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Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
Idus euroson 2008
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Idus euroson 2008

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  • 1. Advances in diagnosis and staging of bilio-pancreatic tumors: intraductal ultrasonography (IDUS)
  • 2. Int roduction
    • Diagnosis and staging of bilio-pancreatic tumors is sometimes difficult
    • Abdominal ultrasound , computer tomogra phy and magnetic nuclear resonance have increasing sensibility and specificity in diagnosing and staging of bilio-pancreatic tumors
    Timisoara 2008
  • 3. Histologic specimen
    • endoscopic ultrasound with fine needle aspiration
    • Endoscopic retrograde cholangio-pancreatography (ERCP)
      • Brush cytology
      • Direct biopsy
    Timisoara 2008
  • 4. IDUS
    • Miniprobes
      • Diameter : 1- 2,2 mm
      • Passed into the working channel of the duodenoscope
      • Transpapilary pased into the biliary or pancreatic ducts
      • Radiologic control or over the guide wire
    Timisoara 2008
  • 5. Timisoara 2008
  • 6. Timisoara 2008
  • 7. Exa mination
    • ERCP: cateterization of the stenozis with guide wire
    • Probe is passed over the guide through the stenozis, the examination is made retiring the probe
    • Duration : 5-15 min
    Timisoara 2008
  • 8. Indications :
    • Diferential diagnosis and staging of
      • Biliary stenozis
      • Ampuloma
      • Pancreatic disease
    Timisoara 2008
  • 9. IDUS - aims:
    • Feasibility of the method
    • Time of examination
    • Diagnostic value
    • Complications related to the IDUS
    Timisoara 2008
  • 10. Results in 17 patients
    • 11 biliary stenozis
    • 2 ampulomas
    • 4 pancreatic neoplasms
    Timisoara 2008
  • 11. Bilary pathology
    • Cholangiocarcinoma
    • External invasion
    • Intraductal metastatic tumors
    • Sclerosing cholangitis
    • Mirizzi syndrome
    Timisoara 2008
  • 12. ERCP : confluence stenozis Opacification of left intrahepatic ducts after cateterization with guide wire Timisoara 2008
  • 13. Timisoara 2008
  • 14. Hilar tumor, peritumoral abcess Timisoara 2008
  • 15. Main hepatic duct tumor Timisoara 2008
  • 16. External invasion Timisoara 2008
  • 17. Intraductal tumors Timisoara 2008
  • 18. Secondary sclerosing cholangitis Timisoara 2008
  • 19. Mirizzi syndrome Timisoara 2008
  • 20. Ampulom a Staging before endoscopic resection Timisoara 2008
  • 21. Timisoara 2008
  • 22. Pancreatic neoplasm Timisoara 2008
  • 23. Conclu sions
    • IDUS is feasible
    • Moderate prolongation of the examination
    • Useful in selected cases for
      • differential diagnosis
      • Staging
    • No complicationn related to IDUS
    • Recomanded for expert endoscopists
    • Price? Cost effectiveness?
    Timisoara 2008

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