Endosonography Liver Biliary

1. ENDOSONOGRAPHY IN
HEPATOBILIARY CONDITIONS
Hakan Senturk
Department of Gastroenterology
Bezmi Alem Foundation University
Istanbul, TURKEY
29.9.2018 APASL Single Topic

2. DIAGNOSTIC
• Diffuse liver diseases: Incidental diagnosis of liver diseases: Mostly
steatosis, sometimes cirrhosis (with or w/o splenomegaly)
• Differential diagnosis of jaundice and liver function test abnormalities.
• Evaluation of portal vein and its tributaries, including FNA.
• Evaluation of liver masses in the left lobe (and medial sector of right lobe)
of the liver. FNA, in case it is necessary.
• Evaluation of biliary sistem, papilla,and pancreas in the differential
diagnosis of extrahepatic cholestasis.
• Evaluation of lymph nodes in hepatobiliary diseases
• Evaluation of paraesophageal varices.
29.9.2018 APASL Single Topic

3. Therapeutic
• Drainage of liver abscesses
• Biliary drainage and management of stones and strictures:
Hepaticogastrostomy.
• Coil embolization of gastric varices
• (Selective administration of anti-tumor agents into the portal vein)
• (EUS-guided TIPS)
29.9.2018 APASL Single Topic

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5. Liver metastasis
• 574 pts. with suspected GI or pulmonary malignancy:
15 liver lesions detected by EUS. FNA revealed malignacy in 14 (2.4 %)
Previous CT revelaed only 3/14 (21 %).
• 132 newly diagnosed GI or pulmonary cancer: CT vs. EUS
CT diagnosed 19 vs EUS diagnosed 40 liver lesions.
Clin Liver Dis 14(2010): 325-332
29.9.2018 APASL Single Topic

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8. Boston Scientific
ACQUIRE
Cook
Procore
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JFMA 2015;114:820-28

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14. VARİCES
• Presence of paraesophageal varices are associated to more
recurrence after band ligation.
• Gastric varices are better visualized by EUS
• Portal anatomy, and if present, thrombosis extent, are better
delienated by EUS
• (Portal vein pressure can be measured directly.)
Clin Liver Dis 14(2010):195-208
29.9.2018 APASL Single Topic

15. GIE 2017;85:883-88829.9.2018 APASL Single Topic

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20. ENDOSCOPY LIVE DEMONSTRATION FROM
BEZMİ ALEM UNİVERSİTY
Tomorrow 8 am to 6 pm in Room D
• WOPN drainage with Hot-Axios.
• Spyglass Cholagioscopic evaluation and biopsy of biliary strictures.
• Spyglass Cholangiscopic Laser Lithotrpsy of large biliary stones.
• Spyglass laser lithotripsy of Pancreatic duct stones.
• EUS-guided gastrojejunostmy in gastric outlet obstruction.
• RF ablation (EUSRA) of non-resectable pancreatic malignancies.
• RF ablation (ELRA) of biliary malignancies.
• Endoscopic papillectomy
• Interesting pancreatic masses for diagnosis.
29.9.2018 APASL Single Topic