Indications and Therapeutic usage of Endoscopic Ultrasonography (EUS)

1 Diagnostic indications:

Mural and extramural lesions

·         Diagnosis of cyst, GIST, submucosal mass (assessment before mucosectomy, ESD)

·         Thickened gastric fold

·         Determine cause of GI tract stricture (anastomotic, reflux, extrinsic compression, achalasia)


Staging of GI tract malignancies

·         Oesophageal and gastric cancer

·         Gastric lymphoma / MALToma

·         Detection of malignant ascites and peritoneal metastases

·         Restaging after chemotherapy


Staging of non-GI tract malignancies

·         Non-small cell lung cancer

·         Mediastinal tumour / lymph node

·         (Gynaecological cancer)


Biliary diseases

·         Common bile duct stones, sludge and cancer

·         GB tumour, stone, polyps and other pathologies


New methods

EUS harmonic contrast study

EUS elastography

Pancreatic diseases

·         Pancreatic and ampullary cancer

·         Endocrine tumour, cystic tumour , IPMT

·         Acute, chronic and idiopathic pancreatitis

·         Assessment of pseudocyst (before drainage)


Colorectal diseases

·         Colorectal cancer and large polyps

·         Colorectal submucosal mass and carcinoid

·         IBD (CD, UC)

·         Fistula-in-ano, incontinence, pelvic floor dysfunction

·         Early detection of rectal tumour recurrence

·         Pelvic diseases (abscess, prostate, endometriosis, etc)


Portal hypertension

·         Diagnosis of gastroesophageal varices and collaterals

·         Monitoring drug and endoscopic therapy

·         Haemodynamic study


Dyspepsia and unexplained abdominal pain


2. Indications for EUS (EBUS) - FNA and trucut biopsy

EUS-FNA of tumours

·         GIT stromal tumour (GIST, leiomyoma, linitus plastica, etc)

·         Lung tumour and metastases

·         Liver metastases

·         Adrenal metastases



Pancreatic lesion

·         Solid pancreatic mass

·         Cystic lesion - FNA for fluid analysis, EUS guided brush cytology, EUS guided direct intra-cystic biopsy

·         EUS tattoo of small neuroendocrine tumour


EUS-FNA of lymph node in GIT cancer

·         Peri-esophageal, celiac axis lymph node

·         Peri-gastric

·         Peri-pancreatic

·         Peri-rectal


EUS (EBUS) - FNA of mediastinal lymph node for staging of NSCLC


EUS (EBUS) - FNA of other mediastinal lymph nodes and masses

·         Metastases

·         Lymphoma

·         TB, Sarcoidosis, Histoplasmosis, etc


EUS-FNA of other lesions

·         Ascites

·         Pleural effusion

·         Pericardial effusion



3. Therapeutic and Interventional EUS (investigational)

EUS-guided injection therapy

          Celiac plexus neurolysis

          Broad plexus neurolysis (around SMA)

          (Hypogastric plexus neurolysis)

          Botox injection for achalasia

          Sclerotherapy of OV and GV

          Lavage (alcohol, paclitaxel) of pancreatic cystic tumour


EUS-guided tumour therapy

          Iodine 125 seeds placement for brachytherapies

          Fiducial placement for stereotactic radiation

          (Tumour ablation – thermal probe, cryo probe, photodynamic probe, laser probe,  radiofrequency (High intensity focused ultrasound, HIFU) )


(EUS-guided tumour injection therapy)

          Injection of cytoimplant, gene therapy, chemotherapeutic agents, immune modulators

          Alcohol ablation of liver metastases, small pancreatic neuroendocrine tumour, etc.


EUS-guided abscess drainage

·         Liver abscess

·         Sub-phrenic abscess

·         Peri-rectal abscess


EUS-guided ERCP

·         Pancreatic ductal cannulation

·         CBD rendezvous cannulation


EUS-guided drainage

          Pancreatic pseudocyst drainage

          Pancreatico-gastrostomy (EPG)





EUS guide vascular therapy

·         Cyanoacrylate injection for bleeding varices and aneurysm

·         Endocoil placement for varices and aneurysm

·         (TIPS placement)


(EUS guided anastomotic surgery)




EUS-guided angiography

EUS guided needle confocal endomicroscopy


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