Endoscopic ultrasonographi
Transcript of Endoscopic ultrasonographi
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