EUS-guided fine-needle injection/indwelling

To date, there are many reports of therapeutic interventional EUS. Especially, EUS-guided therapy as delivery system (injection/indwelling) is the most challenging/exciting filed. Anti-tumoral EUS-guided injection therapy, with its minimally invasive access for anti-tumoral agent delivery, is divisible into three categories: physicochemical, molecular biological, and immunological. Anti-tumoral physicochemical therapy includes ablation (ethanol injection for cystic tumor), chemotherapy (using gelled paclitaxel), and brachytherapy. Molecular biological and immunological therapies were performed as clinical trial. Pancreatic cancer (PC) is considered a systemic disease even if there was no visible metastasis on imaging modalities. From this point of view, immunological therapy stands to reason. We performed intratumoral injection of the immature dendritic cells in patients with advanced PC. Though these patients were stage IVb with refractory to gemcitabine, the median survival period was 9.9 months. Another study showed the usefulness of a combination therapy of gemcitabine with immunotherapy for locally advanced PC. Recently, EUS-guided coiling therapy for gastric varices (GV) was developed. Several report showed the EUS-guided deployment of coils in the perforating feeding vein is more effective and safe than cyanoacrylate injection. We also performed this technique for isolated GV, and confirmed its feasibility with safety and effectiveness. This technique is expected as new treatment for GV. EUS-guided intervention has opened new and exciting clinical applications in the management of various digestive diseases.