Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Clin J Gastroenterol. 2022 Feb;15(1):11-29. doi: 10.1007/s12328-021-01559-4. Epub 2022 Jan 14.
Endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to an advanced therapeutic modality. With the advent of better technologies and accessories, EUS has found ground in the management of gastrointestinal (GI) malignancies, not only for diagnosis but also for therapeutic purposes. EUS can tackle a host of conditions, including hepato-pancreatico-biliary malignancies. Advances and experience in various EUS-guided biliary drainage techniques have enabled the endosonologist to tackle biliary obstruction when conventional techniques of endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage (PTBD) fails. More and more emerging data not only establishes the safety of EUS-BD but also demonstrates superior efficacy over PTBD and sometimes even ERCP. Malignant gastric outlet obstruction can now be safely managed with EUS-guided gastroenterostomy. Starting from pain management in malignant tumors through celiac plexus neurolysis to various tumor ablative therapies, EUS has forged ahead over percutaneous treatment or surgical options in the management of GI malignancies. Additional data is now coming up on the prospects of EUS-guided immunotherapy and biological therapy for tumor management. The future of EUS therapeutics in the field of GI malignancies is bright. With increasing evidence, this modality becoming a key player in management of a host of complex clinical conditions arising out of GI malignancies is in the offing. This review focuses on elucidating the role of therapeutic EUS in the management of GI malignancies, a synopsis of various techniques, data on its safety and efficacy as well as future advancements in this domain.
内镜超声（EUS）已经从单纯的诊断工具发展成为一种先进的治疗方式。随着更好的技术和附件的出现，EUS 在胃肠道（GI）恶性肿瘤的治疗中找到了一席之地，不仅用于诊断，也用于治疗目的。EUS 可以治疗多种疾病，包括肝胰胆恶性肿瘤。各种 EUS 引导下胆道引流技术的进步和经验使内镜超声医师能够在传统的内镜逆行胰胆管造影术（ERCP）和/或经皮经肝胆道引流术（PTBD）失败时治疗胆道梗阻。越来越多的新数据不仅确立了 EUS-BD 的安全性，而且证明其在疗效上优于 PTBD，有时甚至优于 ERCP。现在，恶性胃出口梗阻可以通过 EUS 引导的胃造口术安全治疗。从恶性肿瘤的疼痛管理到腹腔神经丛松解术，再到各种肿瘤消融治疗，EUS 在 GI 恶性肿瘤的治疗中已经超越了经皮治疗或手术选择。现在有更多关于 EUS 引导免疫治疗和生物治疗用于肿瘤管理的前景的数据。EUS 治疗在 GI 恶性肿瘤领域的未来是光明的。随着越来越多的证据表明，这种方式在治疗一系列由 GI 恶性肿瘤引起的复杂临床疾病方面将成为关键因素。这篇综述重点阐述了治疗性 EUS 在 GI 恶性肿瘤治疗中的作用，概述了各种技术，以及其安全性和疗效的数据，以及该领域的未来进展。
