Gastrointestinal imaging: Endoscopic ultrasound

EUS is now firmly established as the investigation of choice in the locoregional staging of several gastrointestinal tumors and submucosal masses. In some situations, it is recommended that combination of information from other imaging modalities with EUS findings is needed to maximize accuracy. However, the increasing use of EUS-guided FNA should improve the accuracy of EUS as a stand-alone investigation. Other advances have been made in the diagnosis of chronic pancreatitis with EUS, especially patients with early changes. EUS may also emerge as the investigation of choice in patients with biliary pancreatitis of low to moderate risk of persistent choledocholithiasis. EUS staging of lung cancer is very accurate, and undoubtedly EUS will continue to be used more and more for this indication. With the increasing use of EUS FNA, other potential therapeutic applications of EUS were developed, and some of these show great promise. As technical advances are made with scope design, accessory devices, and probes, it is likely that many of these potential therapeutic applications will become routine procedures. The discipline of EUS intervention is a young one, and other new therapeutic advances are a certainty. EUS has matured over the last few years as a pivotal investigation in many disorders of the gastrointestinal tract and mediastinum. Recognition of this has finally led to a wider availability of EUS in clinical practice, and undoubtedly EUS will be regarded over the next few years as a standard investigation rather than one of intellectual curiosity.