विवरण
Endoscopic Ultrasound (EUS) guided interventions are advanced procedures that leverage real-time ultrasound imaging to navigate and precisely target internal structures near the gastrointestinal tract. This technique allows for fine-needle aspiration or biopsy of lesions, cyst drainage, and therapeutic interventions like celiac plexus neurolysis or fiducial marker placement. EUS guidance enhances diagnostic accuracy and therapeutic precision, making it a valuable tool in the management of various gastrointestinal and adjacent organ conditions. The minimally invasive nature of EUS procedures often contributes to reduced patient discomfort and quicker recovery.
सारांश
- Endoscopic ultrasound (EUS) is a minimally invasive procedure that provides real-time, high-resolution images of luminal and extraluminal structures. There are two types of EUS scopes: radial for diagnostic imaging and linear for diagnostic and therapeutic procedures. Linear EUS allows for the passage of accessories like needles and stents.
- EUS is commonly used to detect CBD calculi, often preferred over MRCP due to higher sensitivity, especially for small stones. In cases of chronic pancreatitis, EUS helps determine the etiology, assess severity using criteria like the Rosemont or simplified criteria, and evaluate for complications. For subepithelial lesions, EUS aids in determining the layer of origin and characteristics to differentiate between benign and malignant features.
- EUS is crucial for staging pancreatic cancer and sampling masses or lymph nodes. It is also valuable in assessing pancreatic neuroendocrine tumors and guiding surgical planning. Additionally, EUS can evaluate early luminal cancers and ampullary adenomas. Endoanal scans are used to assess anal sphincter integrity.
- Fine needle aspiration (FNA) is performed to obtain samples from mediastinal lymph nodes, pancreaticobiliary masses, and cystic lesions. Fluid analysis of cystic lesions, including mucus string sign, glucose levels, amylase, CEA, and cytology, helps characterize the cyst.
- Therapeutic EUS includes draining pancreatic pseudocysts and other collections, such as hepatic abscesses and pelvic abscesses. EUS-guided biliary drainage, including rendezvous ERCP, choledochoduodenostomy, and hepaticogastrostomy, is an alternative to PTBD in cases of failed ERCP. In hepatology, EUS is used for coiling and glue injection of gastric varices. It can also provide celiac plexus block for refractory pain.
- Lumen-opposing metal stents (LAMS) enable EUS-guided gastrojejunostomy. Complications of EUS-guided interventions include bleeding, perforation, and infection. Prophylactic antibiotics are recommended for cystic lesion aspiration. Proper management of anticoagulation is essential before and after EUS procedures.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
Dr Jatin Yegurla
Consultant Gastroenterologist at Apollo Hospitals, Jubilee Hills, Hyderabad
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