Background: Endoscopic ultrasound (EUS) has been used in the clinical arena for almost
35 years and it is now well-integrated in everyday hospital practice.
Method: We conducted a systematic review of the available English-language articles.
Objective: The purpose of this review is to summarize the relevant applications of operative EUS.
Results: More than 5000 scientific papers published in the literature have demonstrated its high
accuracy for the diagnosis and staging of a variety of benign and malignant conditions. The main
indications of operative EUS, both diagnostic and therapeutic, are related to its ability to combine
ultrasound imaging and safe and effective needle insertion into lesions originating from the gut wall
and from organs nearby. In addition, technologic advancements of echoendoscopes with a therapeutic
working-channel have allowed to perform several EUS-guided interventions, i.e. celiac plexus
neurolysis, drainage of fluid collections, drainage of dilated biliary and pancreatic ducts, and vascular