A review of emerging endoscopic ultrasound (EUS) technologies highlights three developments aimed at improving tissue acquisition, procedural safety, and precision medicine: the EndoFix Tissue Fixation System, the InstaFan multi-needle biopsy device, and two motorized biopsy platforms, EndoDrill and Precision-GI.
EndoFix introduces suture-based tissue fixation before lumen-apposing metal stent (LAMS) placement. Used in EUS-guided gallbladder drainage, it is designed to maintain apposition between adjacent structures and potentially reduce leakage, stent migration, and misdeployment. The device received FDA approval in 2025.
InstaFan deploys five needles through a single puncture — one central 22-gauge fine needle biopsy (FNB) and four peripheral 25-gauge fine needle aspiration (FNA) needles — to sample multiple regions of a lesion. This may increase tissue volume and capture tumor heterogeneity while reducing repeated punctures.
EndoDrill and Precision-GI use motorized rotational mechanisms to obtain larger tissue cores. The review describes their potential to improve specimen integrity and provide sufficient material for molecular profiling, RNA and whole-genome sequencing, and patient-derived organoid development.
Why it matters: EUS needle innovation is moving beyond obtaining a diagnosis toward collecting high-quality tissue for precision oncology and translational research. These technologies could expand the role of EUS in both diagnostic and therapeutic procedures, although their clinical evidence remains at an early stage.