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An introduction to Endoscopic Ultrasound

An introduction to Endoscopic Ultrasound. Dr Bernard Stacey Consultant Gastroenterologist Southampton. EUS. Equipment Technique Indications Normal anatomy Staging cancers Benign disease. Equipment. Radial Linear. 7.5 and 12 MHz frequencies. Technique. Preparation

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An introduction to Endoscopic Ultrasound

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  1. An introduction toEndoscopic Ultrasound Dr Bernard Stacey Consultant Gastroenterologist Southampton

  2. EUS • Equipment • Technique • Indications • Normal anatomy • Staging cancers • Benign disease

  3. Equipment • Radial • Linear

  4. 7.5 and 12 MHz frequencies

  5. Technique • Preparation • As for normal upper GI endoscopy • Sedation • Alfentanyl and midazolam • Propofol • Antibiotic prophylaxis • Usual indications + biopsy / therapeutics

  6. Indications • Staging cancers • Oesophageal, pancreatico-biliary • Confirming EMR potential • T1 disease, excluding sub-mucosal involvement • Diagnosis and follow up of benign lesions • GIST, lipoma, cysts • Investigating RUQ pain • Investigating pancreatitis

  7. Anatomy

  8. Anatomy

  9. EUS Superficial mucosa / balloon interface Lamina propria Submucosa Balloon Muscularis propria (T2) Adventitia

  10. Normal anatomy

  11. Normal anatomy

  12. Coeliac axis

  13. Splenic vein / portal vein confluence

  14. Staging oesophageal cancer • Part of national guidelines in assessment of potential curable disease • Complementary with CT • T stage • N stage • (M stage)

  15. T1

  16. T2

  17. T3

  18. T4? Abutment echorich plane between tumour and vessel intact Adherence echorich plane partially/totally disrupted >3cm Invasion tumour compressing / growing into vessel lumen

  19. T4

  20. Coeliac nodes --> M1a disease

  21. Benign disease

  22. Gallstones missed on conventional USS Sludge

  23. 5mm 12mm

  24. GIST

  25. To EMR or not to EMR…?

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