An introduction to Endoscopic Ultrasound

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An introduction toEndoscopic Ultrasound

• Dr Bernard Stacey
• Consultant Gastroenterologist
• Southampton

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EUS

• Equipment
• Technique
• Indications
• Normal anatomy
• Staging cancers
• Benign disease

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Equipment

• Radial
• Linear

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7.5 and 12 MHz frequencies
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Technique

• Preparation
• As for normal upper GI endoscopy
• Sedation
• Alfentanyl and midazolam
• Propofol
• Antibiotic prophylaxis
• Usual indications biopsy / therapeutics

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Indications

• Staging cancers
• Oesophageal, pancreatico-biliary
• Confirming EMR potential
• T1 disease, excluding sub-mucosal involvement
• Diagnosis and follow up of benign lesions
• GIST, lipoma, cysts
• Investigating RUQ pain
• Investigating pancreatitis

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Anatomy
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Anatomy
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EUS
Superficial mucosa / balloon interface
Lamina propria
Submucosa
Balloon
Muscularis propria (T2)
Adventitia
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Normal anatomy
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Normal anatomy
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Coeliac axis
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Splenic vein / portal vein confluence
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Staging oesophageal cancer

• Part of national guidelines in assessment of
  potential curable disease
• Complementary with CT
• T stage
• N stage
• (M stage)

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T1
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T2
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T3
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T4?
Abutment echorich plane between tumour and vessel
intact Adherence echorich plane partially/totally
disrupted gt3cm Invasion tumour compressing /
growing into vessel lumen
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T4
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Coeliac nodes --gt M1a disease
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Benign disease
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Gallstones missed on conventional USS
Sludge
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5mm
12mm
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GIST
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To EMR or not to EMR?