Endoscopic ultrasound, the one-stop shop for abdominal pain?

The Endosonography for Right Sided and Acute Upper Intestinal Misery (EFRAIM) study indicates that the yield of endoscopic ultrasound (EUS) is equivalent if not superior to upper endoscopy combined with transabdominal ultrasound in patients presenting with acute discomfort. Furthermore, this strategy may be more cost effective as EUS simultaneously enables assessment of intraluminal disease as well as extra intestinal pathology. These results are in sync with prior studies demonstrating the hegemony of EUS in the assessment of pancreaticobiliary disease and its role in the assessment of enigmatic chronic abdominal pain. Nevertheless, EUS does not permit assessment for appendicitis or genitourinary catastrophe. Thus a careful history and physical examination to localize pain to the right upper quadrant and epigastrium is essential.