Future directions in endoscopic ultrasound-guided tissue acquisition

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is safe and has a high diagnostic yield. Multiple factors affect the outcome of EUS-TA such as operator experience, procedure technique, needle-type, and cytopathologist training and experience. There have been numerous advances aiming to increase the diagnostic yield of EUS-TA. These include novel devices, modified tissue acquisition techniques, enhancements in EUS imaging, improved tissue processing methods, and increasingly frequent molecular and genetic testing of acquired tissue. Importantly, recent advances in personalized medicine may require greater amounts of tissue to be acquired to guide subsequent oncotherapy. As a result of all these new developments, several additional questions have arisen including defining the precise role of EUS-guided fine-needle biopsy, the optimal technique for EUS-TA, and standardization of tissue processing protocols. This review discusses recent advances and future directions regarding EUS-TA.