EUS - Endoscopic Ultrasound

Technical Aspects
Endoscopic Ultrasound is a combination of endoscopy and ultrasound.
It is a fascinating ultrasound method in with a high diagnostic and therapeutic impact.
Its development came up in the 1980ies with stiff rectal probes. The possibility to produce miniaturized ultrasound transducers with a longitudinal or a radial array of ultrasound elements provides the application to flexible endoscopes.
Especially the longitudinal technique is difficult to learn because of the multiple and unusual anatomical sections of the organs and structures in the body.
Only a longitudinal endoscopic ultrasound instrument offers the possibilty to control interventional EUS.
When learning this method it is very important to define the anatomical landmarks properly to recognize the relationship between pathological lesions and normal anatomy



 

Gastric fold

Diagnostic Impact
The high resolution of the ultrasound image depicts the wall of the gastrointestinal tract itself and visualizes the adjacent organs.
The main indication is the staging of tumors in the gastrointestinal tract according to the TNM-classification.
Ultrasound guided fine needle aspiration (EUS-FNA) provides cytologic or histologic specimen with high sensitivity and specifity.



 

Pancreatic adenocarcinoma

Therapeutic impact
EUS-guided pseudocyst drainage.
EUS-guided drainage of rectal abscesses.
EUS-CPN (celiac plexus neurolysis) in patients with pain caused by pancreatic carcinoma or chronic pancreatitis.
EUS-assisted mucosectomy.*
Drainage or relief of cysts, abscesses and effusions.
Drainage of the bile duct (EUS-Cholangiodrainage) not accessible via ERCP, because of tumor or gastric surgery (gastrectomy, Y-Roux anastomosis, B-II)*.
EUS-guided tumor therapy (f.e. pancreatic carcinoma).*
EUS-guided therapy of variceal bleeding.*
(* = in evaluation for clinical practice)