ENDOSCOPIC ULTRASOUND MARKET OVERVIEW AND DEFINITION

Global Endoscopic Ultrasound market was valued at USD 1533.12 Mn. in 2024, and is expected to reach USD 2620.43 Mn. by 2032, reflecting a CAGR of 6.93 % over the forecast period (2025-2032)

Endoscopic ultrasound (EUS) has become an indispensable diagnostic and therapeutic tool in gastroenterology, oncology, and pulmonology. This minimally invasive procedure combines endoscopy and ultrasound to allow high-resolution imaging of the gastrointestinal (GI) tract and associated organs (e.g., pancreas, liver, lymph nodes). EUS has seen a rapid surge in demand over the past decade, due to its accuracy in diagnostic capabilities compared to literary imaging modalities, particularly with regards to identifying and staging GI malignancies.

According to data reported by the American Society for Gastrointestinal Endoscopy (ASGE), there are more than 600,000 EUS procedures performed annually in the United States. This number is expected to increase further every year as we become more experienced with EUS and its newly expanded therapeutic processes. EUS's therapeutic applications (such as fine-needle aspiration (FNA), cyst drainage, and localized drug delivery) continue to expand. We are also finding that the EUS community (i.e. various groups investigating EUS clinical application, such as the European Society of Gastrointestinal Endoscopy (ESGE) and Asian EUS Group) are all experiencing increased procedural volumes and frequency of use, thanks to increased education and training, technological changes, and changes in the perception of the clinical value of EUS. 

The medical field is expanding with new EUS-guided procedures like EUS-guided biliary drainage and EUS-guided radiofrequency ablation (RFA), particularly in oncology. There is a lot of new opportunity in emerging markets in the Asia-Pacific and Latin America, supported by developing healthcare infrastructure and an increasing incidence of GI cancers and pancreatic diseases.

According to the World Health Organization (WHO), pancreatic cancer is now the 7th leading cause of cancer-related death, emphasizing the need for early and accurate diagnosis, which EUS contributes to a large role in. Additionally, as the elderly population increases and the incidence of digestive disorders continues to rise, the use of EUS will only become a more important method of diagnosis. 

Even with opportunity in the market, there remain obstacles, including the cost of the exogenous equipment, a lack of trained endosonographers, and disparities of access (especially with lower incomes). While all of these factors must be mitigated, many public-private partnerships and training centers are working to mitigate these issues and further assist in the global EUS application.

MARKET DYNAMICS

Market Drivers

Rising Incidence of Gastrointestinal and Pancreatic Cancers

The increasing burden of GI and pancreatic cancers worldwide is a primary factor contributing to growth in the EUS market. According to the World Health Organization (WHO) and GLOBOCAN 2022 report, GI cancers represented >26% of global cancer incidence and roughly 35% of cancer deaths. The need for precise and minimally invasive diagnostic and sampling options is warranted by the growing burden of GI cancers, particularly pancreatic cancer due to its infamous history of late detection and poor life expectancy. The American Cancer Society report estimates pancreatic cancer will become the third leading cause of cancer deaths globally in 2030.

EUS allows clinicians to obtain high-resolution images and collection of tissue sampling for timely diagnosis and staging of pancreatic, esophageal, gastric, colorectal, and many other cancers. Additionally, EUS can also allow clinicians to provide interventional opportunities such as EUS-guided fine-needle aspiration (FNA), and biopsies which are essential to a histopathological diagnosis. The American Society for Gastrointestinal Endoscopy (ASGE), reports sensitivity for EUS-FNA for pancreatic lesions is 85-90%, and specificity is between 95-100%, making it one of the best diagnostic tools available. Moreover, the growing uptake of EUS across cancer centers - in particular, in the more advanced regions of North America and Western Europe - reflects its clinical necessity. A report released in March 2023 by the European Society of Gastrointestinal Endoscopy (ESGE) reported a 15% year-on-year growth in the use of EUS for pancreatic and biliary indications in a sampling of tertiary care hospitals. Given the increasing burden of cancer and the importance of early diagnosis in improving survival, measuring the demand for EUS procedures in oncology care pathways will likely see more growth across the world.

Technological Advancements and Expanding Therapeutic Applications

Ongoing advances in EUS technology are continuously expanding the diagnostic and therapeutic value of EUS, thereby enhancing market growth opportunities.  New EUS systems can now include high-frequency ultrasound, elastosonography, contrast-enhanced ultrasound, and real-time, needle guidance allowing enhanced clinical decisions in hepatobiliary and pancreatic diseases, among others. These improvements expand the diagnostic accuracy and surface area for therapeutic EUS procedures. EUS-guided interventions, including biliary and pancreatic duct drainage, gastrojejunostomy, neurolysis for pain control, and radiofrequency ablation (RFA) are less-invasive alternatives to surgical interventions.  The American College of Gastroenterology (ACG) states that therapeutic EUS interferes with surgical intervention in up to 40% of cases of pancreatic fluid collections that have potential to positively impact patient outcomes and decrease hospital stay length.

 Moreover, the development of precision and advanced image interpretation and procedural navigation with artificial intelligence (AI) and robotics-assisted platforms are being explored, already a national study from the Japan Gastroenterological Endoscopy Society (JGES) stated diagnostic yield increased 20% with AI-assisted EUS-platforms, especially for subepithelial lesions and early-stage neoplasia. Furthermore, leaders in this field, Olympus, Pentax Medical and FUJIFILM are putting a lot of effort into next generation EUS platforms, increasing innovative products with quicker turnaround times in a competitive market. With an increase of EUS educational opportunities and multidisciplinary expert-led training offered by associations like the Asian EUS Group, these advancements are opening diversity and access to EUS in developed and developing countries alike.

Market Restraint

High Cost of Equipment and Procedural Set-Up

The large capital and operational costs associated with EUS systems is a major limitation, particularly in less resourced environments. The cost of the full suite (echoendoscope, processor, ultrasound platform, and accessory kit) can typically range from USD 150,000 to USD 300,000, depending on brand and configuration. Continuing costs, including disposable needles, cleaning, ongoing maintenance, and so on can add to the cost of ownership, making it a costly procedure for healthcare providers.

According to the Healthcare Cost and Utilization Project (HCUP), average costs per EUS procedure can cost health systems between USD 1,500 and USD 3,000 in the US, depending on complexity and setting. High upfront and procedural costs limit adoption, especially in low and middle-income countries (LMICs) at public hospitals or smaller diagnostic centers. In addition, poor coverage of reimbursements in some regions complicates the process. In the US, the Centers for Medicare & Medicaid Services (CMS) reimburse for only some EUS-guided procedures, which would discourage some providers from adopting the technology. A 2023 survey recently completed (2023) by the World Endoscopy Organization (WEO) reported that over 45 % of hospitals in Southeast Asia and Sub-Saharan Africa characterized cost as a barrier to adopting advanced endoscopy technology, including EUS.

Market Opportunity

Expansion of EUS Applications in Pulmonology and Interventional Oncology

A sizeable growth opportunity in the endoscopic ultrasound (EUS) market relates to its expanding application beyond gastroenterology in clinical applications, most notably in pulmonology and interventional oncology. The rapid adoption of endobronchial ultrasound (EBUS), a subtype of EUS, is transforming the diagnosis of lung cancer and assessment of mediastinal lymph nodes. With greater than 80% accuracy, and endorsed by the American Thoracic Society (ATS), EBUS was recently concluded as the best method for mediastinal staging and is superior to traditional mediastinoscopy. The global burden of lung cancer, still the leading cause of cancer death at 1.8 million deaths per year according to GLOBOCAN 2022, serves as a compelling reason for the interest in less invasive biopsies. Combining EUS and EBUS provides a comprehensive examination of both anterior and posterior mediastinal nodes, thus facilitating better assessment for accurate staging and treatment options.

Use of EUS has transitioned into intervention oncology, with the use of EUS for tumor ablation, fiducial placement for radiation therapy, and injection of chemotherapeutic agents showing increasing traction. The Society of Interventional Oncology (SIO) has reported, for example, a 25% annual increase in EUS-guided oncology interventions performed in major cancer centers throughout the world. This multidisciplinary expansion of technology utilization in medicine has provided hospitals and device manufacturers with additional revenue opportunities.

Market Trends

Rising Adoption of Artificial Intelligence in EUS Diagnostics

One of the significant advancements in the endoscopic ultrasound (EUS) domain has been the adoption of artificial intelligence (AI) to enhance optomic performance, procedural efficiency, and clinical decision-making. AI-enabled endoscopic ultrasound (EUS) platforms with embedded artificial intelligence will utilize deep learning algorithms to distinguish benign from malignant lesions and facilitate fine-needle aspiration (FNA) or elastography and/or contrast-enhanced imaging with reduced operator bias.  A 2024 multi-center study published in the American Journal of Gastroenterology demonstrated that the AI at the front end improved the overall sensitivity for pancreatic cancer by 17% compared to standard human interpretation. The European Society of Gastrointestinal Endoscopy (ESGE) has been a strong advocate for using AI to reduce inter-operator variability when making cancer diagnoses and advancing operator training for new endosonographers.

Companies, as well as established medtech giants, are also in the process of developing EUS systems that utilize AI for real-time lesion annotations, risk stratification, and procedural guidance. For instance, with an AI-equipped EUS platform, a live EUS procedure could be performed, resulting in the AI providing automatic marks of the lesion borders, suggested needle pathways, and optimized overall procedural time by 30% (Japan Gastroenterological Endoscopy Society [JGES]). As AI continues to be more accessible and regulatory processes become more sophisticated, the trend toward intelligent automation in EUS diagnostics will enhance clinical performance and operational productivity, as AI will be the disruptor of the next-generation EUS competitive landscape.

SEGMENTATION ANALYSIS

By Product Analysis

Endoscopes Lead the EUS Market with High Clinical and Capital Value

In the EUS market, endoscopes represent the largest product type since they are the primary interface used during endoscopic ultrasound procedures. These instruments are endoscopes that include optical capabilities and ultrasonic capabilities (radial and linear echoendoscopes) that permit real-time visualization and guidance of interventional procedures. According to the American Society for Gastrointestinal Endoscopy (ASGE), 90% of the EUS procedures being performed in tertiary high-volume centers have been performed with linear echoendoscopes because of their utility in being able to enable the use of fine-needle aspiration (FNA) for tissue sampling and interventional procedures. 

There is particularly high demand in the oncology and hepatobiliary areas, where accurate characterization of tissue and the ability to access lesions located deep in the body by these units is paramount. In addition, the continual inclusion of high-definition imaging, elastography, and contrast-enhanced capability in endoscope design has increased their clinical utility. Market share is dominated by Olympus, Pentax Medical, and FUJIFILM, with most of the market consisting of consolidated competitors that are innovating. Endoscopes also create an ongoing expense for capital investment into hospitals and ambulatory centers, which represents the largest budget line item for endoscopy equipment, as they are funded into capital replacement budgets. In developed healthcare markets, there is a higher reimbursement for EUS-guided procedures, meaning there is a supporting financial rationale for the purchase of these devices, which guarantee a consistent revenue stream for this type of intervention.

By Application Analysis

Lung Cancer Drives EUS Expansion Through EBUS Integration

Lung cancer is slated to become the fastest growing area in the EUS field owing to the rapid uptake of endobronchial ultrasound (EBUS), and through blended assessment and diagnosis with combined EUS-EBUS staging, noting the WHO and GLOBOCAN 2022, lung cancer accounts for 2.2 million new cases, and 1.8 million deaths worldwide, furthering the opportunity for minimally invasive diagnostics in comparison for other cancers. ACCP and ATS recommend EBUS and EUS as the primary means of evaluating mediastinal lymph node (N2 and N3) staging with an estimated diagnostic accuracy of 90% or better. EBUS and EUS also help to minimize the number of surgical mediastinoscopies with real-time tissue sampling that can be used for genomic profiling and personalized therapy.

In addition, the increased focus on early detection of lung cancers through lung cancer screening programs is supporting operating volumes for procedures in both developed and emerging markets; Asia-Pacific is seeing a strong shift towards EBUS based diagnostics. The Japan Lung Cancer Society, for example, noted a 27% increase in EUS/EBUS procedures in the past three years.

REGIONAL INSIGHTS

North America Maintains Market Leadership Through Advanced Infrastructure and Procedural Adoption

North America's already dominant share of the global endoscopic ultrasound (EUS) market will only get larger with such an enormous healthcare system, early adoption of new and advanced technologies, and a significant volume of procedures in oncology and gastroenterology, more than any other region of the globe. More than 600,000 EUS procedures are performed every year in the United States, of which many of the procedures occur in a high-volume tertiary center location (from the American Society for Gastrointestinal Endoscopy (ASGE)).  The region has widespread use of both linear and radial echoendoscopes, availability to FNA, and other appropriate reimbursement pathways for EUS-guided interventions appropriate for use in industry. 

Academic facilities and cancer centers continue to do experimental interventional EUS work in the U.S. and Canada (e.g. guided ablation and biliary drainage), which will perhaps propel further innovation. With access to Olympus America, Boston Scientific, and FUJIFILM Sonosite, medical professionals in the region also have easy access to imaging systems and training on the advanced systems. The region has excellent guidelines from the ACG and ACG in place that also aid in isolated interventions whenever appropriate. Given the high clinical guidelines and procedures standards and the system of how we do EUS and what instances to do it for in North America, we believe that North America is the template for U.S. standards and the persistent growth of EUS utilization locally and globally.

Asia-Pacific Sees Rapid Surge Fueled by Screening Programs and Infrastructure Development

 The EUS market has been experiencing the fastest expanding growth in the Asia-Pacific region due to increasing burdens of gastrointestinal and pulmonary disease, government-led initiatives to screen for cancer, and large investments in endoscopy infrastructure. The demand for procedures that utilize diagnostic and/or therapeutic EUS, such as EBUS, on site are growing steeply in countries such as Japan, South Korea, China, and India as there is higher awareness, improving access, and reimbursement policies are generous relative to five years ago. According to the Japan Gastroenterological Endoscopy Society (JGES), Japan had a 27% increase in procedures based on EUS and EBUS over the past three years. In the Chinese environment, there are national efforts to develop the early detection of cancer; many institutions are acquiring EUS systems and equipment, especially in urban tertiary hospitals. Moreover, the Asia-Pacific region is benefiting from local manufacturing infrastructural support, including support and training, that is being provided by original equipment manufacturers (OEMs) such as FUJIFILM and Olympus, enabling lower-cost models of adoption.

Emerging economies are seeing a similar increase in demand from the private healthcare sector, on account of an emerging and growing middle class and urbanization. Given the still-developing pool of skilled individuals and an expanding cross-specialty application of EUS use (including pulmonology and oncology), Asia-Pacific is well-positioned as a growth engine of global EUS and endoscopy market opportunities during the forecast period.

KEY INDUSTRY DEVELOPMENTS:

• May of 2024, Cook Medical announced the launch of the EchoTip AcuCore EUS Biopsy Needle. This needle is designed for performing precise biopsies of gastrointestinal lesions under endoscopic ultrasound (EUS). The aim is to allow for better core sample acquisition for reliable and predictable diagnosis and staging of hard-to-reach lesions, which will improve the diagnostic yields of EUS-guided procedures.
• February of 2024, Fujifilm India announced their new ALOKA ARIETTA 850 Diagnostic Ultrasound System. The first installation was at Fortis Hospital, Bengaluru. This state-of-the-art endoscopic ultrasound will allow physicians to obtain excellent image quality along with a user-friendly interface for an accurate diagnosis and treatment of gastrointestinal problems. Notably, it will provide the opportunity for non-invasive procedures, including pancreatic pseudocyst drainage and cancer therapies, to enhance health care outcomes in the region.

ENDOSCOPIC ULTRASOUND MARKET REPORT SCOPE & SEGMENTATION

MARKET REGIONAL COVERAGE           

• North America (United States, Canada, Mexico)
• Europe (Germany, Italy, United Kingdom, France, Russia, Hungary, Netherlands, Ireland, Austria, Rest of Europe)
• Asia Pacific (China, India, Japan, South Korea, Australia, New Zealand, Thailand, Singapore, Philippines, Indonesia, Vietnam, Rest of Asia Pacific)
• Middle East and Africa (South Africa, Israel, UAE, Iran, Kuwait, Iraq, Saudi Arabia, Qatar, Rest of Middle East and Africa
• South America (Brazil, Argentina, Rest of South America)

ENDOSCOPIC ULTRASOUND MARKET ACTIVE PLAYERS

• Boston Scientific Corporation
• Medtronic
• ConMed
• Olympus Corporation
• Steris
• SonoScape Medical Corp.
• PENTEX Medical
• FUJIFILM India Private Limited
• Cook Medical
• Medi-Globe GmbH

*Disclaimer: The active players are listed in no specific order.