Unité d’endoscopie digestive, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
Endosonography initially a diagnostic technique complementary to cross-sectional imaging, then a method for guiding biopsies of peridigestive lesions is increasingly a therapeutic technique aimed at peridigestive organs: this is interventional endosonography. It made endoscopic ultrasound-guided drainage of pancreatic pseudo-cysts and necrosis, and more recently of pelvic and mediastinal abscesses, a possible option. Endoscopic ultrasound-guided celiac plexus block is also associated with pancreatic disesases. Endoscopic ultrasound-directed transpapillary stent placement and endoscopic ultrasound-guided main pancreatic duct drainage are gaining recognition. Ongoing trials could soon open the way for translumenal endoscopic surgery (NOTES) procedures, endoscopic ultrasound-guided intratumoral therapy, destruction of cystic tumors or endoscopic ultrasound-guided angiography. Technological advances should lead to a diversification and specialisation of echoendoscopes and ancillary devices. Although the risks of these new techniques are not yet fully known; infectious risk seems moderate and manageable. Interventional endosonography is a complex discipline restricted for the time being to skilled endoscopists experienced in both diagnostic endosonography and bilio-pancreatic interventional endoscopy.