The Role of Endoscopic Ultrasound-Guided Procedures in the Diagnosis and Treatment of Pancreatic and Biliary Diseases

Abstract

Endoscopic ultrasound (EUS) has emerged as a critical tool in the diagnosis and management of pancreatic and biliary diseases, combining high-resolution imaging with the capability for tissue acquisition and therapeutic interventions. This technique leverages high-frequency ultrasound from within the gastrointestinal tract, enabling precise visualization of the pancreas, bile ducts, and surrounding structures. EUS-guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB) have transformed the diagnostic approach to pancreatic lesions, offering superior sensitivity and specificity compared to other modalities. In the realm of biliary diseases, EUS has proven invaluable in detecting microlithiasis, identifying biliary strictures, and differentiating benign from malignant conditions Therapeutically, EUS-guided procedures, including biliary drainage and celiac plexus neurolysis, have expanded the role of EUS beyond diagnosis. EUS-guided biliary drainage has emerged as an alternative to percutaneous transhepatic biliary drainage, particularly in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). The integration of novel techniques such as EUS-guided pancreatic duct drainage and ablation therapies for pancreatic cysts further highlights its therapeutic potential. Despite its advantages, the use of EUS is not without challenges, including operator dependency, complication risks, and equipment costs. Recent advancements aim to overcome these barriers, with innovations such as artificial intelligence (AI)-assisted EUS improving diagnostic accuracy and reducing operator variability. This paper reviews the role of EUS-guided procedures in the diagnosis and management of pancreatic and biliary diseases, highlighting their clinical applications, recent advancements, and potential future directions. By integrating imaging and intervention, EUS has significantly advanced patient care, providing minimally invasive solutions for complex conditions. Continued research and technological innovations are expected to further refine the efficacy and safety of EUS-guided techniques, reinforcing their position as a cornerstone in gastrointestinal endoscopy.