Endoscopic ultrasound-guided treatments: Are we getting evidence based - a systematic review

Table 1 Level of evidence per subject

Level of evidence	Ia	Ib	IIa	IIb	III	IV	Total
EUS-GD of pancreatic fluid collections	1	5	0	16	42	20	84
EUS-guided necrosectomy	1	1	0	0	15	3	20
EUS-guided cholangiography and biliary drainage	0	1	0	7	37	40	85
EUS-guided pancreatography and pancreatic duct drainage	0	0	0	0	9	6	15
EUS-guided gallbladder drainage	0	1	0	3	1	2	7
EUS-GD of abdominal (non-peripancreatic) and pelvic collections	0	0	0	2	3	2	7
EUS-guided Celiac Plexus Neurolysis or Block	4	7	1	5	16	19	52
EUS-guided ethanol ablation	0	1	0	5	13	9	28
EUS-guided tumor ablation	0	0	0	9	4	21	34
EUS-guided fiducial placement	0	0	0	2	10	14	26
EUS-guided vascular intervention	0	1	0	2	15	5	23
Total	6	17	1	51	165	141	381

EUS-GD: Endoscopic ultrasound-guided drainage.

Table 2 Endoscopic ultrasound-guided drainage of pancreatic fluid collections

Ref.	Design	Cases	Technical success	Clinical success	Recurrence	Complications1
Binmoeller et al[8]	RS	27	93%	78%	22%	52%
Pfaffenbach et al[9]	PS	11	91%	82%	18%	None
Giovannini et al[10]	PS	35	100%	89%	9%	3%
Norton et al[11]	RS	14	93%	93%	23%	14%
Vosoghi et al[12]	RS	14	100%	93%	7%	7%
Enya et al[13]	PS	13	100%	85%	0%	None
Hookey et al[14]	RS	32	96%	93%	12%	11%
Krüger et al[15]	PS	35	94%	88%	12%	33%
Azar et al[16]	RS	23	91%	82%	18%	4%
Antillon et al[17]	PS	33	94%	87%	4%	15%
Kahaleh et al[18]	PS	46	100%	93%	NR	19%
Ahlawat et al[19]	PS	11	100%	82%	18%	18%
Arvanitakis et al[20]	RCT	46	100%	94%	11%	22%
Lopes et al[21]	RS	51	94%	84%	17%	25%
Varadarajulu et al[22]	PS	23	100%	95%	0%	None
Lopes et al[23]	PS	31	100%	94%	19%	26%
Ardengh et al[24]	PS	77	94%	91%	11%	6%
Varadarajulu et al[25]	RS	20	100%	95%	NR	None
Varadarajulu et al[26]	RCT	24	100%	96%	NR	4%
Varadarajulu et al[27]	PS	60	95%	93%	4%	2%
Barthet et al[28]	PS	28	100%	89%	NR	25%
Talreja et al[29]	PS	18	100%	95%	0%	44%
Park et al[30]	RCT	39	95%	95%	6%	7%
Yasuda et al[31]	RS	26	92%	87%	17%	None
Itoi et al[32]	PS	13	100%	100%	0%	None
Varadarajulu et al[33]	PS	10	100%	90%	0%	None
Ang et al[34]	PS	10	100%	100%	0%	10%
Ahn et al[35]	RS	47	98%	100%	11%	11%
Jazrawi et al[36]	RS	10	100%	100%	10%	None
Sadik et al[37]	PS	26	100%	88%	4%	15%
Will et al[38]	PS	132	97%	96%	15%	29%
Seicean et al[39]	PS	24	83%	79%	0%	17%
Heinzow et al[40]	RS	42	88%	78%	21%	21%
Varadarajulu et al[41]	PS	148	100%	99%	NR	5%
Varadarajulu et al[42]	RS	602	100%	69%	0%	8%
Varadarajulu et al[43]	RS	20	100%	100%	5%	None
Zheng et al[44]	PS	14	90%	90%	0%	19%
Voermans et al[45]	RCT	52	100%	82%	9%	11%
Mangiavillano et al[46]	PS	21	86%	81%	14%	5%
Seewald et al[47]	RS	80	97%	83%	13%	26%
Itoi et al[48]	RS	15	100%	100%	0%	6%
Puri et al[49]	PS	40	100%	97%	2%	7%
Fabbri et al[50]	PS	20	100%	95%	5%	15%
Rasmussen et al[51]	RS	22	86%	86%	18%	18%
Khashab et al[52]	RS	10	100%	100%	0%	None
Penn et al[53]	PS	20	100%	85%	18%	15%
Weilert et al[54]	PS	18	100%	78%	NR	33%
Rana et al[55]	RS	202	100%	100%	0%	5%
Binmoeller et al[56]	RS	14	100%	79%	NR	21%
Nan et al[57]	RS	21	100%	100%	NR	5%
Kato et al[58]	RS	67	88%	83%	15%	1%
Künzli et al[59]	RS	108	97%	84%	18%	20%
Siddiqui et al[60]	RS	88	99%	79%	3%	30%
Rische et al[61]	RS	18	100%	94%	6%	33%
Varadarajulu et al[62]	RCT	20	100%	95%	0%	None
Total	55 studies	1867	97% (83%-100%)	90% (69%-100%)	8% (0%-23%)	17% (0%-52%)

¹Complications include: early and late, procedural and stent related;

²Only patients with walled-off pancreatic necrosis. RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported.

Table 3 Endoscopic ultrasound-guided necrosectomy

Ref.	Design	Cases	Technical success	Clinical success	Recurrence	Complications1
Seewald et al[70]	RS	13	100%	85%	15%	30%
Charnley et al[71]	RS	13	100%	92%	0%	None
Voermans et al[72]	RS	25	100%	93%	7%	40%
Hocke et al[73]	RS	30	97%	83%	3%	23%
Schrover et al[74]	RS	8	100 %	75%	12%	25%
Mathew et al[75]	RS	6	100%	100%	0%	None
Escourrou et al[76]	RS	13	100%	100%	0%	46%
Jürgensen et al[77]	RS	35	100%	97%	0%	17%
Bakker et al[78]	RCT	10	100%	100%	20%	40%
Will et al[79]	RS	18	100%	100%	11%	17%
Rische et al[61]	RS	22	100%	86%	14%	36%
Yamamoto et al[80]	RS	4	100%	50%	NR	25%
Hritz et al[81]	RS	4	100%	100%	0%	None
Yasuda et al[82]	RS	57	100%	75%	7%	33%
Ang et al[83]	RS	8	100%	87%	13%	None
Sarkaria et al[84]	RS	17	100%	88%	0%	6%
Total	16 studies	283	100% (97%-100%)	88% (50%-100%)	7% (0%-20%)	28% (0%-46%)

¹Complications include: early and late, procedural and stent related. RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported.

Table 4 Endoscopic ultrasound-guided cholangiography and biliary drainage

Ref.	Design	Cases	Technical success	Clinical success	Complications1
Bories et al[86]	RS	11	91%	80%	72%
Maranki et al[87]	RS	49	84%	80%	18%
Brauer et al[88]	PS	12	92%	72%	16%
Horaguchi et al[89]	PS	16	100%	94%	37%
Kim et al[90]	RS	15	80%	80%	None
Fabbri et al[91]	PS	16	75%	75%	8%
Park et al[92]	RS	57	96%	89%	47%
Hara et al[93]	PS	18	94%	94%	77%
Komaki et al[94]	RS	15	100%	100%	46%
Ramírez-Luna et al[95]	PS	11	91%	82%	18%
Shah et al[96]	RS	68	85%	85%	9%
Iwashita et al[97]	RS	40	73%	73%	12%2
Dhir et al[98]	RS	58	98%	98%	3%
Artifon et al[99]	RCT	13	100%	100%	15%
Song et al[100]	PS	15	87%	87%	47%
Kim et al[101]	PS	13	92%	84%	38%
Vila et al[102]	RS	106	70%	70%	23%
Horaguchi et al[103]	RS	21	100%	100%	10%
Hara et al[104]	PS	18	94%	89%	27%
Park et al[105]	PS	45	91%	87%	11%
Kawakubo et al[106]	RS	14	100%	100%	14%
Dhir et al[107]	RS	35	97%	97%	23%
Khashab et al[108]	RS	35	94%	91%	14%
Gornals et al[109]	RS	15	87%	73%	40%
Gupta et al[110]	RS	240	99%	87%	35%
Dhir et al[111]	RS	68	97%	97%	21%3
Kawakubo et al[112]	RS	64	95%	95%	42%
Total	27 studies	1088	91% (70%-100%)	87% (70%-100%)	29% (3%-77%)

¹Complications include: early and late, procedural- and stent-related;

²2.5% mortality (1 patient );

³4% mortality (3 patients). RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported.

Table 5 Endoscopic ultrasound-guided pancreatography and pancreatic duct drainage

Ref.	Design	Cases	Technical success	Clinical success	Complications1
Will et al[114]	RS	12	100% (SPDD: 67%)	50%	43%
Tessier et al[115]	RS	36	92% (SPDD: 92%)	69%	55%
Kahaleh et al[116]	RS	13	100% (SPDD: 77%)	77%	15%
Barkay et al[117]	RS	21	86% (SPDD: 48%)	86%	10%
Ergun et al[118]	RS	20	100% (SPDD: 90%)	72%	20%
Shah et al[96]	RS	25	100% (SPDD: 86%)	100%	16%
Vila et al[102]	RS	19	58% (SPDD: NR)	NR	26%
Kurihara et al[119]	RS	14	100% (SPDD: 93%)	93%	7%
Fujii et al[120]	RS	45	98% (SPDD: 73%)	53%	24%
Total	9 studies	205	100% (58%-100%)	74.5% (53%-100%)	20%(7%-55%)

¹Complications include: early and late, procedural and stent related. SPDD: Successful pancreatic duct drainage; RS: Retrospective study; NR: Not reported.

Table 6 Endoscopic ultrasound-guided drainage of gallbladder

Ref.	Design	Cases	Technical success	Clinical success	Complications1
Baron et al[121]	CR	1	100%	100%	None
Kwan et al[122]	RS	3	100%	100%	33%
Lee et al[123]	PS	9	100%	100%	11%
Takasawa et al[124]	CR	1	100%	100%	None
Kamata et al[125]	CR	1	100%	100%	None
Kamata et al[126]	CR	1	100%	100%	None
Song et al[127]	PS	8	100%	100%	37%
Súbtil et al[128]	RS	4	100%	100%	25%
Itoi et al[129]	CR	2	100%	100%	None
Jang et al[130]	PS	15	100%	100%	13%
Jang et al[131]	RCT	30	97%	97%	7%
Itoi et al[48]	RS	5	100%	100%	None
Itoi et al[132]	CR	1	100%	100%	None
de la Serna-Higuera et al[133]	RS	13	85%	85%	15%
Widmer et al[134]	RS	3	100%	100%	None
Total	15 studies	97	100% (85%-100%)	100% (85%-100%)	0% (0%-37%)

¹Complications include: early and late, procedural and stent related. RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; CR: Case report.

Table 7 Endoscopic ultrasound-guided drainage of non-peripancreatic and pelvic collections

Ref.	Design	Cases	Technical success	Clinical success	Complications1
Attwell et al[135]	CR	1	100%	100%	None
Giovannini et al[136]	PS	12	100%	75%	25%
Seewald et al[137]	CR	2	100%	100%	None
Seewald et al[138]	CR	1	100%	100%	None
Kahaleh et al[139]	CR	2	100%	100%	None
Lee et al[140]	CR	1	100%	100%	None
Jah et al[141]	CR	1	100%	100%	None
Shami et al[142]	RS	5	100%	100%	None
Ang et al[143]	CR	1	100%	100%	None
Piraka et al[144]	PS	7	100%	100%	28%
Noh et al[145]	PS	3	100%	100%	None
Puri et al[146]	RS	14	100%	93%	None
Itoi et al[147]	CR	1	100%	100%	None
Decker et al[148]	CR	1	100%	100%	None
Gupta et al[149]	RS	20	90%	90%	35%
Ulla-Rocha et al[150]	RS	6	100%	100%	None
Varadarajulu et al[151]	CR	1	100%	100%	None
Knuth et al[152]	CR	1	100%	100%	None
Ramesh et al[153]	RS	38	100%	87%	None
Luigiano et al[154]	CR	2	100%	100%	None
Total	20 studies	120	100% (90%-100%)	100% (75%-100%)	0% (0%-35%)

¹Complications include: early and late, procedural and stent related. PS: Prospective study; RS: Retrospective study; CR: Case report.

Table 8 Endoscopic ultrasound-guided plexus neurolysis/celiac plexus block n (%)

Ref.	Design	Indications	Techniques	Technical success	Clinical success (pain relief)	Complications
Wiersema et al[167]	RS	PC (n = 25)	CPN	100%	79%-88%	4 transient diarrhea
		Metastases (n = 5)
Gress et al[163]	RCT	CP (n = 10)	EUS-guided	100%	50%	None
		CP (n = 8)	CT-guided		25%
Gunaratnam et al[168]	PS	PC (n = 58)	CPN	100%	78%	5 transient abdominal pain
Gress et al[169]	PS	CP (n = 90)	CPB	100%	55%	3 diarrhea
Tran et al[170]	RS	PC (n = 10)	CPN	100%	70%	NR
Ramirez-Luna et al[171]	RS	PC (n = 11)	CPN	100%	72.20%	None
Levy et al[172]	RS	PC (n = 18)	CGN (n = 17)	NR	16/17 (94)	12 hypotension
			CGB (n = 1)		0/1 (0)	6 diarrhea
		CP (n = 18)	CGN (n = 5)	NR	4/5 (80)
			CGB (n = 13)		5/13 (38)
O'Toole et al[173]	RS	PC (n = 2)	CPB (n = 189)	NR	NR	2 post-procedural pain
		CP (n = 187)				1 retroperitoneal abscess
		PC (n = 21)	CPN (n = 31)	NR	NR	1 hypotension
		CP (n = 10)
Santosh et al[164]	RCT	CP (n = 27)	EUS-CPB	100%	70%	2 diarrhea
		CP (n = 29)	Percutaneous-CPB	-	30%
Leblanc et al[165]	RCT	CP (n = 23)	CPB (central)	100%	15/23 (65)	None
		CP (n = 27)	CPB (bilateral)		16/27 (59)
Sahai et al[174]	RS	PC (n = 34)/CP (n = 37)	Central CPN	100%	45.90%	1 adrenal artery bleeding
		PC (n = 45)/CP (n = 44)	Bilateral CPN		70.40%
Sakamoto et al[175]	PS	PC (n = 67)	34CPN	100%	72%-79%	None
			33 BPN	96.90%	19%-78%
Wyse et al[158]	RCT	PC (n = 96)	48 CPN	100%	60.70%	None
			48 control	-	-
LeBlanc et al[160]	RCT	PC (n = 29)	CPB (central)	100%	20/29 (69)	None
		PC (n = 21)	CPB (bilateral)		17/21 (81)
Téllez-Ávila et al[161]	RS	PC (n = 53)	Central (n = 21)	NR	10/21 (48)	None
			Bilateral (n = 32)		18/32 (56)
Iwata et al[176]	RS	PC (n = 47)	CPN	100%	68.10%	NR
Ascunce et al[177]	RS	PC (n = 64)	CPN	100%	50%	1 hypotension
Stevens et al[166]	RCT	CP (n = 40)	Triamcinolone + bupivacaine (n = 21)	100%	68.4%-85.7%	1 severe hypertension
			Bupivacaine (n = 19)			4 pain exacerbation
						1 gastric hematoma
Wiechowska-Kozlowska et al[178]	RS	PC (n = 29)	CPN	100%	86%	3 diarrhea
						1 hypotonia
						2 post-procedural pain
Wang et al[179]	PS	PC (n = 23)	Celiac ganglion irradiation	100%	82.60%	None
Leblanc et al[180]	PS	PC (n = 20)	10 mL (n = 10)	100%	80%	3 nausea and vomiting
			20 mL (n = 10)		100%	2 diarrhea
						1 lightheadness
Seicean et al[181]	PS	PC (n = 32)	CPN	100%	75%	NR
Doi et al[162]	RCT	PC (n = 68)	CPN (n = 34)	100%	45.50%	1 GI bleeding
			CGN (n = 34)	88.20%	73.50%	3 hypotension
						5 diarrhea
						17 pain exacerbation
Total	23 studies	1327	-	100% (88.2%-100%)	71.9% (45.5%-90%)	-

RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; PC: Pancreatic cancer; CP: Chronic pancreatitis; CPN: Celiac plexus neurolysis; CPB: Celiac plexus block; CT: Computed tomography; CGB: Celiac ganglia block; CGN: Celiac ganglia neurolysis; NR: Not reported.

Table 9 Serious adverse events of endoscopic ultrasound-guided celiac plexus neurolysis/celiac plexus block

Ref.	Journal	Year	Complication	Indication	Technique
Gress et al[247]	Gastrointest Endosc	1997	1 retroperitoneal bleeding	CP	EUS-CPN
			1 retroperitoneal abscess	CP	EUS-CPB
Mahajan et al[248]	Gastrointest Endosc	2002	3 empyema	CP	EUS-CPB
Muscatiello et al[249]	Endoscopy	2006	1 retroperitoneal abscess	PC	EUS-CPN
Sahai et al[174]	Am J Gastroenterol	2009	1 retroperitoneal bleeding	CP	EUS-CPB
O’Toole et al[173]	Endoscopy	2009	1 retroperitoneal abscess	CP	EUS-CPB
Ahmed et al[250]	Endoscopy	2009	1 ischemia	CP	EUS-CPN
Shin SK et al[251]	Korean J Pain	2010	1 ejaculatory failure	CP	EUS-CPB
Lalueza et al[252]	Endoscopy	2011	1 brain abscess	CP	EUS-CPN
Gimeno-Garcia et al[253]	Endoscopy	2012	1 ischemia/death	CP	EUS-CPN
Fujii et al[254]	Endoscopy	2012	1 spinal cord infarction/paralysis	PC	EUS-CPN-G
Mittal et al[255]	Neurology	2012	1 spinal cord infarction/paralysis	PC	EUS-CPN-G
Loeve et al[256]	Gastrointest Endosc	2013	1 gastric necrosis/death	PC	EUS-CPN
Jang et al[257]	Clin Endosc	2013	1 hepatic-bowel infarction/death	PC	EUS-CPN
Doi et al[162]	Endoscopy	2013	1 GI bleeding (puncture site)	PC	EUS-CGN

CP: Chronic pancreatitis; PC: Pancreatic cancer; CPN: Celiac plexus neurolysis; CPB: Celiac plexus block.

Table 10 Endoscopic ultrasound-guided ethanol injection of abdominal solid and cystic tumors

Ref.	Design	Indications	Lesion size (mm)	Techniques	Clinical success	Complications
Gan et al[187]	PS	Pancreatic cystic lesions (n = 25)	6-30	Ethanol	35%	None
Oh et al[185]	PS	Pancreatic cystic lesions (n = 14)	17-52	Ethanol and paclitaxel	79%	1 acute pancreatitis
						6 hyperamylasemia
						1 abdominal pain
Oh et al[182]	PS	Septated pancreas cysts (n = 10)	20-68	Ethanol and paclitaxel	60%	1 acute pancreatitis
DeWitt et al[183]	RCT	Pancreatic cystic lesions (n = 42)	10-58	Ethanol vs saline	33%	1 acute pancreatitis
						5 abdominal pain
						1 cystic bleeding
DeWitt et al[184]	PS	Pancreatic cystic lesions (n = 12)	10-50	Ethanol	75% at follow-up	-
Oh et al[186]	PS	Pancreatic cystic lesions (n = 52)	17-68	Ethanol and paclitaxel	62%	1 acute pancreatitis
						1 abdominal pain
						1 fever
						1 splenic vein thrombosis
DiMaio et al[189]	RS	Pancreatic cystic lesions (n = 13)	20.1 ± 7.1	Ethanol (single/multi)	38%	1 abdominal pain
Oh et al[190]	RS	Pancreatic cystic lesions (n = 1)	5.2	Ethanol 99% 28 mL + paclitaxel	Failure, underwent surgery	Portal vein thrombosis
Jurgensen et al[192]	RS	Pancreatic NET (n = 1)	13	Ethanol 95% 8 mL	Complete remission	Pain + lipase increase
Muscatiello et al[193]	RS	Pancreatic NET (n = 1)	11 and 7	Ethanol 40% 2 mL	No recurrence at 18 mo	Small pancreatic necrosis
Deprez et al[194]	RS	Pancreatic NET (n = 1)	13	Ethanol 98% 3.5 mL	Complete remission	Hematoma and duodenal ulcer
Vleggaar et al[195]	RS	Pancreatic NET (n = 1)	10	Ethanol 96% 0.3 mL	Asymptomatic at 6 mo	None
Levy et al[191]	RS	Pancreatic NET (n = 5)	8-21	Ethanol 95-99% 0.1-3 mL	60% symptoms resolution	None
Barclay et al[196]	RS	Solid Hepatic Metastasis (n = 1)	33	Ethanol 98% 6 mL	Good condition at 5.5 yr	Liver hematoma
Gunter et al[197]	RS	GI stromal tumor (n = 1)	40	Ethanol 95%	Complete remission	Abdominal pain
				1.5 mL		Mucosal ulceration
Hu et al[198]	RS	Liver metastasis (n = 1)	35	Ethanol 100% 10 mL	Local control and decrease in size	Fever
Artifon et al[199]	RS	Left adrenal metastasis (n = 1)	50	Ethanol 98% 15 mL	Palliation of related pain	None
DeWitt et al[200]	RS	Metastatic lymph node (n = 1)	10-11	Ethanol	Locally successful	None
				4 + 2 mL
Total (cystic lesion)	8 studies	169 patients	6-68	-	60% (33%-79%)	-

RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported; NET: Neuroendocrine tumor.

Table 11 Endoscopic ultrasound-guided tumor ablation

Ref.	Design	Indications	Techniques	Type	Tumor response	Complications
Chang et al[202]	PS	Pancreatic cancer (n = 8)	Injection	Cytoimplant	2 partial;	None
					1 minor
Hecht et al[203]	PS	Pancreatic cancer (n = 21)	Injection	ONYX-015 + iv gemcitabine	2 partial;	2 sepsis
					2 minor;	2 duodenal perforations
					6 stable;
					11 progression
Chang et al[211]	RS	Pancreatic cancer (n = 1)	Injection	TNFerade + chemoradiotx	Surgical resection	None
Hecht et al[205]	PS	Pancreatic cancer (n = 50)	Injection (27 EUS-guided)	TNFerade + chemoradiotx	1 complete;	6 GI bleeding
					3 partial;	6 deep vein thrombosis
					4 minor;	2 pulmonary embolism
					12 stable	2 pancreatitis
						6 cholangitis
Irisawa et al[204]	PS	Pancreatic cancer (n = 7)	Injection	Immature dendritic cells	2 mixed;	None
					2 stable;
					3 progressive
Hanna et al[207]	PS	Pancreatic cancer (n = 9)	Injection (6 EUS-guided)	BC-819 + chemoradiotx	2 surgically resectable;	None
					3 partial
Chang et al[206]	PS	Esophageal cancer (n = 24)	Injection	TNFerade	6 complete;	5 thromboembolic events (highest dose)
					2 stable
Arcidiacono[208]	PS	Pancreatic cancer (n = 22)	Cryothermal Ablation	EUS-CTP	6 partial response (only 6 patients analyzed)	3 hyperamylasemia
Maier et al[212]	PS	Head/neck cancer (n = 21)	Brachytx	Ir-192 needles	4 full;	None
					15 partial;
					3 none
Lah et al[213]	RS	Metastatic celiac lymph nodes (n = 1)	Brachytx	I-125 seeds	Response	None
Martinez-Monge et al[214]	RS	Metastatic mediastinal lymph node (n = 1)	Brachytx	I-125 seeds	Response	None
Sun et al[209]	PS	Pancreatic cancer (n = 15)	Brachytx	I-125 seeds	4 partial;	1 site infection
					3 minor;	3 hematologic side effects
					5 stable;
					3 progressive
Jin et al[210]	PS	Pancreatic cancer (n = 22 )	Brachytx	I-125 seeds	4 partial;	1 seed migration
					10 stable

RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported; CTP: Cryothermal probe; GI: Gastrointestinal.

Table 12 Endoscopic ultrasound-guided fiducial placement n (%)

Ref.	Design	Indications	Techniques	Technical success	Needle	Complications
Pishvaian et al[215]	PS	Abdominal/mediastinal cancer (n = 13)	Fiducial placement	11/13 (84.6)	19 Gauge	1 infection
Varadarajulu et al[222]	RS	Pancreatic cancer (n = 9)	Fiducial placement	9/9 (100)	NR	None
DiMaio et al[223]	RS	Abdominal/mediastinal cancer (n = 30)	Fiducial placement	29/30 (97)	22 Gauge	None
Sanders et al[217]	PS	Pancreatic cancer (n = 51)	Fiducial placement	46/51 (90)	19 Gauge	1 mild pancreatitis
Park et al[216]	PS	Pancreatic cancer (n = 57)	Fiducial placement	50/57 (88)	19 Gauge	None
Ammar et al[224]	RS	Abdominal cancer/lymph nodes (n = 13)	Single fiducial marker	9/9 trans-gastric	22 Gauge	None
				4/4 trans-duodenal
Varadarajulu et al[225]	PS	Pancreatic cancer (n = 2)	Fiducial placement	2/2 (100)	19 Gauge flexible	None
Khashab et al[218]	RS	Pancreatic cancer (n = 39)	Fiducial placement (traditional vs coiled)	39/39 (100)	19 and 22 Gauge	None
Law et al[226]	RS	Small pancreatic NET (n = 2)	Fiducial placement	2/2 (100)	22 Gauge	None
Majumder et al[219]	RS	Pancreatic cancer (n = 39)	Fiducial placement	35/39 (89.7)	19 Gauge	1 mild pancreatitis
						4 abdominal pain
Yang et al[220]	RS	Prostate cancer (n = 16)	Fiducial placement	16/16 (100)	19 Gauge	None
Yang et al[221]	RS	Prostate cancer recurrence (n = 6)	Fiducial placement	6/6 (100)	19 Gauge	None
Trevino et al[227]	RS	Rectal cancer (n = 1)	Fiducial placement	3/3 (100)	19 Gauge (forward-view EUS)	None
Total	13 studies	278	-	100% (84.6%-100%)	-	0%

RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported; NET: Neuroendocrine tumor:

Table 13 Endoscopic ultrasound-guided vascular interventions n (%)

Ref.	Design	Indications	Techniques	Technical success	Rebleeding	Complications
Fockens et al[229]	RS	Dieulafoy’s lesion (n = 4)	Polidocanol injection	4/4 (100)	2/4 (50)	None
Levy et al[234]	RS	Dieulafoy’s lesion (n = 1)	Alcohol 99% injection	1/1 (100)	No	None
Gonzalez et al[235]	RS	Dieulafoy’s lesion (n = 2)	Polidocanol	2/2 (100)	No	None
			or CYA injection
Levy et al[234]	RS	Various (n = 4)	Alcohol 99% or CYA injection	4/4 (100)	No	None
Gonzalez et al[235]	RS	Pseudo-aneurysm (n = 3)	CYA injection	3/3 (100)	No	None
Gonzalez et al[235]	RS	Gastric varices (n = 2)	CYA injection	2/2 (100)	No	None
Lee et al[231]	RS	Gastric varices (n = 101)	EUS-assisted CYA injection	-	Early 4/54 (7.4)	None
					Late 10/54 (18)
Lahoti et al[236]	RS	Esophageal varices (n = 5)	Sclerotherapy	5/5 (100)	No	1 esophageal stricture
Romero-Castro et al[237]	RS	Gastric varices (n = 5)	CYA injection	5/5 (100)	No	None
De Paulo et al[230]	RCT	Esophageal varices (n = 50)	Endo vs EUS-guided CYA injection	24/25 (96)	2/24 recurrence of varices (8.3)	None
Levy et al[238]	RS	Choledochojejunal anastomotic varices (n = 1)	Coil embolization	1/1 (100)	No	None
Romero-Castro et al[239]	RS	Gastric varices (n = 4)	Coil embolization	3/4 (75)	No	None
Binmoeller et al[233]	RS	Gastric varices (n = 30)	CYA injection + coil embolization	30/30 (100)	4/24 (16.6)	None
Romero-Castro et al[232]	RS	Gastric varices (n = 30)	CYA injection (n = 19) vs coils (n = 11)	97.4 % vs 90.9%	NR	9 CYA embolization;
						1 chest pain; 1 fever;
						1 variceal bleeding
Weilert et al[240]	RS	Rectal varices (n = 1)	CYA injection plus coils	100%	No	None
Gonzalez et al[241]	RS	Splenic artery aneurism (n = 1)	CYA injection	1/1 (100)	No	None
Roberts et al[242]	RS	Visceral pseudoaneurysm (n = 1)	HistoAcryl injection	1/1 (100)	No	None
Roach et al[243]	RS	SMA aneurysm (n = 1)	Thrombin injection	1/1 (100)	No	None
Chaves et al[244]	RS	SMA aneurysm (n = 1)	Thrombin injection	1/1 (100)	No	None
Robinson et al[245]	RS	Splenic artery aneurysm (n = 1)	Thrombin injection	1/1 (100)	No	None
Lameris et al[246]	RS	Visceral pseudoaneurysm (n = 1)	Thrombin + collagen injection	1/1 (100)	No	None

RCT: Randomized controlled trial; PS: Prospective study; RS: Retrospective study; NR: Not reported; CYA: Cyanoacrylate; SMA: Superior mesenteric artery.