Endoscopic Ultrasound (EUS) A Survey of Typical Applications

Klaus Gottlieb, MDClinical Associate Professor; University of Washington

Vadim Brjalin Vadim Brjalin Lääne-Tallinna KeskhaiglaLääne-Tallinna Keskhaigla

Updated by:Dr.Mohammad Shaikhani, Asistan profesor.

Sulaymanyiah University, College of Medicine.Department of Medicine.

Sulaymanyiah GIT/Hepaatology center.

EUS

EUS Indications

EUS: EUS – a new methode in the diagnosis of oesophageal, gastric, EUS – a new methode in the diagnosis of oesophageal, gastric,

biliopancreatic, anal disorders biliopancreatic, anal disorders and intramural lesions of the and intramural lesions of the gastrointestinal tractgastrointestinal tract;It helps ;It helps stagingstaging of the of the GI GI cancer; cancer;

It also allows to stage the lung cancer and detect lymph nodes in It also allows to stage the lung cancer and detect lymph nodes in the mediastinum; it allows to perform different interventional the mediastinum; it allows to perform different interventional diagnostic (FNA, drainage) and therapeutic procedures(celiac axis diagnostic (FNA, drainage) and therapeutic procedures(celiac axis neurolysis, injection of activated lymphocytes into pancreatic neurolysis, injection of activated lymphocytes into pancreatic tumor).tumor).

Ideally suited to the TNM classification for tumor staging as it can Ideally suited to the TNM classification for tumor staging as it can accurately assess the depth of tumor penetration, the presence of accurately assess the depth of tumor penetration, the presence of locoregional nodal metastases and can detect vascular invasion.locoregional nodal metastases and can detect vascular invasion.

EUS-guided FNA biopsy allows for cytopathological diagnosis of EUS-guided FNA biopsy allows for cytopathological diagnosis of malignant primary tumors and is superior to other imaging malignant primary tumors and is superior to other imaging modalities for confirmation of nodal metastasesmodalities for confirmation of nodal metastases

EUS Indications (1)• 1. Staging of esophageal, gastric and rectal

cancer • 2. Evaluation of abnormalities of the

gastrointestinal wall or adjacent structures (submucosal masses, extrinsic compression)

• 3. Evaluation of thickened gastric folds • 4. Diagnosis (FNA) and staging of pancreatic

cancer • 5. Evaluation of pancreatic abnormalities

(suspected masses, cystic lesions including pseudocysts, suspected chronic pancreatitis)

EUS Indications (2)

• 6. Staging of ampullary neoplasms • 7. Diagnosis and staging of

cholangiocarcinoma • 8. Evaluation of suspected

choledocholithiasis • 9. Celiac plexus neurolysis for chronic pain

due to intra-abdominal malignancy or chronic pancreatitis

• 10. Lung cancer diagnosis and staging

Staging of Esophageal Gastric& Rectal Cancer

• TNM System

Celiac LN in T3 Esophageal Cancer

T3 Esophageal Cancer Aorta

<invasion

<Muscularis Propria

LN

Azv

Normal stomach

MALTOMA in stomach:

MALTOMA in stomach:

MALT involving Muscularis

Bi-lobed leomyma in stomach:

MALT involving Muscularis

Gastric Cancer: T1

Gastric Cancer: T1

Gastric Cancer: T2

Gastric Cancer: T3

Rectum: normal

Rectal Cancer:T2N0

Same Rectal Cancer T3N1:Untreated, 4 months later

Rectal ca

A large perirectal mass is seen invading the rectal wall. FNA biopsy (Pentax FG-32UA) of the mass confirmed recurrence of prostatic cancer (inset).

Abnormalties of GI tract wall

• The 5 layers

Submucosal Gastric Tumor

Biopsy this?

Gastric Varix: Biopsy not recommended

Thickened Gastric Folds

• Hyperacidic states• Hypoproteinemia • Lymphoma • Eosinophilic gastroenteritis• Varices• Menetrier’s disease• Crohn’s

Linitis Plastica

MALT Lymphoma

Diagnosis and Staging of Pancreatic Cancer

Periduodenal Collaterals

The Cause: Pancreatic Cancer

Rapidly Growing Pancreatic Mass

EUS FNA

Evaluation of Pancreatic Abnormalties

Evaluation of Pancreatic Abnormalties

Evaluation of Pancreatic Abnormalties

Evaluation of Pancreatic Abnormalties

Pancreatic Pseudocyst

Chronic Pancreatitis

Fatty Infiltration of the Pancreas

Pancreatic mass?

Benign Adrenal Adenoma !

Evaluation of Ampullary Neoplasms

Ampullary Carcinoma

Ampullary Carcinoma (cont.)

Ampullary Adenoma

Ampullary Adenoma

Diagnosis and Staging ofCholangiocarcinoma

Cholangiocarcinoma

Another Cholangiocarcinoma

Suspected Choledocholithiasis

Choledocholithiasis

Choledocholithiasis (cont.)

Choledocholithiasis (cont.)

CBD

< < STONE

<PD

HOP

<CBD stone Duod

CBD Sludge PV

HOP

GB Sludge

Gallbladder sludge and stone

Injection Therapy

Celiac Plexus Block

Tumor Therapy

Alcohol Injection into a Mediastinal Metastasis compressing the Esophagus

Lung Cancer

ATS Lymph Node Map

Surgery and then Recurrence?

EUS guided FNA of Area 7 LN

Keep in touch!