Procedure Directions

Endoscopic Ultrasound

For endoscopic ultrasound of the upper digestive tract, a probe is inserted into the esophagus, stomach and duodenum during a procedure called esophagogastroduodenoscopy. Among other uses, it allows for screening for pancreatic cancer, esophageal cancer, and gastric cancer as well as benign tumors of the upper gastrointestinal tract. It also allows for characterization and biopsy of any focal lesions found in the upper gastrointestinal tract. This is done by inserting a needle through the stomach lining into the target.

Endoscopic ultrasound is performed with the patient sedated. The endoscope is passed through the mouth and advanced to through the esophagus to the suspicious area. From various positions between the esophagus and duodenum organs within and outside the gastrointestinal tract can be imaged to see if they are abnormal and they can be biopsied by a process called fine needle aspiration. Organs such as the liver, pancreas and adrenal glands are easily biopsied as are any abnormal lymph nodes. In addition the gastrointestinal wall itself can be imaged to see if it is abnormally thick suggesting inflammation or malignancy.

The technique is highly sensitive for detection of Pancreatic Cancer (90-95% sensitivity) particularly in patients who are suspected to have a mass or present with jaundice. Its role in staging patients with pancreatic cancer is limited to local metastases; however, in combination with CT scan which provides information on regional metastases, it provides an excellent imaging modality for diagnosis and staging of pancreatic carcinoma.

Endoscopic ultrasound can also be used in conjunction with endoscopic retrograde cholangio pancreatography (ERCP). The ultrasound probe is used to locate gall stones which may have migrated into the common bile duct. This occurrence may cause obstruction of the drain shared by the liver and pancreas which may lead to lower back pain, jaundice and pancreatitis.

Echo-endoscopy can also be used for imaging of the rectum and colon, although these applications are lesser known. It is used primarily to stage newly diagnosed rectal or anal cancer. EUS guided fine needle aspiration may be used to sample lymph nodes during this procedure. Evaluation of the integrity of the anal sphincters may also be done during lower EUS procedures.

B. Jeffrey Wallis, M.D., P.A. - Colonoscopy, EGD, Liver, ERCP

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