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 ˉ 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)

·          Choledocho-duodenostomy

·          Cholecysto-duodenostomy

·          Hepatico-gastrostomy


EUS guide vascular therapy

·         Cyanoacrylate injection for bleeding varices and aneurysm

·         Endocoil placement for varices and aneurysm

·         (TIPS placement)


(EUS guided anastomotic surgery)

·          Gastro-jejunostomy

·          Choledocho-duodenostomy


EUS-guided angiography

EUS guided needle confocal endomicroscopy


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