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Transcript of Git Endoscopic Ultrasound.
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
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