Gel immersion technique in interventional endoscopic ultrasound for pancreatobiliary lesions

Interventional endoscopic ultrasound (iEUS), including EUS-guided tissue acquisition (EUS-TA) and biliary drainage (EUS-BD), plays a crucial role in the assessment and treatment of pancreaticobiliary lesions. Yet, iEUS presents challenges due to anatomical factors, posing a risk of serious complications. For observational pancreaticobiliary EUS, studies have shown that utilizing a high viscosity gel (Viscoclear; Otsuka Pharmaceutical, Tokushima, Japan) instead of water to fill the duodenal lumen yields clearer EUS images and effectively maintains the luminal dilatation for an extended period [1] [2] [3]. Recently, a handful of reports have explored the gel immersion technique within iEUS [4] [5]. Here, we evaluate the effectiveness and safety of the gel immersion method, particularly in EUS-TA and EUS-BD ([Video 1]).