The history of therapeutic EUS

The invention of linear echoendoscopes in the early 1990s marked the start of the evolution of EUS from a purely diagnostic modality into a cornerstone of minimally invasive endoscopic therapy. Early innovations in imaging and needle design laid the groundwork for EUS-guided drainage of pancreatic fluid collections. Over time, these advances have enabled a wide range of therapeutic applications, including biliary, gallbladder, and pancreatic duct drainage, neurolysis, tumor ablation, and enteral access. Moreover, the development of dedicated therapeutic echoendoscopes with a large working channel, specialized stents designed for EUS-guided deployment, and EUS-specific tools (e.g., micro forceps and radiofrequency probes) have expanded the role of EUS into areas once dominated by surgery. This historical review highlights key technological milestones, pivotal studies, and clinical applications that have shaped the evolution of therapeutic EUS and continue to define its expanding role in interventional endoscopy.