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





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


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



         TB, Sarcoidosis, Histoplasmosis, etc


EUS-FNA of other lesions


         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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