Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach?

Pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology, as they would sometimes require multi-approach interventionalprocedures. Recently, therapeutic interventional endoscopic ultrasound (EUS) hasemerged as a potential alternative to surgical or percutaneous approaches.Unfortunately, considering the high cost of EUS, lack of facility and expertise,most gastroenterologists still often refer cases to undergo surgical interventionswithout contemplating the possibility of utilizing EUS first. EUS-guided biliarydrainage has become one of the best choices for establishing access to biliarysystem, given the clear visualization of pancreas, gallbladder, and common bileduct. Although there are still only a few studies which directly compare EUSguided and surgical approaches for biliary drainage, current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and reintervention rates, with similarly high technical and clinical success ratescompared to percutaneous and surgical approaches, especially in patients withhistory of failed endoscopic retrograde cholangiopancreatography attempt.Comparable success rates with shorter length of hospital stay between endoscopicand surgical approaches have also been exhibited for pancreatic pseudocysts andwalled-off necrosis. Recent findings about the progress of EUS approach ingastroenterostomy/jejunostomy also indicated a promising potential of EUS, as aless invasive approach, for managing gastric outlet obstruction.