Therapeutic endoscopic ultrasound for biliary and pancreatic disorders.

The role of endoscopic ultrasound (EUS) has greatly expanded since the first clinical examination performed nearly 30 years ago. The introduction of linear instruments allowed tissue sampling (Kulesza and Eltoum Clin Gastroenterol Hepatol 5:1248-1254, 2007; Levy and Wiersema Gastrointest Endosc 62:417-426, 2005) and therapeutic interventions applications, including celiac plexus and ganglia blockade and neurolysis (Wiersema and Wiersema Gastrointest Endosc 44:656-662, 1996; Levy and Wiersema Gastroenterol Clin North Am, 35:153-165, 2006; Levy et al. Am J Gastroenterol 103:98-103, 2008), pancreatic fluid drainage (Lopes et al. Arq Gastroenterol 45:17-21, 2008; Norton et al. Mayo Clin Proc 76:794-798, 2001; Kruger et al. Gastrointest Endosc 63:409-416, 2006; Seifert et al.: Endoscopy 32:255-259, 2000), cholecystenterostomy (Kwan et al. Gastrointest Endosc 66:582-586, 2007), and delivery of cytotoxic agents (eg, chemotherapy, radioactive seeds, and gene therapy) (Chang et al.: Cancer 88:1325-1335, 2000; Chang Endoscopy 38(Suppl 1):S88-S93, 2006). The continued need to develop less invasive alternatives to surgical and interventional radiologic therapies drove the development of EUS-guided methods for biliary and pancreatic intervention. This article reviews existing data and focuses on established and emerging EUS techniques for accessing and draining the bile and pancreatic ducts.