EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part V – EUS-Guided Therapeutic Interventions (short version)

Abstract

The fifth section of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) assesses the evidence for all the categories of endoscopic ultrasound-guided treatment reported to date. Celiac plexus neurolysis and block, vascular intervention, drainage of fluid collections, drainage of biliary and pancreatic ducts, and experimental tumor ablation techniques are discussed. For each topic, all current evidence has been extensively analyzed and summarized into major recommendations for reader consultation (short version; the long version is published online).

Zusammenfassung

Der fünfte Teil der Leitlinien der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) zur interventionellen Sonografie bewertet die Evidenz zu allen endosonografisch gestützten Therapieverfahren, über die bisher publiziert worden ist: Neurolyse und Blockade des Plexus coeliacus, vaskuläre Interventionen, Drainage von Flüssigkeitsansammlungen und nekrotischen Kollektionen, biliäre und Pankreasgangdrainagen sowie experimentelle Techniken zur Tumorablation. Für alle diese Verfahren wurde die aktuelle Evidenz gründlich analysiert und in Form von Empfehlungen zusammengefasst, die den Lesern zur Anwendung im klinischen Alltag zur Verfügung stehen (Kurzversion; die Langversion ist online publiziert).

Key words

guidelines - endoscopic ultrasound - EUS guidance - pseudocyst drainage - cholangiodrainage - pancreatic duct drainage - celiac plexus neurolysis

Introduction

This is the second of two guidelines (part IV and V) within the framework of the Guidelines on Interventional Ultrasound (INVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describing endoscopic ultrasound (EUS)-guided diagnostic and therapeutic interventions. Part V deals with endoscopic ultrasound (EUS)-guided therapeutic interventions and gives recommendations for the safe and efficient performance of these advanced techniques based on the available evidence at the time of guideline preparation. It complements part IV, which addresses general aspects of interventional EUS and EUS-guided sampling [1]. The methods of guideline development are described in the introduction to the EFSUMB Guidelines on Interventional Ultrasound [2]. Levels of Evidence (LoE) and Grades of Recommendations (GoR) have been assigned according to the Oxford Centre for Evidence-based Medicine criteria (March 2009 edition) [http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009].

EUS-guided celiac plexus neurolysis/block

Background

Celiac plexus neurolysis (CPN) and celiac plexus block (CPB) are reported to offer both temporary and long-lasting pain relief, thus reducing opioid use in intra-abdominal malignancy and chronic pancreatitis [3] [4] [5] [6] [7]. In 1996, the first case series of endoscopic ultrasound (EUS)-guided CPN was reported [8]. The anatomical location of the celiac plexus around the origin of the celiac trunk and the superior mesenteric artery allows the EUS-guided technique to provide near-field, real-time visualization, with a resultant potentially safer, faster and technically easier approach than percutaneous techniques. Moreover, celiac ganglia visualization by EUS allows direct injection [13] in approximately 80 % of cases [9] [10] [11] [12].

Technique

Both linear and forward-view echo-endoscopes may be used for EUS-guided CPN and CPB [8] [14]. Color and power Doppler techniques allow easy identification of vascular structures (in order to avoid inadvertent intravascular injection). EUS-guided CPN and CPB techniques are identical. The only differences are with respect to clinical indications and the materials injected. EUS-guided CPN has been used in patients with pancreatic cancer and chronic pancreatitis by injecting bupivacaine and ethanol, while EUS-guided CPB has been used in patients with chronic pancreatitis by injecting bupivacaine with or without triamcinolone [4] [15] [16] [17] [18] [19] [20].

EUS-guided celiac plexus neurolysis in patients with pancreatic and upper gastrointestinal malignancies

Comparison with standard analgesic treatment

EUS-guided CPN was demonstrated to be safe and effective in alleviating refractory pain due to pancreatic cancer. 8 studies (283 patients) indicated that 80 % of patients experienced pain relief [21]. A 5-study meta-analysis (119 patients) demonstrated efficacy of EUS-guided CPN in 72.5 % [22]. In a randomized controlled trial (RCT), 96 patients with advanced pancreatic cancer were randomly assigned to early EUS-guided CPN or conventional pain management, with greater pain relief observed in the early EUS-guided CPN group at three months compared to the conventional management group [23].

Single central injection vs. bilateral injections

Results from a retrospective single center study (n = 160, 45 % EUS-guided CPN, 55 % EUS-guided CPB) favored bilateral injections to a single central injection as the only predictor of > 50 % 7-day pain reduction [24]. A study of 50 patients with pancreatic cancer randomized to receive single or bilateral injections of alcohol did not observe any difference in onset or duration of pain relief [25].

Direct celiac ganglia neurolysis

Visualization of the ganglia is possible in approximately 80 % of patients [9] [10] [11] [12]. In 34 patients with upper gastrointestinal cancer randomly assigned to either EUS-guided direct celiac ganglia neurolysis (CGN) or standard EUS-guided CPN, a higher complete response rate was observed with EUS-guided CGN (50 % vs. 18 %) [26].

Other technical aspects

The injected volume of alcohol does not have a significant influence. In patients with pancreatic cancer, EUS-guided CPN using either 10 ml or 20 ml of absolute alcohol had similar efficacy and safety [27]. Performing EUS-guided CPN in patients with non-resectable pancreatic cancer early after diagnosis may provide better pain relief than late salvage therapy [23] [28].

EUS-guided celiac plexus block in patients with chronic pancreatitis

Two systematic reviews reported on the efficacy of steroid-based EUS-guided CPB in patients with refractory pain due to chronic pancreatitis (6 studies, 221 patients; 9 studies, 376 patients) showing a satisfactory reduction of abdominal pain in 52 % [22] and 60 % of the patients, respectively [21]. The largest prospective cohort (n = 90) reported the proportion of patients responding to EUS-guided CPB decreased from 55 % immediately after treatment to 10 % at 24 weeks [15]. A large retrospective study (n = 248) showed that repeat EUS-guided CPB in patients with chronic pancreatitis is safe. Pain relief after the first procedure was observed in 76 % of patients and was significantly associated with response to subsequent sessions [29].

To evaluate the effect of the addition of triamcinolone to bupivacaine, 40 patients were randomized to receive either bupivacaine alone or bupivacaine and triamcinolone. There was no significant difference in pain control between the two groups (14 % vs. 16 % for controls), and the trial was stopped [30]. An RCT reported a significant advantage of EUS-guided CPB using bupivacaine and triamcinolone vs. a sham procedure in terms of pain reduction. However, morphine use was similar between the two groups [31].

An RCT comparing the safety and efficacy of EUS-guided vs. computed tomography-guided CPB in chronic pancreatitis showed that the former was significantly more effective than the latter in short-term (50 % vs. 25 % at 4 weeks) and long-term pain control (30 % vs. 12 % at the end of follow-up) [32].

Another RCT comparing EUS-guided vs. percutaneous fluoroscopy-guided CPB with bupivacaine and triamcinolone demonstrated improvement in pain scores (visual analog score) in 70 % of cases in the EUS group vs. 30 % of cases in the percutaneous group [33].

Adverse events

Adverse events related to EUS-guided CPN and CPB occur in up to 30 % of cases, most commonly diarrhea (7 %), increase in abdominal pain (2 %-4 %) and hypotension (4 %). All symptoms are usually mild (grade I-II) and self-limiting [6] [34] [35]. Serious adverse events related to EUS-guided CPN (0.2 %) and CPB (0.6 %) are reported and include bleeding, retroperitoneal abscess (in EUS-guided CPB), abdominal ischemia, permanent paralysis and death (2 cases) [35].

EUS-guided vascular interventions

Background

EUS may be useful to guide endoscopic treatment of esophageal and gastric varices by identifying peri-intestinal collaterals and perforating veins, or documenting inadequate obliteration of varices and collaterals [36] [37] [38] [39]. EUS can identify rare causes of gastrointestinal bleeding, e. g. arterial pseudoaneurysm [40] [41] [42] [43] [44] and Dieulafoy lesions [45].

Treatment of bleeding in patients with portal hypertension

EUS-guided management of upper gastrointestinal varices and bleeding has benefits over endoscopy by identifying perforating and/or collateral veins, thus allowing precise delivery of sclerosing agents, glue, or coils [46]. An RCT compared standard endoscopic sclerotherapy of esophageal varices with EUS-guided sclerotherapy of collateral veins. Recurrent bleeding in the EUS group was less frequent and occurred later [47]. Comparable results have been reported in a case series [48]. Efficacy of EUS-guided coil vs. cyanoacrylate therapy has been compared in consecutive patients with gastric varices. EUS-guided coil application required fewer endoscopies and reported fewer adverse events compared with EUS-guided cyanoacrylate injection [49].

Treatment of non-variceal bleeding

Case series and single cases report successful EUS-guided treatment of non-variceal bleeding from peptic ulcer disease, Dieulafoy lesions, and gastrointestinal tumors after unsuccessful standard endoscopic treatment [46), (45, 50, 51]. In 17 patients with ineffective or unsuitable standard treatment of non-variceal bleeding, EUS-guided hemostatic interventions had a long-term success rate of 88 % [52].

Pseudoaneurysm therapy and other vascular procedures

Single reports demonstrate successful EUS-guided injection treatment, with cyanoacrylate, vascular coils, absolute alcohol, or 500 IU thrombin directly into pseudoaneurysms of the splenic and superior mesenteric artery where conventional therapy has failed [46] [51] [52] [53] [54] [55] [56] [57] [58].

EUS-guided drainage of pancreatic fluid collections

Background

Pancreatic and peri-pancreatic fluid collections (PFC) develop as a consequence of acute pancreatitis and resurgences of chronic pancreatitis, pancreatobiliary endoscopic interventions, endoscopic pancreatic surgery and pancreatic trauma. The revised Atlanta classification categorizes PFC as acute peri-pancreatic fluid collection (APFC), pancreatic pseudocyst (PPC), acute necrotic collection (ANC) and walled-off pancreatic necrosis (WOPN) [59].

Intervention is mainly indicated for infected necrosis, less often for symptomatic sterile necrosis, and should ideally be delayed as long as possible (≥ 4 weeks after the onset), for better necrotic tissue demarcation and liquefaction [60] [61]. Prior to any drainage procedure, differentiation of PPC from cystic neoplasms, detection of solid debris within PFC, and the identification of visceral pseudoaneurysms and portosystemic collaterals are mandatory [62] [63] [64] [65] [66].

Treatment indications

APFC and ANC regress spontaneously in the majority of cases without intervention. The rate of regression is influenced by the size and time from diagnosis [67]. The rate of spontaneous regression is lower in chronic PPC, reported at < 10 % [68]. Drainage is considered if collections become symptomatic or infected [69] [70] [71] [72] [73]. Infected collections may be sampled by EUS-guided fine needle aspiration (EUS-FNA) to obtain microbial analysis, which guides antibiotic treatment [74] [75]. With a sterile collection, luminal or biliary extrinsic compression and persistent severe abdominal pain are indications for drainage [61] [76] [77].

EUS-guided drainage technique

EUS-guided drainage is suitable for pancreatic collections abutting the gastric or duodenal wall where a transgastric or transduodenal approach is feasible. Two types of linear echoendoscopes are available for EUS-guided PFC drainage: i) a traditional side-viewing longitudinal echoendoscope and ii) a forward-viewing echoendoscope specifically made for interventional procedures. No difference in outcome between the echoendoscopes has been documented [78]. EUS-guided drainage is performed either by a multistep or by a one-step procedure, usually guided by fluoroscopy [18] [79] [80] [81] [82] [83] [84] [85]. EUS-guided PFC drainage is also feasible without fluoroscopic guidance [86] [87] [88].

A variety of stents have been used to maintain patency of the fistulous tract between the gut lumen and the PFC: single plastic stents (straight or double pigtail), multiple plastic stents, nasocystic drainage catheters, enteral metal stents and biliary metal stents [18] [81] [82] [85] [89] [90] [91] [92] [93] [94] [95] [96] [97] [98] [99] [100]. Expandable metal stents have a shorter procedure time, documented in an RCT [101] and a meta-analysis [102]. PFC drainage by self-expandable metal stents improved clinical success and decreased the adverse event rate compared with PFC drainage by plastic stents [99]. Novel lumen-apposing self-expandable metal stents and other dedicated stents have been developed that can be deployed in a single step for PFC drainage [98] [101] [103] [104] [105] [106] [107] [108] [109] [110] [111] [112] [113] [114] [115] [116] [117] [118] [119].

Outcome of EUS-guided drainage

Pancreatic fluid collections

EUS-guided treatment provides comparable efficacy to surgical drainage with a shorter hospital stay and lower cost [120] [121] [122]. In 81 patients with symptomatic PPC, the clinical success rate of endoscopic internal drainage was comparable to that of percutaneous drainage, but percutaneous drainage was associated with a significantly higher rate of re-intervention, a longer hospital stay, and an increase in follow-up imaging [123].

Pooled data from 55 studies (n = 1867) demonstrate mean technical and clinical success rates of 97 % (83 – 100 %) and 90 % (69 – 100 %), respectively, for EUS-guided transmural drainage of PPC, with a mean recurrence rate of 8 % (0 – 23 %) [124]. There is limited data on abscess drainage with treatment success rates ranging from 80 % to 98 %, comparable to that of non-infected PPC [125] [126]. EUS-guided drainage of PPC has a higher technical success when compared to conventional transmural endoscopic drainage. However, in PPC with clear bulging there is no difference in clinical outcome [127] [128] [129]. EUS-guided drainage is the preferred modality when there is no visible luminal bulge or when there is a clinical suspicion of portal hypertension and collaterals or in coagulopathy [128] [129] [130] [131] [132].

Walled-off pancreatic necrosis

Over the last 10 years endoscopic drainage has become important in the treatment of WOPN with a comparable efficacy to surgical drainage with lower costs and a shorter hospital stay [133]. Surgical drainage is reserved for endoscopic failures, recurrence following successful endoscopic drainage or those not meeting the criteria for endoscopic or percutaneous drainage. The clinical outcomes in the case of EUS-guided drainage of WOPN are generally inferior to PPC. A retrospective study reported a treatment success rate of 94 % for sterile and infected PPC versus 63 % for WOPN [134] [135]. Mean clinical success rates of 81 % to 88 % and mean recurrence rates of 7 % to 11 % have been reported in systematic reviews concerning an aggressive endoscopic approach using transmural drainage followed by endoscopic necrosectomy [124] [136] [137]. Combining all available non-surgical drainage techniques (trans-papillary, transmural, percutaneous) gives an overall success rate of up to 94 % [126]. A meta-analysis documented a median of 4.09 drainage procedures to be necessary for effective transmural necrosectomy of WOPN [136]. The number of endoscopic sessions is dependent on the size of the collection and the amount of solid debris [65]. In necrotizing pancreatitis and secondary infection, a step-up approach consisting of percutaneous drainage followed by minimally invasive retroperitoneal necrosectomy is a better treatment strategy than open necrosectomy [126] [137] [138] [139] [140] [141] [142] [143] [144] [145] [146] [147] [148]. EUS-guided creation of multiple transluminal gateways for WOPN achieves successful response in 92 % [91]. Analysis of the factors impacting the results of the endoscopic treatment of WOPN found multiple transluminal gateway treatment was more successful than conventional single gateway access (94 % vs. 62 %) [149]. The optimal strategy in WOPN is a “tailored” minimally invasive approach, based on the collection size, location and stepwise response to intervention [147] [150] [151].

Timing of stent removal

There are conflicting recommendations as to the optimal time for stent removal, ranging from a few weeks to indefinitely [125] [149] [152] [153] [154]. Pancreatic ductal leak or disconnection was shown to be significantly associated with PPC resolution failure at 3 weeks [155]. Results of several prospective and retrospective studies suggest long-term transmural stenting in WOPN, in particular in patients with pancreatic ductal leaks or disruption [149] [153] [154].

Adverse events

Adverse events range from 0 – 26 % [102] [135] [156] [157], most frequently bleeding (2 %), perforation (1.6 %), secondary infection (4 %) and stent migration. Few procedure-related mortality cases have been reported mainly due to bleeding [1] [8] [9]. Severe bleeding events occurred following erosion of the splenic and gastroduodenal artery [134] or following rupture of a visceral pseudoaneurysm [126] [158] [159]. Vascular derangements subsequent to acute pancreatitis must be excluded before performing transmural drainage [160]. Secondary infection arises from contamination of an incompletely drained PFC, from premature stent occlusion, stent dislocation, or uneven collapse [152] [161] [162] [163] [164]. In WOPN compared to PPC, procedure complexity and a serious underlying clinical condition increase the morbidity and mortality [35] [135] [136] [165]. A meta-analysis on endoscopic transmural treatment of WOPN (8 studies, n = 288) demonstrated adverse events in 21.3 % and recurrence in 10.9 % of cases. Surgery was needed for non-resolving WOPN in 13 % of cases [136]. Another systematic review included 13 case series and one prospective study with 455 patients and found a procedure-related morbidity of 36 % (bleeding: 18 %) and an overall mortality of 6 % [137].

A consensus report from the USA suggests that management of patients with WOPN should only be performed in high-volume centers with specialized experience in interventional endoscopy and radiology, intensive care, and surgery [143].

EUS-guided drainage of non-pancreatic fluid collections

Background

EUS-guided drainage of non-pancreatic fluid collections may be as safe and effective as percutaneous or operative drainage [166]. A systematic review of EUS-guided fluid drainage procedures of collections bordering the gastrointestinal tract (mediastinum, perihepatic (subphrenic), hepatic, pelvic, perirectal space) reported technical and clinical success rates of 99 % and 92 %, respectively, with an overall adverse event rate of 13 % [124].

Technique

The technique does not differ from the EUS-guided PFC drainage. Mediastinal abscesses can be drained by EUS guidance with either plastic or self-expandable metal stents [167] [168] [169] [170], along with abdominal abscesses (hepatic, perihepatic, subphrenic and splenic) and other fluid collections, e. g. bilomas, hematomas or inflammatory collections [168] [171] [172] [173] [174] [175] [176] [177] [178] [179] [180] [181] [182]. The technique is particularly valuable for the management of postoperative intra-abdominal fluid collections after intended curative surgery or liver transplantation [168] [174] [175] [178] [180]. Pelvic and prostatic collections may also be drained by EUS guidance, as an alternative to surgery or percutaneous techniques, with a reported technical success of 100 %, a clinical success rate of 96 % and low adverse events [180] [183] [184] [185] [186] [187] [188] [189] [190] [191] [192].

Drainage routes can be transesophageal, transgastric or transcolonic (transrectal), depending on the relationship between the collection and the gastrointestinal tract [175]. Metallic stents may be preferred due to the decreased risk of leakage or occlusion [182].

EUS-guided biliary and pancreatic interventions

EUS-guided cholangiography/drainage

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice in obstructive jaundice due to any form of benign or malignant disease [193] [194]. When ERCP is not feasible or fails, alternative techniques are percutaneous transhepatic cholangiography and drainage (PTCD) or surgical biliary bypass [195] [196] [197] [198]. Alternatively, successful EUS-guided bile duct interventions using various access routes and drainage techniques have been described following ERCP failure [199] [200] [201] [202]. Common terminology for all EUS-guided diagnostic and therapeutic interventions independent of the access route into the bile ducts was introduced by a consortium of experts [203]. EUS-guided cholangiography and cholangiodrainage (ESC-D) is indicated if biliary drainage is necessary and conventional ERCP has failed or is not feasible due to surgically altered anatomy of the upper gastrointestinal tract, gastric or duodenal obstruction, non-traversable obstruction of the papilla or bile duct, or the presence of anatomical variants (e. g. duodenal diverticulum) [203] [204] [205].

Several single-center and multicenter studies with different approaches, techniques and devices have reported technical and clinical success rates for ESC-D of 69 – 100 % and 70 – 100 %, respectively [124] [206] [207] [208].

ESC-D vs. PTCD

Patients with unresectable malignant biliary obstruction and failed ERCP (n = 25) were randomized to PTCD or ESC-D. In both groups, the technical and clinical success rates were 100 % with no significant difference in adverse events [209]. In a retrospective analysis of 50 patients, internal stenting was technically and clinically successful in 23/25 (92 %) with ESC-D vs. only 12/26 (46 %) with PTCD. Adverse events were significantly higher in the PTCD group (46 %) compared to the ESC-D group (20 %) [210]. In another retrospective study including 73 patients who underwent ESC-D (n = 22) or PTCD (n = 51) for malignant obstruction, the technical success rate was higher in the PTCD group (100 % vs. 86 %), while the clinical success rate was similar (93 % vs. 86 %). PTCD was associated with more adverse events (29 % vs. 18 %) and a significantly higher re-intervention rate (80 % vs. 16 %) [211].

ESC-D vs. ERCP

In patients with distal bile duct obstruction and failure of selective retrograde cannulation, the EUS-guided rendezvous treatment (n = 58) success rate was higher compared with a historical cohort of patients (n = 144) who underwent precut sphincterotomy (98.3 % vs. 90.3 %) without a difference in adverse events (3.4 % vs. 6.9 %) [212]. A comparison of endoscopic placement of self-expandable metal stents using either ERCP or ESC-D for malignant distal bile duct obstruction was performed, with no statistically significant difference between ESC-D and ERCP in terms of technical success, adverse events, and mean procedure time [213].

Technique

ESC-D can be performed by a variety of routes depending on the indication, obstruction level and anatomical circumstances. Extrahepatic and intrahepatic routes may be used. Extrahepatic access to a dilated common bile duct is possible with the transducer in the duodenum, while intrahepatic access is normally possible from the stomach or in prior gastrectomy, from the jejunum. Biliary drainage may be achieved transmurally along the respective biliary access route (anterograde or retrograde) by bridging the bile duct stricture (anterograde) or by using a transpapillary rendezvous maneuver (retrograde). Depending on the individual anatomy and location of the stricture, the choice of drainage route is usually limited [214].

Technical and clinical outcomes

Case analysis review (n = 1127) reports overall mean technical and clinical success rates of 91 % and 88 %, respectively, for ESC-D [124].

Rendezvous technique: First reported in 2004 [202], other studies have described the rendezvous technique as effective in obtaining biliary cannulation [208] [215] [216] [217], with a cumulative success rate (9 studies, n = 267) of 81 %, with a higher success rate for the extrahepatic over the intrahepatic route (87 %, n = 160 vs. 65 %, n = 62) [208]. A retrospective study found significantly shorter procedure and hospitalization times for the extrahepatic compared to the intrahepatic approach, and the extrahepatic approach was associated with fewer adverse events, despite similar technical and clinical success rates [218].

Transluminal drainage, intra- and extrahepatic approach: Comparing the rendezvous technique (n = 13) with the direct transluminal approach (n = 20), no significant differences in the technical (94 %) and clinical success rate (97.0 %) or in the frequency of adverse events between the groups were shown (15 % vs. 10 %) [219].

A comparison of the outcomes of the intrahepatic and the extrahepatic approach (n = 49) reported an overall success rate (technical success 96 % vs. 91 %, and clinical success 91 % vs. 77 %, respectively) and adverse event rate (20 % vs. 12.5 %) to be similar for both methods [220]. An analysis of the long-term success of ESC-D (n = 240) reported no statistically significant difference in the overall success rate between the extrahepatic and intrahepatic approaches (84.3 % vs. 90.4 %), but when only malignant indications for ESC-D were considered, the intrahepatic approach was superior (success rates 94.9 % vs. 83.8 %) [221]. A rarely used approach, with pooled 77 % success (30/39 cases) is the transhepatic access followed by an intraductal anterograde drainage or dilatation of strictures of the bile duct, papilla or biliodigestive anastomoses [214] [222] [223] [224], which may then be combined with transluminal intrahepatic drainage procedures [225].

Adverse events

An adverse event rate of 29 % (range 3 – 77 %) and a mortality rate of 3 % are reported for ESC-D [124]. A systematic review of 20 papers [35] reported higher adverse event rates for the intrahepatic access route (18 %), compared to the extrahepatic access route (14 %). With the drainage technique, the rendezvous technique resulted in an adverse event rate of 11 %, while the transluminal drainage adverse event rate was 21 % [35]. Comparable results were obtained in a separate review [207].

Lower adverse events are reported by experienced centers [223] [224] [226] [227].

Comparative analysis of two prospective studies suggests that the rate of adverse events may be reduced by a defined algorithm of guidewire manipulation, aiming at replacing EUS-guided retrograde transluminal drainage by rendezvous techniques or anterograde internal approach [224] [228].

A multicenter trial showed a significant advantage of covered metal stents over plastic stents in terms of reduced frequency of biliary leakage (4 % vs. 11 %) [229].

EUS-guided gallbladder drainage

Transduodenal or transgastric access and drainage routes are feasible for EUS-guided gallbladder drainage using plastic or metal stents, including specifically designed lumen-apposing metal stents [230] [231] [232]. EUS-guided gallbladder drainage is a valuable alternative to non-surgical percutaneous or trans-papillary access techniques in patients with acute cholecystitis, who are poor candidates for surgery [233] [234] [235] [236] [237] [238] [239]. Pooled data reported 98 % technical and 99 % clinical success rates, with adverse events occurring in < 8 % [232].

Similar technical and clinical success rates, but lower pain scores, were reported for EUS-guided gallbladder drainage in prospective comparison to percutaneous gallbladder drainage [240].

EUS-guided pancreatography/drainage

Background

EUS-guided pancreatography was first described in a patient with a symptomatic pancreatic duct stone after pancreaticoduodenectomy [241], followed by a few further reports describing EUS-guided access and interventions of the main pancreatic duct [124] [242].

Technique, outcomes and adverse events

In the rendezvous procedure EUS is only used to obtain transmural access to the main pancreatic duct and to pass the guidewire through the minor or major papilla.

With the anterograde technique, puncture of the main pancreatic duct and stent placement is performed using needles and guidewires through the echoendoscope.

The reported clinical success rate is approximately 75 % (range 53 – 100 %) [124], with the adverse event rate reported at 19 % [242], reflecting the technical challenges of this technique where re-interventions are often necessary [243].

EUS-guided tumor ablation therapy

Background

EUS-guided tumor ablation includes ethanol and antitumor agent delivery, radiofrequency ablation (RFA), photodynamic treatment, implantation of radioactive seeds for brachytherapy and gold or silver fiducials to ‘target’ image-guided sterotactic radiation therapy. These therapies have been used for pancreatic cancer, pancreatic cystic lesions, pancreatic neuroendocrine tumors, and other malignant tumors.

EUS-guided ethanol ablation

Cystic pancreatic lesions

Surgical resection is usually the treatment of choice for mucinous cystic tumors. However, EUS-guided ethanol lavage has been suggested as an alternative when patients are not fit for surgery [244]. The cyst is usually punctured with a 22G or 19G fine needle under EUS guidance, the fluid is aspirated, and ethanol is injected into the cyst and re-aspirated after 3 – 5 min [244] [245] [246] [247] [248] [249]. Other studies have combined ethanol lavage with injection of Paclitaxel, a viscous, hydrophobic chemotherapeutic agent believed to have a prolonged effect [250] [251] [252] [253]. A meta-analysis of 7 studies (n = 152) reported complete cyst resolution in 56.2 % of cases and partial cyst resolution in 23.7 % of patients following EUS-guided ethanol ablation [254]. Abdominal pain (mean, 6.5 %) and pancreatitis (mean, 3.9 %) were the most frequent complications [254].

Pancreatic neuroendocrine tumors

EUS-guided ethanol ablation of symptomatic sporadic insulinoma (size range 5 – 21 mm) using 95 – 98 % ethanol was reported in 13 patients not fit for surgery. Resolution of symptoms with euglycemia was achieved in all patients, with a single episode of mild procedure-associated pancreatitis and one hematoma with ulceration of the duodenal wall recorded [255] [256] [257] [258] [259] [260].

Successful EUS-guided ethanol injection treatment has been described also in pancreatic neuroendocrine tumors in a patient with MEN 1 [261], solitary metastatic lymph nodes [262] [263], gastrointestinal stromal tumor [264], solitary hepatic metastases [265] [266] and left adrenal metastasis [267].

EUS-guided injection of anti-tumoral agents

Pilot and phase 1 – 2 studies report direct EUS-guided injection of several anti-tumoral agents into unresectable pancreatic tumors. These include cytoimplant, an allogeneic mixed lymphocyte culture [268], dendritic cells [269] [270] [271], TNFerade, a replication deficient adenovirus that expresses the tumor necrosis factor alpha [272] [273] [274], and Onyx-015, a selective adenovirus that preferentially replicates inside malignant cells [275]. Due to a substantial lack of efficacy despite the minimal number of adverse events encountered, these techniques have not become established in clinical practice.

EUS-guided radiofrequency ablation

RFA is used to ablate neoplastic tissue by local thermal-induced coagulative necrosis of the tumor [276]. Results and safety of EUS-guided RFA (liver, pancreas, lymph nodes) have been evaluated only in animal experiments with encouraging results [277] [278] [279] [280] [281], and only in a few human patients with pancreatic tumors [282] [283].

EUS-guided interstitial brachytherapy

EUS guidance can also be used to implant intra-tumoral radioactive seeds [284] [285]. The clinical efficacy and safety of EUS-guided implantation of radioactive I¹²⁵ seeds in advanced pancreatic cancer was evaluated with routine gemcitabine-based 5-FU chemotherapy 1 week after brachytherapy [286]. Compared with brachytherapy alone [287], the combination of chemotherapy and radioactive I¹²⁵ seeds did not demonstrate better tumor response nor long-term effects. Partial tumor response and pain relief were observed in 27 % and 30 % of patients, respectively. Local adverse events or grade III toxicity developed in 40 % of patients [287].

EUS-guided intratumoral placement of fiducial markers

Fiducial markers include radiopaque spheres, coils, or seeds that are implanted in or near the tumor to guide stereotactic body radiation therapy. EUS-guided fiducial placement has been reported to be feasible and safe in several studies of inoperable pancreatic [288] [289] [290] [291] [292] [293], abdominal [293] [294] [295] [296] or mediastinal malignancy [284] [294] and for primary and recurrent prostate cancer [297] [298]. The reported success rate is between 84.6 % to 100 %, and adverse events are few (7/278, 2.5 %) and limited to mild pancreatitis, abdominal pain and infection [124]. Problems of EUS-guided placement of fiducials are migration before beginning targeted image-guided radiation treatment (in approximately 7 %) and deviation from ideal fiducial geometry [289] [290] [291] [292] [299].

Depending on the type of fiducial, 22G and 19G needles can be used for application.

• References Online

• 1 Jenssen C, Hocke M, Fusaroli P et al. EFSUMB guidelines on interventional ultrasound, part IV. EUS-guided interventions: General aspects and EUS-guided sampling. Ultraschall in Med 2015; Epub ahead of print
• 2 Dietrich CF, Lorentzen T, Sidhu PS et al. An introduction into the EFSUMB guidelines on interventional ultrasound. Ultraschall in Med 2015; 36: 460-463
• 3 Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 2007; 102: 430-438
• 4 Penman ID, Rosch T, Group EUSW. EUS 2008 Working Group document: evaluation of EUS-guided celiac plexus neurolysis/block (with video). Gastrointest Endosc 2009; 69: S28-S31
• 5 Arcidiacono PG, Calori G, Carrara S et al. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev 2011; CD007519
• 6 Nagels W, Pease N, Bekkering G et al. Celiac plexus neurolysis for abdominal cancer pain: a systematic review. Pain Med 2013; 14: 1140-1163
• 7 Zhong W, Yu Z, Zeng JX et al. Celiac plexus block for treatment of pain associated with pancreatic cancer: a meta-analysis. Pain Pract 2014; 14: 43-51
• 8 Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc 1996; 44: 656-662
• 9 Gerke H, Silva Jr RG, Shamoun D et al. EUS characteristics of celiac ganglia with cytologic and histologic confirmation. Gastrointest Endosc 2006; 64: 35-39
• 10 Levy M, Rajan E, Keeney G et al. Neural ganglia visualized by endoscopic ultrasound. Am J Gastroenterol 2006; 101: 1787-1791
• 11 Gleeson FC, Levy MJ, Papachristou GI et al. Frequency of visualization of presumed celiac ganglia by endoscopic ultrasound. Endoscopy 2007; 39: 620-624
• 12 Ha TI, Kim GH, Kang DH et al. Detection of celiac ganglia with radial scanning endoscopic ultrasonography. Korean J Intern Med 2008; 23: 5-8
• 13 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 2008; 103: 98-103
• 14 Fusaroli P, Ceroni L, Caletti G. Forward-view Endoscopic Ultrasound: A Systematic Review of Diagnostic and Therapeutic Applications. Endosc Ultrasound 2013; 2: 64-70
• 15 Gress F, Schmitt C, Sherman S et al. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 2001; 96: 409-416
• 16 Collins D, Penman I, Mishra G et al. EUS-guided celiac block and neurolysis. Endoscopy 2006; 38: 935-939
• 17 Penman ID, Gilbert D. Basic technique for celiac plexus block/neurolysis. Gastrointest Endosc 2009; 69: S163-S165
• 18 Dietrich CF, Hocke M, Jenssen C. Interventional endosonography. Ultraschall in Med 2011; 32: 8-22 quiz 23–25
• 19 Dietrich CF, Hocke M, Jenssen C. Interventional endosonography. In: Dietrich CF, Nuernberg D, eds. Interventional Ultrasound. A Practical Guide and Atlas. Stuttgart, New York, Delhi, Rio: Thieme; 2015: 224-253
• 20 Adler DG, Conway JD, Coffie JM et al. EUS accessories. Gastrointest Endosc 2007; 66: 1076-1081
• 21 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 2009; 54: 2330-2337
• 22 Kaufman M, Singh G, Das S et al. Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol 2010; 44: 127-134
• 23 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 2011; 29: 3541-3546
• 24 Sahai AV, Lemelin V, Lam E et al. Central vs. bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term effectiveness. Am J Gastroenterol 2009; 104: 326-329
• 25 LeBlanc JK, Al-Haddad M, McHenry L et al. A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?. Gastrointest Endosc 2011; 74: 1300-1307
• 26 Doi S, Yasuda I, Kawakami H et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy 2013; 45: 362-369
• 27 Leblanc JK, Rawl S, Juan M et al. Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis in Pancreatic Cancer: A Prospective Pilot Study of Safety Using 10 mL versus 20 mL Alcohol. Diagn Ther Endosc 2013; 2013: 327036
• 28 Si-Jie H, Wei-Jia X, Yang D et al. How to improve the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis in pain management in patients with pancreatic cancer: analysis in a single center. Surg Laparosc Endosc Percutan Tech 2014; 24: 31-35
• 29 Sey MS, Schmaltz L, Al-Haddad MA et al. Effectiveness and safety of serial endoscopic ultrasound-guided celiac plexus block for chronic pancreatitis. Endosc Int Open 2015; 3: E56-E59
• 30 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 2012; 10: 186-191 191 e181
• 31 Eisendrath P, Paquin SC, Delhaye M et al. A Randomized, double-blinded, multi-center, sham-controlled trial of EUS-guided celiac plexus block for pain due to chronic pancreatitis (abstract). Gastrointest Endosc 2014; 79: AB168
• 32 Gress F, Schmitt C, Sherman S et al. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999; 94: 900-905
• 33 Santosh D, Lakhtakia S, Gupta R et al. Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis. Aliment Pharmacol Ther 2009; 29: 979-984
• 34 O'Toole TM, Schmulewitz N. Complication rates of EUS-guided celiac plexus blockade and neurolysis: results of a large case series. Endoscopy 2009; 41: 593-597
• 35 Alvarez-Sanchez MV, Jenssen C, Faiss S et al. Interventional endoscopic ultrasonography: an overview of safety and complications. Surg Endosc 2014; 28: 712-734
• 36 Leung VK, Sung JJ, Ahuja AT et al. Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding. Gastroenterology 1997; 112: 1811-1816
• 37 El-Saadany M, Jalil S, Irisawa A et al. EUS for portal hypertension: a comprehensive and critical appraisal of clinical and experimental indications. Endoscopy 2008; 40: 690-696
• 38 Kume K, Yamasaki M, Watanabe T et al. Mild collateral varices and a fundic plexus without perforating veins on EUS predict endoscopic non-recurrence of esophageal varices after EVL. Hepatogastroenterology 2011; 58: 798-801
• 39 Liao SC, Yang SS, Ko CW et al. A miniature ultrasound probe is useful in reducing rebleeding after endoscopic cyanoacrylate injection for hemorrhagic gastric varices. Scand J Gastroenterol 2013; 48: 1347-1353
• 40 Cattan P, Cuillerier E, Cellier C et al. Hemobilia caused by a pseudoaneurysm of the hepatic artery diagnosed by EUS. Gastrointest Endosc 1999; 49: 252-255
• 41 Falodia S, Garg PK, Bhatia V et al. EUS diagnosis of a left gastric artery pseudoaneurysm and aneurysmogastric fistula seen with a massive GI hemorrhage (with video). Gastrointest Endosc 2008; 68: 389-391
• 42 Pinto-Marques P, Giria J, Brito M et al. Unusual cause for upper GI bleeding: a splenic artery aneurysm mimicking a Dieulafoy lesion. Role for systematic EUS assessment?. Gastrointest Endosc 2010; 71: 845-846 ; discussion 847
• 43 Fukatsu K, Ueda K, Maeda H et al. A case of chronic pancreatitis in which endoscopic ultrasonography was effective in the diagnosis of a pseudoaneurysm. World J Gastrointest Endosc 2012; 4: 335-338
• 44 Varshney P, Songra B, Mathur S et al. Splenic artery pseudoaneurysm presenting as massive hematemesis: a diagnostic dilemma. Case Rep Surg 2014; 2014: 501937
• 45 Fockens P, Meenan J, van Dullemen HM et al. Dieulafoy's disease: endosonographic detection and endosonography-guided treatment. Gastrointest Endosc 1996; 44: 437-442
• 46 Levy MJ, Wong KeeSong LM, Farnell MB et al. Endoscopic ultrasound (EUS)-guided angiotherapy of refractory gastrointestinal bleeding. Am J Gastroenterol 2008; 103: 352-359
• 47 de Paulo GA, Ardengh JC, Nakao FS et al. Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins. Gastrointest Endosc 2006; 63: 396-402 ; quiz 463
• 48 Lahoti S, Catalano MF, Alcocer E et al. Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler. Gastrointest Endosc 2000; 51: 331-333
• 49 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 2013; 78: 711-721
• 50 Ribeiro A, Vazquez-Sequeiros E, Wiersema MJ. Doppler EUS-guided treatment of gastric Dieulafoy's lesion. Gastrointest Endosc 2001; 53: 807-809
• 51 Gonzalez JM, Giacino C, Pioche M et al. Endoscopic ultrasound-guided vascular therapy: is it safe and effective?. Endoscopy 2012; 44: 539-542
• 52 Law R, Fujii-Lau L, Wong Kee Song LM et al. Efficacy of Endoscopic Ultrasound-Guided Hemostatic Interventions for Resistant Nonvariceal Bleeding. Clin Gastroenterol Hepatol 2015; 13: 808-812.e1
• 53 Roach H, Roberts SA, Salter R et al. Endoscopic ultrasound-guided thrombin injection for the treatment of pancreatic pseudoaneurysm. Endoscopy 2005; 37: 876-878
• 54 Robinson M, Richards D, Carr N. Treatment of a splenic artery pseudoaneurysm by endoscopic ultrasound-guided thrombin injection. Cardiovasc Intervent Radiol 2007; 30: 515-517
• 55 Gonzalez JM, Ezzedine S, Vitton V et al. Endoscopic ultrasound treatment of vascular complications in acute pancreatitis. Endoscopy 2009; 41: 721-724
• 56 Lameris R, du Plessis J, Nieuwoudt M et al. A visceral pseudoaneurysm: management by EUS-guided thrombin injection. Gastrointest Endosc 2011; 73: 392-395
• 57 Chaves DM, Costa FF, Matuguma S et al. Splenic artery pseudoaneurysm treated with thrombin injection guided by endoscopic ultrasound. Endoscopy 2012; 44 (Suppl. 02) UCTN:E99-E100
• 58 Roberts KJ, Jones RG, Forde C et al. Endoscopic ultrasound-guided treatment of visceral artery pseudoaneurysm. HPB (Oxford) 2012; 14: 489-490
• 59 Banks PA, Bollen TL, Dervenis C et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
• 60 van Santvoort HC, Bakker OJ, Bollen TL et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011; 141: 1254-1263
• 61 Tenner S, Baillie J, DeWitt J et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108: 1400-1415; 1416
• 62 Hariri M, Slivka A, Carr-Locke DL et al. Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized. Am J Gastroenterol 1994; 89: 1781-1784
• 63 Morgan DE, Baron TH, Smith JK et al. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 1997; 203: 773-778
• 64 Jurgensen C, Arlt A, Neser F et al. Endoscopic ultrasound criteria to predict the need for intervention in pancreatic necrosis. BMC Gastroenterol 2012; 12: 48
• 65 Rana SS, Bhasin DK, Sharma RK et al. Do the morphological features of walled off pancreatic necrosis on endoscopic ultrasound determine the outcome of endoscopic transmural drainage?. Endosc Ultrasound 2014; 3: 118-122
• 66 Rana SS, Chaudhary V, Sharma R et al. Comparison of abdominal ultrasound, endoscopic ultrasound and magnetic resonance imaging in detection of necrotic debris in walled-off pancreatic necrosis. Gastroenterol Rep (Oxf) 2015; Epub ahead of print
• 67 Sarath iPatra P, Das K, Bhattacharyya A et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg 2014; 101: 1721-1728
• 68 Lerch MM, Stier A, Wahnschaffe U et al. Pancreatic pseudocysts: observation, endoscopic drainage, or resection?. Dtsch Arztebl Int 2009; 106: 614-621
• 69 Buchler MW, Gloor B, Muller CA et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000; 232: 619-626
• 70 Besselink MG, van Santvoort HC, Boermeester MA et al. Timing and impact of infections in acute pancreatitis. Br J Surg 2009; 96: 267-273
• 71 Petrov MS, Shanbhag S, Chakraborty M et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010; 139: 813-820
• 72 Lankisch PG, Weber-Dany B, Maisonneuve P et al. Pancreatic pseudocysts: prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis. Pancreatology 2012; 12: 85-90
• 73 Schmidt PN, Roug S, Hansen EF et al. Spectrum of microorganisms in infected walled-off pancreatic necrosis – Impact on organ failure and mortality. Pancreatology 2014; 14: 444-449
• 74 Rau B, Pralle U, Mayer JM et al. Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis. Br J Surg 1998; 85: 179-184
• 75 Negm AA, Poos H, Kruck E et al. Microbiologic analysis of peri-pancreatic fluid collected during EUS in patients with pancreatitis: impact on antibiotic therapy. Gastrointest Endosc 2013; 78: 303-311
• 76 Jacobson BC, Baron TH, Adler DG et al. ASGE guideline: The role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 2005; 61: 363-370
• 77 Dumonceau JM, Delhaye M, Tringali A et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2012; 44: 784-800
• 78 Voermans RP, Ponchon T, Schumacher B et al. Forward-viewing versus oblique-viewing echoendoscopes in transluminal drainage of pancreatic fluid collections: a multicenter, randomized, controlled trial. Gastrointest Endosc 2011; 74: 1285-1293
• 79 Seewald S, Thonke F, Ang TL et al. One-step, simultaneous double-wire technique facilitates pancreatic pseudocyst and abscess drainage (with videos). Gastrointest Endosc 2006; 64: 805-808
• 80 Ang TL, Teo EK, Fock KM. EUS-guided drainage of infected pancreatic pseudocyst: use of a 10F Soehendra dilator to facilitate a double-wire technique for initial transgastric access (with videos). Gastrointest Endosc 2008; 68: 192-194
• 81 Itoi T, Itokawa F, Tsuchiya T et al. EUS-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique. Dig Endosc 2009; 21 (Suppl. 01) S53-S56
• 82 Fabbri C, Luigiano C, Maimone A et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. World J Gastrointest Endosc 2012; 4: 479-488
• 83 Khashab MA, Lennon AM, Singh VK et al. Endoscopic ultrasound (EUS)-guided pseudocyst drainage as a one-step procedure using a novel multiple-wire insertion technique (with video). Surg Endosc 2012; 26: 3320-3323
• 84 Binmoeller KF, Weilert F, Shah JN et al. Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience. Surg Endosc 2013; 27: 1835-1839
• 85 Braden B, Dietrich CF. Endoscopic ultrasonography-guided endoscopic treatment of pancreatic pseudocysts and walled-off necrosis: New technical developments. World J Gastroenterol 2014; 20: 16191-16196
• 86 Seicean A, Stan-Iuga R, Badea R et al. The safety of endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopic control: a single tertiary center experience. J Gastrointestin Liver Dis 2011; 20: 39-45
• 87 Rana SS, Bhasin DK, Rao C et al. Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis. Dig Endosc 2013; 25: 47-52
• 88 Rana SS, Bhasin DK. Nonfluoroscopic endoscopic ultrasound-guided transmural drainage of pseudocysts: A pictorial technical review. Endosc Ultrasound 2015; 4: 92-97
• 89 Voermans RP, Veldkamp MC, Rauws EA et al. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc 2007; 66: 909-916
• 90 Varadarajulu S. EUS followed by endoscopic pancreatic pseudocyst drainage or all-in-one procedure: a review of basic techniques (with video). Gastrointest Endosc 2009; 69: S176-181
• 91 Varadarajulu S, Phadnis MA, Christein JD et al. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc 2011; 74: 74-80
• 92 Heinzow HS, Meister T, Pfromm B et al. Single-step versus multi-step transmural drainage of pancreatic pseudocysts: the use of cystostome is effective and timesaving. Scand J Gastroenterol 2011; 46: 1004-1013
• 93 Bello B, Matthews JB. Minimally invasive treatment of pancreatic necrosis. World J Gastroenterol 2012; 18: 6829-6835
• 94 Committee AT, Desilets DJ, Banerjee S et al. New devices and techniques for management of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 835-838
• 95 Siddiqui AA, Dewitt JM, Strongin A et al. Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain. Gastrointest Endosc 2013; 78: 589-595
• 96 Lin H, Zhan XB, Sun SY et al. Stent selection for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a multicenter study in china. Gastroenterol Res Pract 2014; 2014: 193562
• 97 Bang JY, Wilcox CM, Trevino JM et al. Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc 2014; 28: 2877-2883
• 98 Walter D, Will U, Sanchez-Yague A et al. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study. Endoscopy 2015; 47: 63-67
• 99 Sharaiha RZ, DeFilippis EM, Kedia P et al. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc 2015; Epub ahead of print
• 100 Teoh AY, Ho LK, Dhir VK et al. A multi-institutional survey on the practice of endoscopic ultrasound (EUS) guided pseudocyst drainage in the Asian EUS group. Endosc Int Open 2015; 3: E130-E133
• 101 Lee BU, Song TJ, Lee SS et al. Newly designed, fully covered metal stents for endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collections: a prospective randomized study. Endoscopy 2014; 46: 1078-1084
• 102 Bang JY, Hawes R, Bartolucci A et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: A systematic review. Dig Endosc 2015; 27: 486-498
• 103 Talreja JP, Shami VM, Ku J et al. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc 2008; 68: 1199-1203
• 104 Antillon MR, Bechtold ML, Bartalos CR et al. Transgastric endoscopic necrosectomy with temporary metallic esophageal stent placement for the treatment of infected pancreatic necrosis (with video). Gastrointest Endosc 2009; 69: 178-180
• 105 Belle S, Collet P, Post S et al. Temporary cystogastrostomy with self-expanding metallic stents for pancreatic necrosis. Endoscopy 2010; 42: 493-495
• 106 Tarantino I, Traina M, Barresi L et al. Transgastric plus transduodenal necrosectomy with temporary metal stents placement for treatment of large pancreatic necrosis. Pancreas 2010; 39: 269-270
• 107 Berzosa M, Maheshwari S, Patel KK et al. Single-step endoscopic ultrasonography-guided drainage of peripancreatic fluid collections with a single self-expandable metal stent and standard linear echoendoscope. Endoscopy 2012; 44: 543-547
• 108 Fabbri C, Luigiano C, Cennamo V et al. Endoscopic ultrasound-guided transmural drainage of infected pancreatic fluid collections with placement of covered self-expanding metal stents: a case series. Endoscopy 2012; 44: 429-433
• 109 Itoi T, Binmoeller KF, Shah J et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75: 870-876
• 110 Krishnan A, Ramakrishnan R. EUS-guided endoscopic necrosectomy and temporary cystogastrostomy for infected pancreatic necrosis with self-expanding metallic stents. Surg Laparosc Endosc Percutan Tech 2012; 22: e319-e321
• 111 Penn DE, Draganov PV, Wagh MS et al. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 2012; 76: 679-684
• 112 Weilert F, Binmoeller KF, Shah JN et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy 2012; 44: 780-783
• 113 Gornals JB, De la Serna-Higuera C, Sanchez-Yague A et al. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc 2013; 27: 1428-1434
• 114 Itoi T, Nageshwar Reddy D, Yasuda I. New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci 2013; 20: 403-406
• 115 Yamamoto N, Isayama H, Kawakami H et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 809-814
• 116 Bapaye A, Itoi T, Kongkam P et al. New fully covered large-bore wide-flare removable metal stent for drainage of pancreatic fluid collections: Results of a multicenter study. Dig Endosc 2015; 27: 499-504
• 117 Saxena P, Singh VK, Messallam A et al. Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video). Gastrointest Endosc 2014; 80: 319-324
• 118 Rinninella E, Kunda R, Dollhopf M et al. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc 2015; Epub ahead of print
• 119 Huggett MT, Oppong KW, Pereira SP et al. Endoscopic drainage of walled-off pancreatic necrosis using a novel self-expanding metal stent. Endoscopy 2015; Epub ahead of print
• 120 Rosso E, Alexakis N, Ghaneh P et al. Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment. Dig Surg 2003; 20: 397-406
• 121 Varadarajulu S, Lopes TL, Wilcox CM et al. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008; 68: 649-655
• 122 Varadarajulu S, Bang JY, Sutton BS et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145: 583-590 e581
• 123 Akshintala VS, Saxena P, Zaheer A et al. A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc 2014; 79: 921-928 ; quiz 983 e922, 983 e925
• 124 Fabbri C, Luigiano C, Lisotti A et al. Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review. World J Gastroenterol 2014; 20: 8424-8448
• 125 Hocke M, Will U, Gottschalk P et al. Transgastral retroperitoneal endoscopy in septic patients with pancreatic necrosis or infected pancreatic pseudocysts. Z Gastroenterol 2008; 46: 1363-1368
• 126 Will U, Wanzar C, Gerlach R et al. Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necroses – treatment algorithm in a large single-center study. Ultraschall in Med 2011; 32: 176-183
• 127 Kahaleh M, Shami VM, Conaway MR et al. Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 2006; 38: 355-359
• 128 Varadarajulu S, Wilcox CM, Tamhane A et al. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 2007; 66: 1107-1119
• 129 Park DH, Lee SS, Moon SH et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009; 41: 842-848
• 130 Varadarajulu S, Christein JD, Tamhane A et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68: 1102-1111
• 131 Panamonta N, Ngamruengphong S, Kijsirichareanchai K et al. Endoscopic ultrasound-guided versus conventional transmural techniques have comparable treatment outcomes in draining pancreatic pseudocysts. Eur J Gastroenterol Hepatol 2012; 24: 1355-1362
• 132 Jagielski M, Smoczynski M, Jablonska A et al. The role of endoscopic ultrasonography in endoscopic debridement of walled-off pancreatic necrosis – A single center experience. Pancreatology 2015; Epub ahead of print
• 133 Bakker OJ, van Santvoort HC, van Brunschot S et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307: 1053-1061
• 134 Baron TH, Harewood GC, Morgan DE et al. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc 2002; 56: 7-17
• 135 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 2011; 15: 2080-2088
• 136 Puli SR, Graumlich JF, Pamulaparthy SR et al. Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol 2014; 28: 50-53
• 137 van Brunschot S, Fockens P, Bakker OJ et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 2014; 28: 1425-1438
• 138 Seifert H, Biermer M, Schmitt W et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58: 1260-1266
• 139 Ross A, Gluck M, Irani S et al. Combined endoscopic and percutaneous drainage of organized pancreatic necrosis. Gastrointest Endosc 2010; 71: 79-84
• 140 Gluck M, Ross A, Irani S et al. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 2010; 8: 1083-1088
• 141 Gardner TB, Coelho-Prabhu N, Gordon SR et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U. S. series. Gastrointest Endosc 2011; 73: 718-726
• 142 Gluck M, Ross A, Irani S et al. Dual modality drainage for symptomatic walled-off pancreatic necrosis reduces length of hospitalization, radiological procedures, and number of endoscopies compared to standard percutaneous drainage. J Gastrointest Surg 2012; 16: 248-256 ; discussion 256–247
• 143 Freeman ML, Werner J, van Santvoort HC et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012; 41: 1176-1194
• 144 van Brunschot S, Bakker OJ, Besselink MG et al. Treatment of necrotizing pancreatitis. Clin Gastroenterol Hepatol 2012; 10: 1190-1201
• 145 Yasuda I, Nakashima M, Iwai T et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy 2013; 45: 627-634
• 146 da Costa DW, Boerma D, van Santvoort HC et al. Staged multidisciplinary step-up management for necrotizing pancreatitis. Br J Surg 2014; 101: e65-e79
• 147 Bang JY, Holt BA, Hawes RH et al. Outcomes after implementing a tailored endoscopic step-up approach to walled-off necrosis in acute pancreatitis. Br J Surg 2014; 101: 1729-1738
• 148 Ross AS, Irani S, Gan SI et al. Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes. Gastrointest Endosc 2014; 79: 929-935
• 149 Bang JY, Wilcox CM, Trevino J et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol 2013; 28: 1725-1732
• 150 Rische S, Riecken B, Degenkolb J et al. Transmural endoscopic necrosectomy of infected pancreatic necroses and drainage of infected pseudocysts: a tailored approach. Scand J Gastroenterol 2013; 48: 231-240
• 151 Mukai S, Itoi T, Sofuni A et al. Expanding endoscopic interventions for pancreatic pseudocyst and walled-off necrosis. J Gastroenterol 2015; 50: 211-220
• 152 Cahen D, Rauws E, Fockens P et al. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 2005; 37: 977-983
• 153 Arvanitakis M, Delhaye M, Bali MA et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609-619
• 154 Rana SS, Bhasin DK, Rao C et al. Consequences of long term indwelling transmural stents in patients with walled off pancreatic necrosis & disconnected pancreatic duct syndrome. Pancreatology 2013; 13: 486-490
• 155 Dhir V, Teoh AY, Bapat M et al. EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients. Gastrointest Endosc 2015; 82: 650-657
• 156 Rasmussen DN, Hassan H, Vilmann P. Only few severe complications after endoscopic ultrasound guided drainage of pancreatic pseudocysts. Dan Med J 2012; 59: A4406
• 157 Ng PY, Rasmussen DN, Vilmann P et al. Endoscopic Ultrasound-guided Drainage of Pancreatic Pseudocysts: Medium-Term Assessment of Outcomes and Complications. Endosc Ultrasound 2013; 2: 199-203
• 158 Sanchez CortesE, Maalak A, LeMoine O et al. Endoscopic cystenterostomy of nonbulging pancreatic fluid collections. Gastrointest Endosc 2002; 56: 380-386
• 159 Hookey LC, Debroux S, Delhaye M et al. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc 2006; 63: 635-643
• 160 Fockens P, Johnson TG, van Dullemen HM et al. Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage. Gastrointest Endosc 1997; 46: 412-416
• 161 Smits ME, Rauws EA, Tytgat GN et al. The efficacy of endoscopic treatment of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 202-207
• 162 Binmoeller KF, Seifert H, Walter A et al. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 219-224
• 163 De Palma GD, Galloro G, Puzziello A et al. Endoscopic drainage of pancreatic pseudocysts: a long-term follow-up study of 49 patients. Hepatogastroenterology 2002; 49: 1113-1115
• 164 Kruger M, Schneider AS, Manns MP et al. Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access. Gastrointest Endosc 2006; 63: 409-416
• 165 Haghshenasskashani A, Laurence JM, Kwan V et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc 2011; 25: 3724-3730
• 166 Tilara A, Gerdes H, Allen P et al. Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections. J Am Coll Surg 2014; 218: 33-40
• 167 Wehrmann T, Stergiou N, Vogel B et al. Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series. Gastrointest Endosc 2005; 62: 344-349
• 168 Varadarajulu S, Eloubeidi MA, Wilcox CM. The concept of bedside EUS. Gastrointest Endosc 2008; 67: 1180-1184
• 169 Saxena P, Kumbhari V, Khashab MA. EUS-guided drainage of a mediastinal abscess. Gastrointest Endosc 2014; 79: 998-999
• 170 Consiglieri CF, Escobar I, Gornals JB. EUS-guided transesophageal drainage of a mediastinal abscess using a diabolo-shaped lumen-apposing metal stent. Gastrointest Endosc 2015; 81: 221-222
• 171 Seewald S, Brand B, Omar S et al. EUS-guided drainage of subphrenic abscess. Gastrointest Endosc 2004; 59: 578-580
• 172 Seewald S, Imazu H, Omar S et al. EUS-guided drainage of hepatic abscess. Gastrointest Endosc 2005; 61: 495-498
• 173 Lee DH, Cash BD, Womeldorph CM et al. Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage. Gastrointest Endosc 2006; 64: 631-634
• 174 Shami VM, Talreja JP, Mahajan A et al. EUS-guided drainage of bilomas: a new alternative?. Gastrointest Endosc 2008; 67: 136-140
• 175 Piraka C, Shah RJ, Fukami N et al. EUS-guided transesophageal, transgastric, and transcolonic drainage of intra-abdominal fluid collections and abscesses. Gastrointest Endosc 2009; 70: 786-792
• 176 Ang TL, Seewald S, Teo EK et al. EUS-guided drainage of ruptured liver abscess. Endoscopy 2009; 41 Suppl 2: E21-E22
• 177 Noh SH, Park doH, Kim YR et al. EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos). Gastrointest Endosc 2010; 71: 1314-1319
• 178 Decker C, Varadarajulu S. EUS-guided drainage of an intra-abdominal abscess after liver transplantation. Gastrointest Endosc 2011; 73: 1056-1058
• 179 Itoi T, Ang TL, Seewald S et al. Endoscopic ultrasonography-guided drainage for tuberculous liver abscess drainage. Dig Endosc 2011; 23 (Suppl. 01) 158-161
• 180 Ulla-Rocha JL, Vilar-Cao Z, Sardina-Ferreiro R. EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery. Therap Adv Gastroenterol 2012; 5: 95-102
• 181 Prasad GA, Varadarajulu S. Endoscopic ultrasound-guided abscess drainage. Gastrointest Endosc Clin N Am 2012; 22: 281-290, ix
• 182 Alcaide N, Vargas-Garcia AL, de la Serna-Higuera C et al. EUS-guided drainage of liver abscess by using a lumen-apposing metal stent (with video). Gastrointest Endosc 2013; 78: 941-942 ; discussion 942
• 183 Giovannini M, Bories E, Moutardier V et al. Drainage of deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy 2003; 35: 511-514
• 184 Varadarajulu S, Drelichman ER. EUS-guided drainage of pelvic abscess (with video). Gastrointest Endosc 2007; 66: 372-376
• 185 Varadarajulu S, Drelichman ER. Effectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients (with video). Gastrointest Endosc 2009; 70: 1121-1127
• 186 Puri R, Eloubeidi MA, Sud R et al. Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance. J Gastroenterol Hepatol 2010; 25: 1416-1419
• 187 Puri R, Jain P, Sud R et al. EUS-guided drainage of an isolated primary tubercular prostatic abscess. Gastrointest Endosc 2010; 71: 425-428
• 188 Fernandez-Urien I, Vila JJ, Jimenez FJ. Endoscopic ultrasound-guided drainage of pelvic collections and abscesses. World J Gastrointest Endosc 2010; 2: 223-227
• 189 Ramesh J, Bang JY, Trevino J et al. Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol 2013; 28: 620-625
• 190 Hadithi M, Bruno MJ. Endoscopic ultrasound-guided drainage of pelvic abscess: A case series of 8 patients. World J Gastrointest Endosc 2014; 6: 373-378
• 191 Puri R, Choudhary NS, Kotecha H et al. Endoscopic ultrasound-guided pelvic and prostatic abscess drainage: experience in 30 patients. Indian J Gastroenterol 2014; 33: 410-413
• 192 Holt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). J Hepatobiliary Pancreat Sci 2015; 22: 12-15
• 193 Carr-Locke DL. Overview of the role of ERCP in the management of diseases of the biliary tract and the pancreas. Gastrointest Endosc 2002; 56: S157-S160
• 194 Adler DG, Baron TH, Davila RE et al. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005; 62: 1-8
• 195 Ponchon T. Diagnostic endoscopic retrograde cholangiopancreatography. Endoscopy 2000; 32: 200-208
• 196 Schofl R. Diagnostic endoscopic retrograde cholangiopancreatography. Endoscopy 2001; 33: 147-157
• 197 Farrell J, Carr-Locke D, Garrido T et al. Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: indications and technical outcomes. Endoscopy 2006; 38: 1246-1249
• 198 DeBenedet AT, Elmunzer BJ, McCarthy ST et al. Intraprocedural quality in endoscopic retrograde cholangiopancreatography: a meta-analysis. Am J Gastroenterol 2013; 108: 1696-1704 ; quiz 1705
• 199 Wiersema MJ, Sandusky D, Carr R et al. Endosonography-guided cholangiopancreatography. Gastrointest Endosc 1996; 43: 102-106
• 200 Giovannini M, Moutardier V, Pesenti C et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900
• 201 Burmester E, Niehaus J, Leineweber T et al. EUS-cholangio-drainage of the bile duct: report of 4 cases. Gastrointest Endosc 2003; 57: 246-251
• 202 Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases. Gastrointest Endosc 2004; 59: 100-107
• 203 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 2013; 19: 1372-1379
• 204 Sarkaria S, Sundararajan S, Kahaleh M. Endoscopic ultrasonographic access and drainage of the common bile duct. Gastrointest Endosc Clin N Am 2013; 23: 435-452
• 205 Prichard D, Byrne MF. Endoscopic ultrasound guided biliary and pancreatic duct interventions. World J Gastrointest Endosc 2014; 6: 513-524
• 206 Maranki J, Hernandez AJ, Arslan B et al. Interventional endoscopic ultrasound-guided cholangiography: long-term experience of an emerging alternative to percutaneous transhepatic cholangiography. Endoscopy 2009; 41: 532-538
• 207 Kedia P, Gaidhane M, Kahaleh M. Endoscopic guided biliary drainage: how can we achieve efficient biliary drainage?. Clin Endosc 2013; 46: 543-551
• 208 Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol 2014; 7: 94-102
• 209 Artifon EL, Aparicio D, Paione JB et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol 2012; 46: 768-774
• 210 Bapaye A, Dubale N, Aher A. Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J 2013; 1: 285-293
• 211 Khashab MA, Valeshabad AK, Afghani E et al. A Comparative Evaluation of EUS-Guided Biliary Drainage and Percutaneous Drainage in Patients with Distal Malignant Biliary Obstruction and Failed ERCP. Dig Dis Sci 2015; 60: 557-565
• 212 Dhir V, Bhandari S, Bapat M et al. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc 2012; 75: 354-359
• 213 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 2015; 81: 913-923
• 214 Iwashita T, Lee JG, Shinoura S et al. Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation. Endoscopy 2012; 44: 60-65
• 215 Vila JJ, Perez-Miranda M, Vazquez-Sequeiros E et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76: 1133-1141
• 216 Iwashita T, Lee JG. Endoscopic ultrasonography-guided biliary drainage: rendezvous technique. Gastrointest Endosc Clin N Am 2012; 22: 249-258, viii-ix
• 217 Isayama H, Nakai Y, Kawakubo K et al. The endoscopic ultrasonography-guided rendezvous technique for biliary cannulation: a technical review. J Hepatobiliary Pancreat Sci 2013; 20: 413-420
• 218 Dhir V, Bhandari S, Bapat M et al. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J 2013; 1: 103-108
• 219 Khashab MA, Valeshabad AK, Modayil R et al. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc 2013; 78: 734-741
• 220 Artifon EL, Marson FP, Gaidhane M et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?. Gastrointest Endosc 2015; 81: 950-959
• 221 Gupta K, Perez-Miranda M, Kahaleh M et al. Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution. J Clin Gastroenterol 2014; 48: 80-87
• 222 Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy 2010; 42: 232-236
• 223 Shah JN, Marson F, Weilert F et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75: 56-64
• 224 Park doH, Jeong SU, Lee BU et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc 2013; 78: 91-101
• 225 Ogura T, Masuda D, Imoto A et al. EUS-guided hepaticogastrostomy combined with fine-gauge antegrade stenting: a pilot study. Endoscopy 2014; 46: 416-421
• 226 Will U, Fueldner F, Kern C et al. EUS-Guided Bile Duct Drainage (EUBD) in 95 Patients. Ultraschall in Med 2015; 36: 276-283
• 227 Poincloux L, Rouquette O, Buc E et al. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy 2015; 47: 794-801
• 228 Park doH, Jang JW, Lee SS et al. EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results. Gastrointest Endosc 2011; 74: 1276-1284
• 229 Kawakubo K, Isayama H, Kato H et al. Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. J Hepatobiliary Pancreat Sci 2014; 21: 328-334
• 230 Baron TH, Topazian MD. Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc 2007; 65: 735-737
• 231 Kwan V, Eisendrath P, Antaki F et al. EUS-guided cholecystenterostomy: a new technique (with videos). Gastrointest Endosc 2007; 66: 582-586
• 232 Penas-Herrero I, de la Serna-Higuera C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci 2015; 22: 35-43
• 233 Lee SS, Park DH, Hwang CY et al. EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study. Gastrointest Endosc 2007; 66: 1008-1012
• 234 Song TJ, Park doH, Eum JB et al. EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video). Gastrointest Endosc 2010; 71: 634-640
• 235 Jang JW, Lee SS, Park doH et al. Feasibility and safety of EUS-guided transgastric/transduodenal gallbladder drainage with single-step placement of a modified covered self-expandable metal stent in patients unsuitable for cholecystectomy. Gastrointest Endosc 2011; 74: 176-181
• 236 Moon JH, Choi HJ, Kim DC et al. A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos). Gastrointest Endosc 2014; 79: 990-995
• 237 Choi JH, Lee SS, Choi JH et al. Long-term outcomes after endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis. Endoscopy 2014; 46: 656-661
• 238 Irani S, Baron TH, Grimm IS et al. EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video). Gastrointest Endosc 2015; Epub ahead of print
• 239 Walter D, Teoh AY, Itoi T et al. EUS-guided gall bladder drainage with a lumen-apposing metal stent: a prospective long-term evaluation. Gut 2015; Epub ahead of print
• 240 Jang JW, Lee SS, Song TJ et al. Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology 2012; 142: 805-811
• 241 Harada N, Kouzu T, Arima M et al. Endoscopic ultrasound-guided pancreatography: a case report. Endoscopy 1995; 27: 612-615
• 242 Fujii-Lau LL, Levy MJ. Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Pancreat Sci 2015; 22: 51-57
• 243 Fujii LL, Topazian MD, Abu DayyehBK et al. EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience. Gastrointest Endosc 2013; 78: 854-864 e851
• 244 Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc 2013; 77: 526-533
• 245 Gan SI, Thompson CC, Lauwers GY et al. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc 2005; 61: 746-752
• 246 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 2009; 70: 710-723
• 247 DeWitt J, DiMaio CJ, Brugge WR. Long-term follow-up of pancreatic cysts that resolve radiologically after EUS-guided ethanol ablation. Gastrointest Endosc 2010; 72: 862-866
• 248 DiMaio CJ, DeWitt JM, Brugge WR. Ablation of pancreatic cystic lesions: the use of multiple endoscopic ultrasound-guided ethanol lavage sessions. Pancreas 2011; 40: 664-668
• 249 Caillol F, Poincloux L, Bories E et al. Ethanol lavage of 14 mucinous cysts of the pancreas: A retrospective study in two tertiary centers. Endosc Ultrasound 2012; 1: 48-52
• 250 Oh HC, Seo DW, Lee TY et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008; 67: 636-642
• 251 Oh HC, Seo DW, Kim SC et al. Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention?. Scand J Gastroenterol 2009; 44: 242-247
• 252 Oh HC, Seo DW, Song TJ et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology 2011; 140: 172-179
• 253 DeWitt JM, Al-Haddad M, Sherman S et al. Alterations in cyst fluid genetics following endoscopic ultrasound-guided pancreatic cyst ablation with ethanol and paclitaxel. Endoscopy 2014; 46: 457-464
• 254 Kandula M, Moole H, Cashman M et al. Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: A meta-analysis and systematic review. Indian J Gastroenterol 2015; 34: 193-199
• 255 Jurgensen C, Schuppan D, Neser F et al. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc 2006; 63: 1059-1062
• 256 Deprez PH, Claessens A, Borbath I et al. Successful endoscopic ultrasound-guided ethanol ablation of a sporadic insulinoma. Acta Gastroenterol Belg 2008; 71: 333-337
• 257 Vleggaar FP, Bij de Vaate EA, Valk GD et al. Endoscopic ultrasound-guided ethanol ablation of a symptomatic sporadic insulinoma. Endoscopy 2011; 43 (Suppl. 02) UCTN:E328-E329
• 258 Levy MJ, Thompson GB, Topazian MD et al. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc 2012; 75: 200-206
• 259 Qin SY, Lu XP, Jiang HX. EUS-guided ethanol ablation of insulinomas: case series and literature review. Medicine (Baltimore) 2014; 93: e85
• 260 Bor R, Farkas K, Balint A et al. [Endoscopic ultrasound-guided ethanol ablation: an alternative option for the treatment of pancreatic insulinoma]. Orv Hetil 2014; 155: 1647-1651
• 261 Muscatiello N, Salcuni A, Macarini L et al. Treatment of a pancreatic endocrine tumor by ethanol injection guided by endoscopic ultrasound. Endoscopy 2008; 40 (Suppl. 02) E258-E259
• 262 DeWitt J, Mohamadnejad M. EUS-guided alcohol ablation of metastatic pelvic lymph nodes after endoscopic resection of polypoid rectal cancer: the need for long-term surveillance. Gastrointest Endosc 2011; 74: 446-447
• 263 DiMaio CJ, Krishnan S, Roayaie S. EUS-guided ethanol ablation for management of metastatic hepatocellular carcinoma. J Interv Gastroenterol 2014; 4: 13-14
• 264 Gunter E, Lingenfelser T, Eitelbach F et al. EUS-guided ethanol injection for treatment of a GI stromal tumor. Gastrointest Endosc 2003; 57: 113-115
• 265 Barclay RL, Perez-Miranda M, Giovannini M. EUS-guided treatment of a solid hepatic metastasis. Gastrointest Endosc 2002; 55: 266-270
• 266 Hu YH, Tuo XP, Jin ZD et al. Endoscopic ultrasound (EUS)-guided ethanol injection in hepatic metastatic carcinoma: a case report. Endoscopy 2010; 42 (Suppl. 02) E256-E257
• 267 Artifon EL, Lucon AM, Sakai P et al. EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma. Gastrointest Endosc 2007; 66: 1201-1205
• 268 Chang KJ, Nguyen PT, Thompson JA et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer 2000; 88: 1325-1335
• 269 Nonogaki K, Hirooka Y, Itoh A et al. Combined treatment with immunotherapy and chemotherapy using endoscopic ultrasonography: A phase 1 trial as first line treatment in patients with locally advanced pancreatic carcinoma (abstract). Gastrointest Endosc 2007; 65: AB207
• 270 Irisawa A, Takagi T, Kanazawa M et al. Endoscopic ultrasound-guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas 2007; 35: 189-190
• 271 Hirooka Y, Itoh A, Kawashima H et al. A combination therapy of gemcitabine with immunotherapy for patients with inoperable locally advanced pancreatic cancer. Pancreas 2009; 38: e69-e74
• 272 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 2012; 75: 1139-1146 e1132
• 273 Hecht JR, Farrell JJ, Senzer N et al. EUS or percutaneously guided intratumoral TNFerade biologic with 5-fluorouracil and radiotherapy for first-line treatment of locally advanced pancreatic cancer: a phase I/II study. Gastrointest Endosc 2012; 75: 332-338
• 274 Herman JM, Wild AT, Wang H et al. Randomized phase III multi-institutional study of TNFerade biologic with fluorouracil and radiotherapy for locally advanced pancreatic cancer: final results. J Clin Oncol 2013; 31: 886-894
• 275 Hecht JR, Bedford R, Abbruzzese JL et al. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res 2003; 9: 555-561
• 276 Buscarini E, Savoia A, Brambilla G et al. Radiofrequency thermal ablation of liver tumors. Eur Radiol 2005; 15: 884-894
• 277 Goldberg SN, Mallery S, Gazelle GS et al. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 1999; 50: 392-401
• 278 Varadarajulu S, Jhala NC, Drelichman ER. EUS-guided radiofrequency ablation with a prototype electrode array system in an animal model (with video). Gastrointest Endosc 2009; 70: 372-376
• 279 Gaidhane M, Smith I, Ellen K et al. Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) of the Pancreas in a Porcine Model. Gastroenterol Res Pract 2012; 2012: 431451
• 280 Kim HJ, Seo DW, Hassanuddin A et al. EUS-guided radiofrequency ablation of the porcine pancreas. Gastrointest Endosc 2012; 76: 1039-1043
• 281 Sethi A, Ellrichmann M, Dhar S et al. Endoscopic ultrasound-guided lymph node ablation with a novel radiofrequency ablation probe: feasibility study in an acute porcine model. Endoscopy 2014; 46: 411-415
• 282 Hlavsa J, Prochazka V, Kala Z et al. Radiofrequency ablation of pancreatic neuroendocrine tumor. Klin Onkol 2011; 24: 209-215
• 283 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 2012; 76: 1142-1151
• 284 Martinez-Monge R, Subtil JC, Lopez-Picazo JM. Transoesophageal endoscopic-ultrasonography-guided 125I permanent brachytherapy for unresectable mediastinal lymphadenopathy. Lancet Oncol 2006; 7: 781-783
• 285 Sun S, Xu H, Xin J et al. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy 2006; 38: 399-403
• 286 Jin Z, Du Y, Li Z et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study. Endoscopy 2008; 40: 314-320
• 287 Sun S, Ge N, Wang S et al. Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer. Endoscopic Ultrasound 2012; 1: 41-47
• 288 Varadarajulu S, Trevino JM, Shen S et al. The use of endoscopic ultrasound-guided gold markers in image-guided radiation therapy of pancreatic cancers: a case series. Endoscopy 2010; 42: 423-425
• 289 Park WG, Yan BM, Schellenberg D et al. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc 2010; 71: 513-518
• 290 Sanders MK, Moser AJ, Khalid A et al. EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic cancer. Gastrointest Endosc 2010; 71: 1178-1184
• 291 Khashab MA, Kim KJ, Tryggestad EJ et al. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc 2012; 76: 962-971
• 292 Majumder S, Berzin TM, Mahadevan A et al. Endoscopic ultrasound-guided pancreatic fiducial placement: how important is ideal fiducial geometry?. Pancreas 2013; 42: 692-695
• 293 Choi JH, Seo DW, Park doH et al. Fiducial placement for stereotactic body radiation therapy under only endoscopic ultrasonography guidance in pancreatic and hepatic malignancy: practical feasibility and safety. Gut Liver 2014; 8: 88-93
• 294 DiMaio CJ, Nagula S, Goodman KA et al. EUS-guided fiducial placement for image-guided radiation therapy in GI malignancies by using a 22-gauge needle (with videos). Gastrointest Endosc 2010; 71: 1204-1210
• 295 Fernandez DC, Hoffe SE, Barthel JS et al. Stability of endoscopic ultrasound-guided fiducial marker placement for esophageal cancer target delineation and image-guided radiation therapy. Pract Radiat Oncol 2013; 3: 32-39
• 296 Machiels M, van Hooft J, Jin P et al. Endoscopy/EUS-guided fiducial marker placement in patients with esophageal cancer: a comparative analysis of 3 types of markers. Gastrointest Endosc 2015; 82: 641-649
• 297 Yang J, Abdel-Wahab M, Ribeiro A. EUS-guided fiducial placement before targeted radiation therapy for prostate cancer. Gastrointest Endosc 2009; 70: 579-583
• 298 Yang J, Abdel-Wahab M, Ribeiro A. EUS-guided fiducial placement after radical prostatectomy before targeted radiation therapy for prostate cancer recurrence. Gastrointest Endosc 2011; 73: 1302-1305
• 299 Davila Fajardo R, Lekkerkerker SJ, van der Horst A et al. EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. Gastrointest Endosc 2014; 79: 851-855