Endoscopic ultrasound in diagnosis and treatment of treatment
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THE FIRST NATIONAL ULTRASOUND
CONFERENCE
THE UPDATE: ENDOSCOPIC ULTRASOUND IN
THE DIAGNOSIS AND TREATMENT OF
GASTROENTEROLOGY DISEASES
Prof.Tran Van Huy - Dr.Vinh Khanh
Department of Internal Medicine - Hue University of Medicine and Pharmacy
OBJECTIVES
1
1
Overview of endoscopic ultrasound
2
The role of EUS in the diagnosis
3
The role of EUS in the treatment
2
3
5 4
Conclusion
6
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OBJECTIVES
1
1
Overview of endoscopic ultrasound
2
The role EUS in the diagnosis
3
The role EUS in the treatment
2
3
5 4
6
Conclusion
ENDOSCOPIC ULTRASOUND
The way to progress
1st TTS EUS Probe (1976)
• Integrated EUS scopes (1980)
• Single frequency scopes (1980)
• Variable frequency scopes (1985)
• 1st EUS – FNA (1991)
• Color Doppler
• 1st EUS guided cholangiography (1996)
• Large Channel Scopes
• 1st EUS guided CD-stomy (2002)
Interventional Endosonography (2017)
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ENDOSCOPIC ULTRASOUND
Radial
For diagnosis
Linear
Diagnosis and intervention
Mini probe
12MHz – 20 MHz
RADIAL - LINEAR
Radial EUS
L
Imaging
perpendicular to the
endoscope
Linear EUS
L
Imaging parallel to
the endoscope
GI Atlas, Wiley
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Radial EUS
Linear EUS
OBJECTIVES
1
1
Overview of endoscopic ultrasound
2
The role of EUS in the diagnosis
3
The role of EUS in the treatment
2
3
5 4
Conclusion
6
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1. SUBMUCOSA TUMORS
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1. SUBMUCOSA TUMORS
•
Approximately 1 in 300 patients.
•
Diagnosed by endoscopy.
•
EUS: location, layer, size, contour, echogenicity, vascularity.
- Follow up
- Accuracy: 90%.
1.
2.
Alexander J. Eckardt, Christian Jenssen (2015), Current endoscopic ultrasound-guided approach to incidental subepithelial lesions: optimal or optional?, Annals
of Gastroenterology 28, 1-13.
Hwang JH1, Saunders MD, Rulyak SJ, et al. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest
Endosc 2005;62:202-208.
1.Kazuya Akahoshi (2012),Practical Handbook of Endoscopic Ultrasonography.
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SUBMUCOSA TUMORS
CYST
2. GASTROINTESTINAL CANCER
EUS
Prognosis
Observe of
chemoradiotherapy
Staging
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THE ROLE OF EUS IN TMN
STAGING
N
EUS - FNA
T
M
Accuracy: 7492%
TMN
ACCURACY OF EUS v. CT BY STAGE
OF ESOPHAGEAL CANCER
Staging Accuracy (%)
100
80
60
40
20
0
EUS
T1 or T2
CT
T3
T4
N0
N1
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ACCURACY OF EUS v. CT IN THE
STAGING OF GASTRIC CANCER
90
80
85
78
70
60
48
50
42
40
30
20
10
0
T STAGE
N STAGE
EUS
CT
ESOPHAGUS CANCER
T3N1Mx
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3. COMMON BILE DUCT STONE
Ultrasound
ERCP
CT-Scanner
DIAGNOSIS
EUS
MRCP
EUS v. MRCP IN THE DIAGNOSIS CBDs
Sensitivity
Specificity
Positive
predictive value
Negative
predictive value
Accuracy
EUS (%)
MRCP (%)
100EUS
95,4
100%
90,9
95.4%
100
RCP
72,7
62,5
90.9%
100100%
96.9%
100
96,9
82,2
De Ledinghen V GIE 1999
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4. CHRONIC PANCREATITIS
Morphology
Function
Early
chronic
pancreatitis
Difficulties
Chronic
pancreatitis
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DIAGNOSIS OF CHRONIC
PANCREATITIS
Diagnosis of chronic pancreatitis on EUS
Conventional classification
Rosemont classification
Rosemont classification detect early chronic pancreatitis.
