Endoscopic Ultrasound A Survey of Typical Applications

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Endoscopic Ultrasound A Survey of Typical
Applications

• Klaus Gottlieb, MD
• Clinical Associate ProfessorUniversity of
  Washington

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EUS
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EUS Indications
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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)

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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

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Staging of Esophageal Gastric and Rectal Cancer

• TNM System

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Gastric Cancer T1
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Rectal CancerT2N0
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Same Rectal Cancer T3N1Untreated, 4 months later
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Abnormalties of GI tract wall

• The 5 layers

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Submucosal Gastric Tumor
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Biopsy this?
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Gastric Varix Biopsy not recommended
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Thickened Gastric Folds

• Hyperacidic states
• Hypoproteinemia
• Lymphoma
• Eosinophilic gastroenteritis
• Varices
• Menetriers disease
• Crohns

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Linitis Plastica
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MALT Lymphoma
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Diagnosis and Staging of Pancreatic Cancer
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Periduodenal Collaterals
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The Cause Pancreatic Cancer
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Rapidly Growing Pancreatic Mass
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EUS FNA
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Evaluation of Pancreatic Abnormalties
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Pancreatic Pseudocyst
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Chronic Pancreatitis
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Fatty Infiltration of the Pancreas
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Pancreatic mass?
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Benign Adrenal Adenoma !
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Evaluation of Ampullary Neoplasms
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Ampullary Carcinoma
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Ampullary Carcinoma (cont.)
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Ampullary Adenoma
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Diagnosis and Staging ofCholangiocarcinoma
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Cholangiocarcinoma
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Another Cholangiocarcinoma
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Suspected Choledocholithiasis
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Choledocholithiasis
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Choledocholithiasis (cont.)
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Choledocholithiasis (cont.)
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Injection Therapy
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Celiac Plexus Block
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Tumor Therapy
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Alcohol Injection into a Mediastinal Metastasis
compressing the Esophagus
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Lung Cancer
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ATS Lymph Node Map
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Surgery and then Recurrence?
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EUS guided FNA of Area 7 LN
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