Operative endosonography

New interventional applications have recently been added to the endosonographic methods, thanks to the improvement of linear scanning devices. This particular orientation of ultrasonic waves, unlike the traditional radial scanning, allows the use of new accessories to make cytologic and hystologic samples under endosonographic guidance (fine needle aspiration) and new therapeutic approaches. Let's mention first the fine needle aspiration of deep intramural GI lesions, of potentially pathologic lymph nodes, of pancreatic, hepatic or adrenal gland masses. Regarding therapeutic applications it's worth considering the drainage of pancreatic pseudocysts, the botulinum toxin injection for achalasia and the celiac plexus neurolysis under endosonographic control. When handled by experts, these techniques have been shown to be effective, safe and fast in a high percentage of cases, and they allow a noticeable cost reduction compared to more invasive procedures.