultrasonography (EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the bilio-pancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations.

Keywords: Biliary drainage; Confocal laser endomicroscopy; Endoscopic ultrasonography; Endoscopic ultrasonography fine-needle aspiration; Pancreatic cancer treatment.

Figure 1

Needle-based confocal laser endomicroscopy of an intraductal papillary mucinous neoplasm: papillary projections (A) and, imaged in cross section, dark rings with a central core (B).

Figure 2

Needle-based confocal laser endomicroscopy of a serous cystadenoma showing the typical vascular network.

Figure 3

Needle-based confocal laser endomicroscopy of pancreatic adenocarcinoma: dark cells aggregates with pseudo-glandular aspects, irregular vessels with leakage of fluorescein (A) and histological correlations (B).

Figure 4

Needle-based confocal laser endomicroscopy of normal pancreatic tissue: coffee bean aspect.

Figure 5

Needle-based confocal laser endomicroscopy of a malignant lymph node: glandular structures with dark cells and neo-vascularization with leakage of fluorescein.