• Endoscopic ultrasound
• Endoscopic ultrasound-guided biopsy
• Endoscopic ultrasound-guided drainage
• Pancreatic cancer
• Pancreatitis

• Gastric varices
• Gastrointestinal bleeding
• Portal pressure gradient measurement
• Portal vein
• Pseudoaneurysm
• Vascular intervention

• NVUGIB
• endoscopic ultrasound
• hemostasis
• refractory bleeding
• treatment

• Dieulafoy
• EUS
• bleeding
• endotherapy
• hemostasis
• pseudoaneurysm

• EUS-Guided Gallbladder Drainage (EUS-GBD)
• EUS-Guided Gastroenterostomy (EUS-GE)
• EUS-Guided Pancreatic Fluid Collection Drainage (EUS-PFC Drainage)

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

• Endosonography
• Esophageal and gastric varices
• Portal pressure

The continued need to develop minimally invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. EUS has now stepped into the therapeutic arena. EUS provides the unique advantage of both real-time imaging and access to structures within and adjacent to the gastrointestinal (GI) tract. Hence, EUS-guided therapeutic techniques continue to evolve in several directions enabling a variety of minimally invasive therapies for pancreatic and biliary pathologies. Furthermore, the close proximity of the GI tract to vascular structures in the mediastinum and abdomen permits EUS-guided vascular access and therapy. Studies have demonstrated several EUS-guided vascular interventions by using standard endoscopic accessories and available tools from the interventional radiology armamentarium. This article provides an overview of the literature including clinical and nonclinical studies for the management of nonvariceal and variceal GI bleeding, formation of intrahepatic portosystemic shunts (IPSS), and EUS-guided cardiac access and therapy.

• Coil Embolization
• Cyanoacrylate Injection
• Interventional Endoscopic Ultrasound
• Refractory GI Bleeding

Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience.

• Severe acute pancreatitis
• Complications
• Necrosectomy
• Percutaneous drainage
• Endoscopy
• Laparoscopy

• Drainage/methods
• Endoscopy, Digestive System/adverse effects
• Endoscopy, Digestive System/mortality
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreatectomy/mortality
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/mortality
• Pancreatitis, Acute Necrotizing/surgery
• Postoperative Complications/etiology
• Severity of Illness Index
• Treatment Outcome

Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.

• Endoscopic ultrasound-guided drainage
• Endoscopic ultrasound-guided intervention
• Endosonography
• Therapeutic endoscopy

• Celiac plexus neurolysis
• Endoscopic ultrasound
• Fine needle injection
• Levels of evidence
• Necrosectomy
• Pseudocyst drainage

• Catheter Ablation
• Cholangiography
• Digestive System Diseases/diagnostic imaging
• Digestive System Diseases/therapy
• Digestive System Surgical Procedures
• Drainage
• Endoscopy, Digestive System
• Endosonography
• Endovascular Procedures
• Ethanol/administration & dosage
• Evidence-Based Medicine
• Humans
• Injections
• Nerve Block
• Patient Selection
• Predictive Value of Tests
• Treatment Outcome
• Ultrasonography, Interventional

Endoscopic ultrasound (EUS) is continuously stepping into the therapeutic arena, simultaneously evolving in different directions, such as the management of pancreatic and biliary diseases, celiac neurolysis, delivering local intratumoral therapy, and EUS-guided endosurgery. EUS-guided vascular procedures are also challenging, considering the variety of vascular pathology, proximity of the vascular structures to the GI tract wall, high resolution, and real-time guidance offering an attractive access route and precise delivery of the intervention. The literature on vascular therapeutic EUS demonstrates techniques for the management of upper GI variceal and nonvariceal bleeding, pseudoaneurysms, and coiling and embolization procedures, as well as the creation of intrahepatic portosystemic shunts. The paucity of studies, diversity of study designs, and the number of animal model studies hamper a systematic approach to the conclusion and decision making important to clinicians and healthcare policy makers. Nevertheless, theoretical benefits and findings up to date concerning technical feasibility, efficacy, and safety of the procedures drive further research and development in this rather young therapeutic arena.