Interventional Endoscopic Ultrasonography

Kenji Yamao; Vikram Bhatia; Nobumasa Mizuno; Akira Sawaki; Yasuhiro Shimizu; Atsushi Irisawa

Disclosures

J Gastroenterol Hepatol. 2009;24(4):509-519. 

In This Article

I. Introduction: Development of Endoscopic Ultrasonography

Endoscopic ultrasonography (EUS) is a combination of endoscopy and intraluminal ultrasonography. It allows the use of a high frequency transducer with 5 to 10 MHz. Due to the short distance to the target lesion, EUS enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases, for determining the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities.

Rosch et al. stressed the advantages of EUS.[1] These include provision of clear-cut images of small and discrete changes. He also predicted the limitations of EUS, the most important of which was the lack of specificity in the differentiation between benign and malignant changes. Under the prevailing conditions of 1984, Tio et al. described the possibility of using the biopsy channel of an echoendoscope for cytological puncture,[2] so as to enhance the diagnostic value of EUS. In 1990, Harada et al. first reported the EUS-guided puncture technique using a linear array echoendocope for transesophageal puncture in two dogs.[3] In 1992, Vilmann et al.[4] published the first case report of EUS-guided fine needle aspiration (EUS-FNA) of a lesion in the pancreas head using a curved linear array echoendoscope.

Since then, many researchers have expanded the indications for EUS-FNA to various kinds of lesions, and also for therapeutic purposes. In this review, we describe the present place of interventional EUS in clinical practice, including the specific roles of EUS-FNA and therapeutic EUS.

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