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Across cholangiocarcinoma and gallbladder cancer, EUS-guided staging and tissue acquisition are highlighted, often outperforming CT/MRI. 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Eldesouki 2, M. Ammar Kalas 3 and Sherif E. Elhanafi 3,4  \nAcademic Editor: Anastasios Karayiannakis  \nReceived: 5 April 2026  \nRevised: 24 April 2026  \nAccepted: 5 June 2026  \nPublished: 7 June 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA; [mukalas@ttuhsc.edu](mukalas@ttuhsc.edu)  \n2 Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ 07102, USA  \n3 Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA; [mkalas@ttuhsc.edu](mkalas@ttuhsc.edu) (M.A.K.)  \n4 Division of Gastroenterology, University of Texas at Tyler School of Medicine, Tyler, TX 75708, USA  \n* Correspondence: [sduggal@ttuhsc.edu](sduggal@ttuhsc.edu); Tel.: +1-3476537665  \nSimple Summary  \nThis review highlights recent trends and advances in endoscopic ultrasound (EUS) for pancreatobiliary malignancies. In solid and cystic pancreatic lesions, contemporary FNB needles, optimized suction techniques, MOSE, contrast-enhanced EUS, detective flow imaging, elastography, and artificial intelligence enhance diagnostic accuracy, while EUS-guided tissue acquisition supports precision-medicine applications including comprehensive genomic profiling. The review also addresses EUS-based screening, celiac plexus interventions for pain, and tumor ablation—notably EUS-RFA for pancreatic neuroendocrine tumors. In biliary and gallbladder cancer, EUS complements ERCP-based sampling in line with recent ESGE guidelines. Therapeutic EUS, through biliary drainage and gastroenterostomy, provides minimally invasive alternatives for malignant obstruction.  \nAbstract  \nIn this review, we explore the evolving role of endoscopic ultrasound (EUS) in diagnosing and managing pancretobiliary malignancies. For solid pancreatic lesions, techniques like fine-needle biopsy (FNB), contrast-enhanced EUS (CE-EUS), and macroscopic on-site evaluation (MOSE) improve sample quality and diagnostic accuracy. In cystic pancreatic lesions, fine-needle aspiration (FNA), molecular testing, and confocal laser endomicroscopy (nCLE) aid in distinguishing benign from malignant cysts. For cholangiocarcinoma, EUS guided sampling is more accurate than CT in assessing distal lesions and lymph node metastases, while combining EUS with magnetic resonance cholangiography (MRC) enhances diagnostic sensitivity. In gallbladder cancer, EUS surpasses CT and MRI in detecting lymphadenopathy and staging tumors. EUS-FNB (Fine needle biopsy) improves biopsy accuracy, especially for unresectable cases. These advancements highlight EUS as a critical tool for early cancer detection, staging, and tissue acquisition. Beyond diagnosis, EUS plays a pivotal therapeutic role in managing complications such as malignant biliary obstruction and gastric outlet obstruction, offering minimally invasive alternatives like EUS-guided biliary drainage and gastroenterostomy with high clinical success and improved patient outcomes.  \nKeywords: endoscopic ultrasound; pancreatic cancer; gallbladder cancer; cholangiocarcinoma  \n1. Introduction  \nEndoscopic ultrasonography (EUS) is a widely utilized diagnostic and therapeutic modality in the evaluation and management of pancreatobiliary diseases. Introduced into clinical practice in the 1980s, EUS has revolutionized the approach to pancreatic and biliary disorders by providing high-resolution, real-time imaging of the gastrointestinal (GI) tract and surrounding structures [1] . Initially developed as a diagnostic tool, EUS has undergone significant advancements, evolving into an essential te","cbCaigwNUDvJ1NVP","https://ap.wps.com/l/cbCaigwNUDvJ1NVP","pdf",942755,"English","# Introduction\n## Diagnostic role of EUS\n## Progression to tissue acquisition and therapy\n# EUS technologies and imaging approaches\n## Radial versus linear echoendoscopes\n## Contrast-enhanced EUS and elastography\n# Clinical applications in pancreatic and biliary cancers","[{\"question\":\"What does the review focus on regarding endoscopic ultrasonography?\",\"answer\":\"The review highlights recent trends and advances in endoscopic ultrasound (EUS) for diagnosing and managing pancretobiliary malignancies, including both diagnostic and therapeutic uses.\"},{\"question\":\"Which techniques improve diagnosis in solid and cystic pancreatic lesions?\",\"answer\":\"For solid lesions, fine-needle biopsy (FNB), contrast-enhanced EUS, and MOSE improve sample quality and diagnostic accuracy. For cystic lesions, fine-needle aspiration (FNA), molecular testing, and confocal laser endomicroscopy (nCLE) help distinguish benign from malignant cysts.\"},{\"question\":\"How does EUS contribute beyond diagnosis in cancer care?\",\"answer\":\"EUS has a therapeutic role in managing complications such as malignant biliary obstruction and gastric outlet obstruction, using minimally invasive approaches like EUS-guided biliary drainage and gastroenterostomy.\"}]","Role of Endoscopic Ultrasonography in Management of Pancreaticobiliary Cancers - Recent Trends and Advances | PDF",1790140847,76]