EUS - experimental and evolving techniques

In recent years both the utility and the technique of endoscopic ultrasound (EUS) have become more established in the minds of physicians. It has also become more widely available as more medical centres have added it to their diagnostic repertoire. The development of echoendoscopes with larger accessory channels has opened up the possibility for further developments of new devices and procedures. Needles with larger diameter have become available, which besides obtaining tissue from the target organ, may now also allow the injection of agents or objects into it [1] [2]. These new developments have laid the ground for the evolution of an exiting new dimension of use: EUS-guided surgical therapy.

As much as minimally invasive surgery has resulted in reduced scaring, shorter hospital stays and a favourable cost-benefit ratio compared to conventional surgery, the trend to even further minimize the surgical approach has lead to new, transgastric endoscopic procedures without any percutaneous access to the abdominal cavity [3] [4] [5] [6] [7] [8] [9].

Parallel to this new natural orifice transgastric endoscopic approach (NOTES) (10) the EUS-train has moved on to explore new territory of more invasive therapeutic use, where EUS serves as a guide for the transgastric assessment of organs within the peritoneal cavity without the need of direct access [11] [12] [13] [14]. But even if direct access was necessary, EUS can select pathology because of its unique ability to explore and visualize the inside of organs without direct viewing. This ability can be used to find and guide as where and which lesion should be endoscopically operated upon. This overview will describe some of the possible future EUS-guided techniques, which might evolve into routine procedures as soon as the necessary basic tools become commercially available.

References

• 1 Chang K J, Nguyen P T, Thompson J A, Kurosaki , Casey L R, Leung E C, Granger G A. 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;  88 325-335
• 2 Gunter E, Lingenfelser T, Eitelbach F, Muller H, Ell C. EUS-guided ethanol injection for treatment of GI stromal tumor.  Gastrointest Endosc. 2003;  57 13-115
• 3 Kalloo A N, Singh V K, Sanjay B, Jagannath S B, Niiyama H, Hill S L. Flexible transgastric peritoneoscopy: a novel approach to diagnosis and therapeutic intervention in the peritoneal cavity.  Gastrointest Endosc. 2004;  60 14-117
• 4 Ikeda K. Fritscher-Ravens A, Mosse CA, Mills T, Tajiri H, Swain CP. Endoscopic full-thickness resection with sutured closure in a porcine model.  Gastrointest Endosc.. 2005;  62 122-129
• 5 Hu B, Chung S CS, Sun L CL, Kawashima K, Yamamoto T, Cotton P B, Gostout C J, Hawes R H, Kalloo A, Kantsevoy S V, Pasricha P J. Transoral obesity surgery: Endoluminal gastroplasty with an endoscopic suture device.  Endoscopy. 2005;  37 411-414
• 6 Kantsevoy S V, Hu B, Jagannath S B, Vaughn C A, Beitler D M, Chung S S, Cotton P B, Gostout C J, Hawes R H, Pasricha P J, Magee C A, Pipitone L J, Talamini M A, Kalloo A N. Transgastric endoscopic splenectomy.  Is it possible? . 2006;  20 22-25
• 7 Kantsevoy S V, Jagannath S B, Niiyama H, Chung S S, Cotton P B, Gostout C J, Hawes R H, Pasricha P J, Magee C A, Vaughn C A, Barlow D, Shimonaka H, Kalloo A N. Endoscopic gastrojejunostomy with survival in a porcine model.  . 2005;  62 87-92
• 8 Bergstrom M, Ikeda K, Swain P, Park P O. Transgastric anastomosis by using flexible endoscopy in a porcine model.  Gastrointest Endosc.. 2006;  63 307-312
• 9 Park P O, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis.  Gastrointest Endosc. 2005;  61 1-6
• 10 Bowman D E. ASGE/SAGES working group on natural orifice translumenal endoscopic surgery: White paper October 2005.  Gastrointest Endosc. 2006 ;  63 199-203
• 11 Fritscher-Ravens , Mosse C A, Mukherjee D. et al . Translumenal Endosurgery: Single lumen access anastomosis device for flexible endoscopy.  Gastrointest Endosc. 2003;  58 585-591
• 12 Fritscher-Ravens A, Mosse C A, Mukherjee D. et al . Transgastric gastropexy and hiatus hernia repair for gastro-esophageal reflux disease under endoscopic ultrasound control: an experimental study in a porcine model.  Gastrointest Endosc. 2004;  59 89-95
• 13 Fritscher-Ravens A, Mosse C A, Mukherjee D, Swain C P. Balloon compression anastomosis at flexible endoscopy.  Gastrointest Endosc. 2003;  57 AB6
• 14 Fritscher-Ravens A, Mosse C A, Mills T N, Mukherjee D, Park P O, Swain C P. A through-the-scope device for suturing and tissue approximation under EUS control.  Gastrointest Endosc. 2002;  56 737-742
• 15 Fritscher-Ravens A, Mosse C A, Ikeda K, Swain P. Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance.  Gastrointest Endosc.. 2006;  63 302-306
• 16 Swain C P, Lichtenberg E, Spelde H, Fox B, Park P O, Bergstrom M, Ikeda K, Mosse C A, Fritscher-Ravens A. Double balloon anastomosis: transgastric gastro-jejunostomy. Gastrointest Endsoc in press
• 17 Fritscher-Ravens A, Mosse S, Mills T, Swain P. Endoscopic cholecystogastropexy, cholecystogastrostomy, and gall stone removal under endoscopic ultrasound control.  GUT. 2004;  53 (suppl. IV) A43
• 18 Thomson M, Fritscher-Ravens A, Hall S, Afzal N, Ashwood P, Swain C P. Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease.  GUT. 2004;  53 1745-1750
• 19 Low D, Anderson R P, Ilves R, Ricciardelli E, Hill L D. Fifteen- to twenty- year results after the Hill antireflux operation.  J Cardiovasc Surg. 1989;  98 444-450
• 20 Fritscher-Ravens A, Mosse A C, Ikeda K, Swain P. Interventional cardiac endoscopic ultrasound.  Gastrointest Endosc. 2005;  61 AB277