Advances in Endoscopic Ultrasonography for Pancreatobilairy Diseases

Endoscopic ultrasonography (EUS) has become an indispensable tool for the diagnosis and treatment of biliary and pancreatic diseases. Originally introduced for high-resolution imaging and tissue acquisition through fine-needle aspiration (EUS-FNA), the clinical role of EUS-FNA has expanded remarkably with the evolution of interventional EUS (iEUS). EUS-guided drainage procedures targeting the bile duct, gallbladder, pancreatic duct, and peripancreatic fluid collection have emerged as minimally invasive alternatives to traditional surgical or percutaneous approaches. The advent of the lumen-apposing metal stent (LAMS) has further enhanced procedural safety and efficacy, enabling direct endoscopic necrosectomy and EUS-guided gastrojejunostomy. Beyond drainage, EUS facilitates tumor ablation, targeted injection therapy, and vascular interventions, significantly broadening its therapeutic spectrum. This review summarizes the current advances and future perspectives in EUS for the management of biliary and pancreatic disorders, with particular emphasis on diagnostic and interventional innovations. Continued technological refinement and procedural standardization are expected to further expand the clinical potential of EUS as a diagnostic and therapeutic platform in pancreatobiliary medicine.