Indications and Therapeutic usage of Endoscopic Ultrasonography (EUS)
1 Diagnostic indications:
Mural and extramural lesions
· Diagnosis of cyst, GIST, submucosal mass (assessment before mucosectomy, ESD)
· Thickened gastric fold
· Determine cause of GI tract stricture (anastomotic, reflux, extrinsic compression, achalasia)
Staging of GI tract malignancies
· Oesophageal and gastric cancer
· Gastric lymphoma / MALToma
· Detection of malignant ascites and peritoneal metastases
· Restaging after chemotherapy
Staging of non-GI tract malignancies
· Non-small cell lung cancer
· Mediastinal tumour / lymph node
· (Gynaecological cancer)
Biliary diseases
· Common bile duct stones, sludge and cancer
· GB tumour, stone, polyps and other pathologies
New methods
EUS harmonic contrast study
EUS elastography
Pancreatic diseases
· Pancreatic and ampullary cancer
· Endocrine tumour, cystic tumour , IPMT
· Acute, chronic and idiopathic pancreatitis
· Assessment of pseudocyst (before drainage)
Colorectal diseases
· Colorectal cancer and large polyps
· Colorectal submucosal mass and carcinoid
· IBD (CD, UC)
· Fistula-in-ano, incontinence, pelvic floor dysfunction
· Early detection of rectal tumour recurrence
· Pelvic diseases (abscess, prostate, endometriosis, etc)
Portal hypertension
· Diagnosis of gastroesophageal varices and collaterals
· Monitoring drug and endoscopic therapy
· Haemodynamic study
Dyspepsia and unexplained abdominal pain
2. Indications for EUS (EBUS) - FNA and trucut biopsy
EUS-FNA of tumours
· GIT stromal tumour (GIST, leiomyoma, linitus plastica, etc)
· Lung tumour and metastases
· Liver metastases
· Adrenal metastases
Pancreatic lesion
· Solid pancreatic mass
· Cystic lesion - FNA for fluid analysis, EUS guided brush cytology, EUS guided direct intra-cystic biopsy
· EUS tattoo of small neuroendocrine tumour
EUS-FNA of lymph node in GIT cancer
· Peri-esophageal, celiac axis lymph node
· Peri-gastric
· Peri-pancreatic
· Peri-rectal
EUS (EBUS) - FNA of mediastinal lymph node for staging of NSCLC
EUS (EBUS) - FNA of other mediastinal lymph nodes and masses
· Metastases
· Lymphoma
· TB, Sarcoidosis, Histoplasmosis, etc
EUS-FNA of other lesions
· Ascites
· Pleural effusion
· Pericardial effusion
3. Therapeutic and Interventional EUS (investigational)
EUS-guided injection therapy
· Celiac plexus neurolysis
· Broad plexus neurolysis (around SMA)
· (Hypogastric plexus neurolysis)
· Botox injection for achalasia
· Sclerotherapy of OV and GV
· Lavage (alcohol, paclitaxel) of pancreatic cystic tumour
EUS-guided tumour therapy
· Iodine 125 seeds placement for brachytherapies
· Fiducial placement for stereotactic radiation
· (Tumour ablation ˉ thermal probe, cryo probe, photodynamic probe, laser probe, radiofrequency (High intensity focused ultrasound, HIFU) )
·
(EUS-guided tumour injection therapy)
· Injection of cytoimplant, gene therapy, chemotherapeutic agents, immune modulators
· Alcohol ablation of liver metastases, small pancreatic neuroendocrine tumour, etc.
EUS-guided abscess drainage
· Liver abscess
· Sub-phrenic abscess
· Peri-rectal abscess
EUS-guided ERCP
· Pancreatic ductal cannulation
· CBD rendezvous cannulation
EUS-guided drainage
· Pancreatic pseudocyst drainage
· Pancreatico-gastrostomy (EPG)
· Choledocho-duodenostomy
· Cholecysto-duodenostomy
· Hepatico-gastrostomy
EUS guide vascular therapy
· Cyanoacrylate injection for bleeding varices and aneurysm
· Endocoil placement for varices and aneurysm
· (TIPS placement)
(EUS guided anastomotic surgery)
· Gastro-jejunostomy
EUS-guided angiography
EUS guided needle confocal endomicroscopy
