Endoscopic ultrasound (EUS) is moving past its traditional role as a diagnostic imaging and sampling tool toward enabling early disease detection, molecular profiling, and personalized treatment, according to a comprehensive review published in Gastroenterology.
The review, led by Michael B. Wallace, MD, MPH, the Fred C. Andersen Professor of Medicine in the Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville, Fla., describes how new technologies and workflows spanning molecular assays, advanced needle designs, and artificial intelligence (AI) are redefining the diagnostic potential of EUS across gastrointestinal and hepatobiliary diseases.
“In the past five years or so, there’s been a great deal of appropriate attention paid to therapeutic interventions of endoscopic ultrasound, particularly because we’ve seen such a dramatic shift in therapeutic options with the advent of lumen-apposing metal stents, and radiofrequency ablation in particular,” Dr. Wallace told GI & Hepatology News. “I think the advances in diagnostic endoscopic ultrasound have been underappreciated, a little bit overshadowed by those advances. So, I think that this is a very timely review.”
Highlights from the article, which Dr. Wallace assembled with coauthors Shounak Majumder, MD, of the Division of Gastroenterology and Hepatology at Mayo Clinic, Rochester, Minn.; Peter Storz, PhD, of the Division of Gastroenterology and Hepatology at Mayo Clinic, Jacksonville; and Jeanin E. van Hooft, MD, PhD, of the Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands, include the following:
Pancreatic and functional testing
In chronic pancreatitis (CP), EUS remains the preferred diagnostic modality when computed tomography or magnetic resonance imaging findings are inconclusive. Secretin-stimulated endoscopic pancreatic function testing (ePFT) can complement morphologic evaluation by measuring bicarbonate concentration in duodenal fluid to diagnose exocrine pancreatic insufficiency.
A prospective study cited in the review involving 145 patients with suspected early CP found diagnostic concordance between EUS and ePFT in 88 cases, allowing CP to be confidently confirmed or excluded. However, discordant findings limited certainty. The authors noted that added procedural time and interpretive expertise have restricted ePFT’s broader adoption.