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Moving EUS forward-viewing ready for prime time.pdf
EDITORIAL
Moving EUS forward-viewing: ready for prime time?
The development of curved linear-array echoendoscopes (CLA-EEs) with the ability of performing real-time EUS-guided FNA has been a major breakthrough,1 which has transformed EUS from a pure imaging modality into a more interventional one. Thereafter, the precision of EUS in targeting adjacent organs and then thrusting a needle into them has stimulated investigators to explore EUS not only for tissue acquisition, but also for more advanced and complex therapeutic and interventional procedures. These include direct injection and delivery of therapeutic agents; drainage of mediastinal, abdominal, and pelvic ?uid collections as well as abscesses, bile, and pancreatic ducts drainage; EUS-guided vascular interventions; and EUS-guided natural ori?ce transluminal endoscopic surgery.2
The standard CLA-EE from Olympus Medical (Center Valley, Pa) has an oblique view of 100 (120 in the one from Pentax Medical, Tokyo, Japan), whereas the endoscopic view is 55 rotated with respect to the axis of the endoscope and of the US probe (45 in the one from Pentax Medical). In both systems, the exit trajectory of the FNA needle and of any other device used is oblique to the endoscope axis, thus rendering passage of large-diameter needles and accessories dif?cult. To overcome some of the limitations of the standard CLA-EE and to further expand interventional applications of EUS, a forwardviewing linear echoendoscope (FV-LE) has been developed in which both the endoscopic and US views are shifted from oblique to forward.3-5 In addition, the exit of the working channel is located at the tip of the instrument, which allows the exit of any used device parallel to the longitudinal axis of the endoscope, thus resulting in a more direct and stable access to the lesion while increasing the precision and force applied to the target.3-5
The available evidence of the performance of the FVLE is mostly based on single-center studies that,
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