Endoscopic Ultrasonography

Cover
Title Page
Copyright
Contents
List of contributors
Preface
Acknowledgments
Chapter 1 A history of endoscopic ultrasonography
	PART 1. Early history (edited by Michael Wallace)
	Acknowledgments
	Reference
Chapter 2 Basic principles and fundamentals of EUS imaging
	How US images are made
		How US waves are made
		What happens when US waves encounter tissue
		How images are made from reflected US waves
	How transducer properties affect the image
		US frequency and axial resolution
		Transducer size and lateral resolution
	Attenuation and tissue penetration
	How tissue properties affect images: the GI wall
		Frequency dependence
		Specular and nonspecular reflectors
			Nonspecular reflectors (scatterers)
			Specular reflectors (interface echoes)
	Detection of tissue movement: doppler imaging
	New techniques in EUS imaging
		Contrast‐enhanced EUS imaging
		Elastography
	Imaging artifacts
		Reverberation artifacts
		Tangential scanning
		Attenuation artifacts
		Side‐lobe artifacts
		Doppler artifacts
	Conclusion
	References
Chapter 3 Learning EUS anatomy
	General principles of EUS
	Echo endoscopes
	Regional anatomy
		The esophagus and extraesophageal spaces
		The stomach and the extragastric spaces
		The duodenum and extraduodenal spaces
		The rectum and the extrarectosigmoid spaces
	Approach to understanding EUS anatomy
	Conclusion
	Reference
Chapter 4 EUS instruments, room setup, and assistants
	EUS instruments and other equipment
	Room setup
	EUS assistants
	Conclusion
	References
Chapter 5 EUS procedure: consent and sedation
	Consent
		Infection
		Bleeding
		Perforation
		FNA needle‐track seeding
		Esophageal dilation for facilitation of EUS evaluation
		Pancreatitis
		Bile peritonitis
		Specific issues related to celiac plexus neurolysis
		Specific issues related to EUS‐guided biliary and pancreatic access
	Sedation
		Pre‐procedure assessment
		Benzodiazepines
		Opiates
		Adjuncts to benzodiazepines and opiates
		Propofol
		Procedural monitoring
		Post‐procedural monitoring
	Conclusion
	References
Chapter 6 The EUS report
	Roles of the endoscopic report
		Clinical care
		Quality control
		Clinical research
		Administrative and legal issues
	Evolution of the medical report
	Standard terminology and structured reporting
		Standard terminology
		Structured reporting
			Speed
			Completeness
	Free text and conventional reports
	Databases
		Hierarchical
		Network
		Relational
	Commercial software for EUS reporting
	The EUS report
		Non‐EUS information
		General EUS information
		EUS interventions (diagnostic and therapeutic)
		Complications
		Procedure summary
		Quality of EUS reports
	Disease‐specific information
		Luminal cancer (esophageal, gastric, rectal)
		Subepithelial lesions
		Solid pancreatic tumor
		Pancreatic cystic lesions
		Pancreatitis
	Conclusion
	References
Chapter 7 Endosonography of the mediastinum
	Case
	Introduction
		What are the techniques for performing EUS/EUS‐FNA in the mediastinum?
		When is EUS/EUS‐FNA of the mediastinum indicated?
	Diagnosis
		Malignant diseases
	Interventional endoscopy
	Summary
	Complications
	Conclusion
	References
Chapter 8 Linear‐array EUS: normal anatomy
	Performing the examination
	The linear esophagus
	The linear stomach
	The linear duodenum
	The linear rectum
		Male
		Female
	Conclusion
	References
Chapter 9 High‐frequency ultrasound probes
	High‐frequency ultrasonography
		Technical features
		Anatomical correlation
		Applications of high‐frequency ultrasonography
		Esophagus
			Esophageal cancer
			Barrett esophagus
			Other indications
		Stomach
			Early gastric cancer
			Other indications
		Small bowel and colon
			Colorectal cancer
			Other applications
	Intraductal ultrasonography
		Technical features
		Anatomical correlation
		Applications of IDUS
			Choledocholithiasis
			Bile duct strictures
			Cholangiocarcinoma
			Ampullary tumors
			Pancreatic adenocarcinoma and pancreatic strictures
			Mucin‐producing tumors
	Complications
	The future
	Conclusion
	References
Chapter 10 EUS elastography
	Introduction
	Technical aspects and methodology of elastography
		Strain elastography
			Qualitative strain elastography
			Quantitative strain elastography
		Shear wave elastography
	Clinical applications of EUS elastography
	Pancreatic diseases
		Differential diagnosis of solid pancreatic lesions
			Chronic pancreatitis
	Lymph nodes
	Gastrointestinal lesions
	Transrectal EUS elastography
	Other indications
	Conclusion
	References
Chapter 11 Fundamentals of EUS FNA
	Pre‐procedural fundamentals
		Indications and contraindications of EUS FNA
		Establishing procedural goals
		Informed consent
		Prophylactic antibiotics
		Equipment and staffing
		Training
	Intraprocedural fundamentals
		Algorithm to obtain EUS FNA
		Accessing the target lesion
		EUS FNA technique
		Lesion characteristics
		Needle size
		Use of suction during EUS FNA
		Use of a stylet during EUS FNA
		Helpful tips for obtaining adequate EUS FNA specimens
		Role of onsite cytopathology
	Post‐procedural fundamentals
		Monitoring of the patient
	Safety of EUS FNA
		Fine needle biopsy (FNB)
	Conclusion
	References
Chapter 12 EUS FNA cytology: material preparation and interpretation
	Introduction
	Technical preparation and quality of EUS biopsy material
	Technical quality of EUS biopsy material
	Personnel
		Cell block
		Needle size
		Needle preparation
		Suction
		Slide preparation and staining
		Liquid‐based preparations
	Usefulness of pancreatic cyst fluid analysis
	Molecular analysis
	Quality of the interpretation
	Integration of pathologic and clinical information
		Rapid onsite cytologic evaluation
		Role of the laboratory in EUS
	References
Chapter 13 EUS: applications in the mediastinum
	Mediastinal cysts
		Mediastinal cyst aspiration or not mediastinal cyst aspiration, that is the question
		Lung cancer
	Rationale for EUS
		Before you start
	Cross‐sectional and functional imaging: how does EUS stack up?
	Medical mediastinoscopy
	Endobronchial ultrasonography
	EUS in early NSCLC
	Failed bronchoscopy and EUS rescue
	EUS and MS
	Getting the examination done
		Radial EUS
		Linear EUS
	Which lymph nodes for FNA?
	FNA: how and how much?
	Special topics
		Primary lung lesions
		T4 disease
		EUS for metastatic disease
		EUS after neoadjuvant therapy
		Cost
		Training
	Conclusion
	References
Chapter 14 EUS for esophageal cancer
	Introduction
	Staging Guidelines for Esophageal Cancer
	Role of EUS in the Staging of Esophageal Cancer
		Staging of Esophageal Cancer Using EUS
		Impact of EUS Staging on Management
	Limitations of EUS
	References
Chapter 15 EUS of the stomach and duodenum
	Benign disorders
		Menetrier\'s disease and other hypertrophic gastropathies
		Gastric varices
		Nonhealing gastric ulcer
			Perigastric/Periduodenal lesions
			Therapeutic EUS of the stomach and duodenum
	Malignant disorders
		Gastric cancer
		Intestinal‐type gastric cancer
		Early gastric cancer (intestinal type)
		Diffuse‐type gastric cancer
	Gastric lymphoma
		Diffuse large B‐cell‐type non‐Hodgkin lymphoma
		MALT lymphoma (extranodal marginal‐zone B‐cell lymphoma)
		EUS staging of gastric lymphoma
		Detection of ascites
	Benign lesions of the duodenum, ampullary adenomas, and ampullary carcinoma
		Duodenal adenomas
		Ampullary lesions
	Conclusion
	References
Chapter 16 EUS for gastrointestinal subepithelial masses
	Endoscopic findings
	EUS imaging techniques
		Esophagus
		Stomach
		Duodenum
		Rectum and colon
	Lesions located in the mucosal layer
		Mucosal polyps
		Mucosal cysts
		GI stromal tumors or leiomyomas
	Lesions located in the submucosa
		Lipomas
		Carcinoid tumors
		Granular cell tumors
		Duplication cysts
		Heterotopic pancreas (pancreatic rest or ectopic pancreas)
		Varices
	Lesions located in the muscularis propria
		Stromal cell tumors (GISTs and leiomyomas)
		Duodenal gangliocytic paraganglioma
		Duodenal adenomyomatosis
	Extrinsic compression lesions
	Comparison of imaging studies for subepithelial masses
	Utility of EUS in the management of subepithelial masses
		Interobserver agreement of the EUS in evaluating submucosal masses
		Outcome studies
	Endoscopic tissue sampling
		Which lesions need sampling?
		Biopsy forceps
		Paradigm shift from EUS‐guided FNA to FNB
		Removal of overlying mucosa, followed by a deep biopsy
		EMR, ESD, STER, and EFTR
		Endoscopic and laparoscopic resection of submucosal masses
	Conclusion
	References
Chapter 17 EUS and its emerging modalities for the diagnosis and staging of pancreatic tumors
	Endoscopic ultrasonography
	EUS‐fine needle aspiration (EUS‐FNA)
	Contrast‐enhanced EUS
	Elastography
	Staging pancreatic cancer with different techniques
	Conclusion
	References
Chapter 18 EUS for pancreatic cysts
	Pancreatic cyst classification
	EUS morphology
	EUS‐guided FNA and cyst fluid analysis
		Biochemical analysis
		Molecular analysis
		Histologic analysis
	Characteristics of pancreatic cystic lesions
		Pancreatic cystic neoplasms
			Mucinous cystic neoplasms
			Intraductal papillary mucinous neoplasms
			Serous neoplasms
			Solid pseudopapillary neoplasms
			Nonneoplastic pancreatic cysts
			Inflammatory pancreatic fluid collections
			Solid tumors presenting as pancreatic cysts
			EUS‐FNA technique
		Evolving approaches
	Conclusion
	References
Chapter 19 The role of diagnostic EUS in inflammatory diseases of the pancreas
	Acute pancreatitis
	Recurrent acute pancreatitis
	Chronic pancreatitis
		EUS features of CP and reproducibility
			EUS inter‐ and intra‐observer variability in CP
			Rosemont criteria
		Confounders associated with EUS as a diagnostic tool for CP
			Factors Influencing EUS Findings in the Pancreas
			Abnormal EUS features in patients with clinical symptoms but normal imaging and/or pancreatography
			Abnormal EUS in patients without clinical symptoms
		Comparison of EUS findings for CP with other diagnostic modalities
			Comparison to histology
			Comparison to ERCP and secretin‐stimulated duodenal aspiration
			Comparison to CT and TUS
			Comparison to MRCP
		EUS‐guided tissue sampling for diagnosis of CP
		Differentiating CP and pancreatic cancer
		Developing EUS technologies for the diagnosis of CP
			Elastography
			Contrast‐enhanced EUS
			Digital image analysis
	Conclusion
	References
Chapter 20 Autoimmune pancreatitis
	Classification of AIP
	Clinical presentation of AIP
	Diagnosis of AIP
		Diagnosis of type 1 AIP
		Diagnosis of type 2 AIP
		Distinguishing AIP from pancreatic cancer
		Role of other tests in AIP
			CT and MRI
			Endoscopic retrograde cholangiopancreatography
		Ampullary biopsy
	EUS imaging features of AIP
		EUS imaging of the pancreas
		EUS imaging of other organs
		Image enhancement techniques in EUS
	EUS‐guided tissue acquisition
		EUS‐FNA
		EUS‐FNB
	Treatment and outcomes of AIP
	Conclusion
	References
Chapter 21 EUS for biliary diseases
	Common bile duct stones
	Acute biliary pancreatitis
	Indeterminate biliary strictures
		Gallbladder polyps and cancer
	EUS‐guided biliary drainage
	EUS‐guided gallbladder drainage
	Conclusion
	Acknowledgment
	References
Chapter 22 EUS in liver disease
	EUS imaging technique to evaluate the liver
	Liver parenchymal abnormalities
		Liver cirrhosis and portal hypertension assessments
		Hepatic steatosis
		EUS‐guided liver biopsy
		EUS‐guided portal pressure gradient measurements
	Emerging imaging techniques: artificial intelligence and virtual biopsy
	Malignant lesions in the liver
		Hepatocellular carcinoma and other primary liver tumors
		Liver metastases
	Benign lesions in the liver
		Hepatic adenomas
		Focal nodular hyperplasia
		Hemangiomas
	Cystic liver lesions
	Intrahepatic biliary disorders
		Intrahepatic cholangiocarcinoma
		Primary sclerosing cholangitis
	Biliary adenomas
	Conclusions
	References
Chapter 23 Colorectal EUS
	Introduction
	Instruments for colorectal endosonography
		Rigid probes
		Echoendoscopes
	Examination technique
	Colorectal cancer staging by EUS
		Tumor (T) stage
		Lymph node (N) stage
		Distant metastastis (M) stage
	Accuracy of T‐staging
	Accuracy of N‐staging
	Fine‐needle aspiration (FNA)
	Interobserver variability in rectal cancer staging by EUS
	EUS compared to CT and MRI
	Three‐dimensional EUS for rectal cancer staging
	Contrast‐enhanced EUS for rectal cancer staging
	Clinical impact of EUS staging in rectal cancer
	EUS for local recurrence of colorectal carcinoma
	Restaging after chemotherapy and radiation
	Linitis plastica of the rectum
	Anal cancer
	Anal sphincter defects
	Subepithelial lesions and compression of the colorectal wall
	Rectosigmoid and pelvic endometriosis
	I‐anorectal abscess and fistula
	Endoscopic ultrasound in inflammatory bowel disease beyond imaging for perianal fistulas
	EUS‐guided drainage of perirectal abscesses
		Prostate cancer and rectal EUS
	Other pelvic malignancies
	Conclusion
	References
Chapter 24 Therapeutic EUS for cancer treatment
	EUS‐guided delivery of antitumor agents
	EUS‐guided tumor ablation
		EUS RFA and PDT
		EUS‐guided laser ablation
	EUS‐guided placement of fiducial markers and brachytherapy
	EUS‐guided celiac neurolysis
		Technique
		Results
	Conclusion
	References
Chapter 25 EUS‐guided biliary access
	Introduction
	Equipment
		Echoendoscope
		EUS needles
		Other instruments
	Indications
	Technique
		Stent selection
	Outcome
		Procedure failure and optimizing the technique
	Conclusion
	References
Chapter 26 Pancreatic fluid collections
	Abbreviations
	Introduction
	Classification of pancreatic fluid collections
	Treatment of pancreatic fluid collections
		Surgical drainage
		Percutaneous drainage
		Endoscopic drainage
			Conventional versus EUS‐guided endoscopic drainage
			Choice of stent in endoscopic drainage
		Comparison studies between the different drainage modalities
	Walled‐off pancreatic necrosis (WOPN)
		Direct endoscopic necrosectomy (DEN)
		Surgical necrosectomy
		Comparison studies between the techniques
	Enteral feeding
	Pancreatic ductal evaluation
	Tailored multidisciplinary approach based on the creation of an algorithm
	Conclusion
	References
Chapter 27 EUS‐guided enteric anastomoses
	Introduction
	EUS‐guided gastroenterostomy for gastric outlet obstruction
		EUS‐gastroenterostomy: technical aspects and clinical outcomes
		Safety of EUS‐gastroenterostomy for gastric outlet obstruction
		EUS‐gastroenterostomy versus enteral stenting versus surgical gastrojejunostomy
	EUS‐directed transgastric interventions
	EUS‐directed transenteric ERCP
	EUS‐guided enteroanastomosis for the management of afferent limb syndrome
	Conclusion
	References
Chapter 28 EUS‐guided drainage of pelvic fluid collections
	Patient preparation
	Procedure
		Plastic stent
		Lumen‐apposing metal stent (LAMS)
	Post‐procedure care and follow‐up
	Current evidence
	Technical and clinical tips
		Fistula creation
		Number and size of stents
		Etiology of the collection and its impact on clinical success
		Limitations
		Complications
	Conclusion
	References
Chapter 29 EUS hemostasis
	EUS hemostasis of nonvariceal GI bleeding
	EUS hemostasis of variceal bleeding
		Esophageal variceal bleeding
		Gastric variceal bleeding
		Rectal variceal bleeding
	EUS hemostasis of pseudoaneurysms
	Conclusion
	References
Chapter 30 Training in EUS
	Training options
	Quality indicators in EUS training
	Learning EUS
		Motivation
		Dimensions for learning EUS
		Visual perception and reality
		Learning curves
		Adult learning theory
		Published data on learning experiences
	Practical aspects of EUS learning
		Simulators for EUS learning
		Internet resources
		Telemedicine
		EUS training without a fellowship
	Terminology
	Hospital privileges
	References
Chapter 31 The future of EUS
	Equipment and devices
		Radial echoendoscope
		Linear EUS
		Tissue harmonic echo (THE)
	Contrast‐enhanced harmonic EUS (CH‐EUS)
	EUS‐elastography
	Confocal endomicroscopy
	FNA and FNB needles
	Through the needle biopsy (TTNB)
	Artificial intelligence
	Interventional EUS
	Summary
	References
Index
EULA