ENDOSCOPIC ULTRASOUND EUS

Cem KALAYCIMarmara University, Istanbul

Dept. Of GastroenterologyBAKU, 2008

Depth of Penetration: EUS compared

EUS Wall Imaging and Correlates with Histology

Mechanical Radial Array Imaging

Electronic Transverse Array Imaging270° ‘Radial’ Echoendoscope

Electronic Radial Array Imaging360° End-Viewing Radial Echoendoscope

Curved Linear Array Diagnostic Echoendoscope

Therapeutic Linear Echoendoscope

EUS-Guided FNA

EUS Accessories

Wilson-Cook Quick-Core Needle

High Frequency Probe Endosonography

Gastric Imaging Station II:Posterior: Celiac Trunk

Celiac Neurolysis

EUS CPB

SM, 36 yo, woman Chronic pancreatitis (idiopathic)+

IDDM ERCP and Biliary endoscopic

sphincterotomy Pancreas cannulation failed (x3)

EUS CPB 16.9.06 Roux en Y+ lateral

pancreaticojejunostomi (Puestow surgery) due to the intractable pain

For 3 months partial relief of pain Subsequently suboptimal pain control

with IV pethidin 400 mg/day + doladomon(paracetamol+adamon+ codeine) 1 tab qid

EUS CPB

4.1.2008 EUS CPB No analgesia requirement until 1. 5. 2008

Gastrointestinal Endoscopy 2001;54:316-324

EUS-CPN chemo-radiotherapy

Gastrointestinal Endoscopy 2001;54:316-324

Gastrointestinal Endoscopy 2001;54:316-324

Insulinoma

74 year old, woman Low blood sugar levels for 1

year(<40 mg/dl), syncope history, high insulin levles, high c peptide level

No lesion on Abdominal CT or MRI

Insulinoma

Insulinoma

EUSH&E,x40H&E, x10, surgical

specimen

H&E, x10

Insulinoma

Kromogranin, x40Sinaptofisin, x20

Gastrinoma

Gastrinoma Triangle

GIST-Definition Mesenchymal tumors arising from

the GI wall, mesentery, omentum, or retroperitoneum that express c-kit proto-oncogene protein, a cell membrane receptor with tyrosine kinase activity.

Imaging of the Gastric WallCorrelation Between Ultrasound and Histology

GIST-Incidence <1 % of routine endoscopy Half of the GI submucosal neoplastic

masses Surgical series 1% of gastric neoplastic

resections Most patients are in 5th or 6th decades 50 % gastric, 25 % small intestine, 10 %

colon, 7 % omentum/mesentery, 5 % esophagusNicki NJ. Curr Opin Gastroenterology 2004;20;482-487

GIST- Clinical Manifestations Usually asymptomatic and

incidental endoscopic finding Three major presentations

Bleeding 40 % Abdominal mass 40 % Abdominal pain 20 %

GIST

GIST

Olgu 1-FU-2-GIST

Olgu 1-ŞA-4-GIST

Olgu1-ŞA-2 -GIST

Olgu1-GIST

Benign Gastric Stromal Cell Tumors (GIST)

Features of Malignant GIST

Subepithelial mass

Calcified lymph node

Subepithelial mass

Spleen

Subepithelial mass

Renal cyst

Submucosal varix

Mediastinal mass

54 year old, male, BII 30 years ago Dysphagia, 6-7 kg weight loss/6 months EGD; fragile mass protruding the

esophageal lumen at 30. cm, Bx were negative x2

Barrium swallow: Esophageal narrowing Thorax CT:LAPs of 12-16 mm diameter at

7th station in mediastinum PET CT: Malignant activity in esophageal

wall, left surrenal and skeleton

Mediastinal mass

Adenocarcinoma, x40 Adenocarcinoma, x40

Pancreatic-Biliary Imaging Station II

1500 patients sensitivity 93 % specificity > 95 %

Gallbladder Sludge

Pancreatic Adenocarcinoma of the Body

Pancreatic Mass FNA

Locally Invasive Pancreatic Cancer

Portal Vein Thrombosis

TNM Staging of GI Tumors

Linear Imaging: Esophageal Mass Example

Stage T4 Gastric Cancer

Esophageal Wall ImagingBenign Esophageal Duplication Cyst

Esophageal Wall ImagingIntramural Wall Lesion

EUS Appearance of Pseudocyst

Mucinous Cyst Neoplasm

Serous Cystadenoma

Macrocystic Serous Cystadenoma

IPMN

IPMNMain Duct Disease

Malignant IPMN

EUS Findings of Chronic Pancreatitis

EUS Findings of Chronic Pancreatitis

Cholangiocarcinoma

Pancreatic Neuroendocrine Tumor

Imaging Characteristics of Autoimmune Pancreatitis

Thank you

Peri-Pancreatic Venous AnatomyPancreatic Head Cancer

EUS Accessories: Balloons

Gastric Imaging Station 1Gastric Wall

Gastric Stromal Cell Tumors (GIST)

Radial Imaging: Esophageal Mass Example

Thickened Gastric Folds