Forward-view Endoscopic Ultrasound: A SystematicReview of Diagnostic and Therapeutic Applications

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and therapeutic procedures have been performed by a curvedlinear array (CLA) echoendoscope since the early 1990’s. This particular echoendoscope, allowing real time visualization of aspirationneedles and of other devices, has substantially remained unchanged since its introduction to the market. In a context of rapidlyexpanding indications for EUS-guided procedures, a dedicated forward view (FV) echoendoscope has been developed and testedunder different clinical conditions. The FV echoendoscope is equipped with front endoscopic and EUS view, allowing deploymentof needles and other devices through the working channel in straight direction. Several new diagnostic and therapeutic applicationsmay thereby potentially be feasible with the FV echoendoscope and the established ones may prove easier to accomplish.The published literature with the FV echoendoscope has been systematically reviewed and the results are presented analytically anddiscussed in detail. EUS-FNA and therapeutic procedures, including pancreatic pseudocyst drainage, treatment of gastric fundalvarices, celiac plexus neurolysis, and duct drainage were reported. The FV echoendoscope showed some unique advantages, openingnew possibilities such as EUS-FNA in difficult gastrointestinal tracts and combined endoscopic/EUS treatment with frontalapproach. However, no statistically significant evidence of superiority of the FV echoendoscope vs. the CLA echoendoscope wasfound in pancreatic pseudocyst drainage. No complications specifically attributable to the use of the FV echoendoscope werereported.