Bowel wall seen with 5 alternating hyperechoic and hypoechoic layers – first interface between superficial mucosa and water, second mucosa and muscularis mucosae, third submucosa, fourth muscularis propria, fifth serosa and perirectal fat Carcinomas hypoechoic and degree to which disrupt and penetrate rectal wall suggests local stage First picture - , second radial echoendoscope
Not only we that we can see but also we can toutch
Transcript of "Eus beyond mucosa and beyond gastroenterology"
EUS beyond mucosa and beyond
Ahmed Alwassief MD
• A novel technology that combines
visualisation of the mucosa and radiologic
power to see beyond “ deep to the mucosa”
• The role of EUS has continued to expand with
the introduction of EUS-guided fine needle
aspiration (FNA) of mural, extra-mural, and
• In the year 2000 guidelines for the use of EUS
• T lesion, adenocarcinoma in lower thoracic esophagus with central depression shown by yellow
arrow (a); endoscopic ultrasound (EUS)
• image showing submucosal invasion but no involvement of muscularis propria (MP) shown by
yellow arrow (b).
• Gastric lymphoma causing a linitis plastic appearance. This patient with a diffusely infi ltrating B - cell lymphoma
has poorly distensible thickened abnormal - appearing gastric folds on endoscopy (a). On endoscopic ultrasound
(b), there is preservation of the fi ve - layer pattern but markedthickening of the gastric wall to 10.9 mm with a
thickened muscularis propria to 2.5 mm (normal 1 mm or less).
• CPN and CPB
• Botulinum injection in achalasia
• EUS-guided Ablation of tumors and cysts
Radiofrequency, or alcohol injection
• EUS-guided placement of radiographic
• EUS-guided drainage procedures “ cysts,
abscesses, CBD, hepatic duct and pancreatic
Chronic Abdominal Pain& CPB or CPN?
• Can be a clinically challenging problem
especially if narcotic analgesia is indicated
At that point CPN or CPB can help in
• Pain relief
• Improving quality of life