Assessment of dyspepsia in the era of endoscopic ultrasonography

Dyspepsia is one of the commonest indications for referral to gastroenterology and endoscopy assessment. It includes a wide range of differential diagnosis and variety of pathologies that needs further assessment in depth. Initial evaluation should focus on the identification and treatment of potential causes of symptoms such as peptic ulcer disease and medication side effects but also on recognizing those at risk for more serious conditions such as cancer or premalignant lesions. Dyspepsia is common in clinical practice with frequent relapses that often requires multiple investigations to assess intraluminal and extraluminal aetiologies. The basic gastroscopy represents a widely used tool for dyspepsia assessment for specific indications. Endoscopic ultrasonography (EUS), introduced into gastroenterological diagnostics more than 20 years ago, has undergone extensive evaluation of its diagnostic capability, probably to a larger extent than most other endoscopic and other imaging techniques in gastroenterology. The introduction of EUS in the recent era added the benefit of better visualization, assessment of layers and lesions and sampling for histological and pathological guidance. In this article, we aim to review the diagnostic yield in different causes of dyspepsia. We will also shed some light on role of EUS in staging of specific causes of dyspepsia including gastric, pancreatic, biliary and subepithelial lesions.