Git Endoscopic Ultrasound.

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Endoscopic ultrasound EUS Updated.

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Git Endoscopic Ultrasound.

  1. 1. Endoscopic Ultrasound (EUS) A Survey of Typical Applications Klaus Gottlieb, MD Clinical Associate Professor; University of Washington Vadim Brjalin Lääne-Tallinna Keskhaigla Updated by: Dr.Mohammad Shaikhani, Asistan profesor. Sulaymanyiah University, College of Medicine. Department of Medicine. Sulaymanyiah GIT/Hepaatology center.
  2. 2. EUS
  3. 4. EUS Indications
  4. 5. EUS: <ul><li>EUS – a new methode in the diagnosis of oesophageal, gastric, biliopancreatic, anal disorders and intramural lesions of the gastrointestinal tract ;It helps staging of the GI cancer; </li></ul><ul><li>It also allows to stage the lung cancer and detect lymph nodes in the mediastinum; it allows to perform different interventional diagnostic (FNA, drainage) and therapeutic procedures(celiac axis neurolysis, injection of activated lymphocytes into pancreatic tumor). </li></ul><ul><li>Ideally suited to the TNM classification for tumor staging as it can accurately assess the depth of tumor penetration, the presence of locoregional nodal metastases and can detect vascular invasion. </li></ul><ul><li>EUS-guided FNA biopsy allows for cytopathological diagnosis of malignant primary tumors and is superior to other imaging modalities for confirmation of nodal metastases </li></ul>
  5. 6. EUS Indications (1) <ul><li>1. Staging of esophageal, gastric and rectal cancer </li></ul><ul><li>2. Evaluation of abnormalities of the gastrointestinal wall or adjacent structures (submucosal masses, extrinsic compression) </li></ul><ul><li>3. Evaluation of thickened gastric folds </li></ul><ul><li>4. Diagnosis (FNA) and staging of pancreatic cancer </li></ul><ul><li>5. Evaluation of pancreatic abnormalities (suspected masses, cystic lesions including pseudocysts, suspected chronic pancreatitis) </li></ul>
  6. 7. EUS Indications (2) <ul><li>6. Staging of ampullary neoplasms </li></ul><ul><li>7. Diagnosis and staging of cholangiocarcinoma </li></ul><ul><li>8. Evaluation of suspected choledocholithiasis </li></ul><ul><li>9. Celiac plexus neurolysis for chronic pain due to intra-abdominal malignancy or chronic pancreatitis </li></ul><ul><li>10. Lung cancer diagnosis and staging </li></ul>
  7. 8. Staging of Esophageal Gastric& Rectal Cancer <ul><li>TNM System </li></ul>
  8. 17. Celiac LN in T3 Esophageal Cancer
  9. 18. T3 Esophageal Cancer Aorta <invasion <Muscularis Propria LN Azv
  10. 22. Normal stomach
  11. 23. MALTOMA in stomach:
  12. 24. MALTOMA in stomach: MALT involving Muscularis
  13. 25. Bi-lobed leomyma in stomach: MALT involving Muscularis
  14. 26. Gastric Cancer: T1
  15. 27. Gastric Cancer: T1
  16. 28. Gastric Cancer: T2
  17. 29. Gastric Cancer: T3
  18. 31. Rectum: normal
  19. 32. Rectal Cancer:T2N0
  20. 33. Same Rectal Cancer T3N1: Untreated, 4 months later
  21. 34. Rectal ca
  22. 35. A large perirectal mass is seen invading the rectal wall. FNA biopsy (Pentax FG-32UA) of the mass confirmed recurrence of prostatic cancer (inset).
  23. 36. Abnormalties of GI tract wall <ul><li>The 5 layers </li></ul>
  24. 37. Submucosal Gastric Tumor
  25. 38. Biopsy this?
  26. 39. Gastric Varix: Biopsy not recommended
  27. 40. Thickened Gastric Folds <ul><li>Hyperacidic states </li></ul><ul><li>Hypoproteinemia </li></ul><ul><li>Lymphoma </li></ul><ul><li>Eosinophilic gastroenteritis </li></ul><ul><li>Varices </li></ul><ul><li>Menetrier’s disease </li></ul><ul><li>Crohn’s </li></ul>
  28. 41. Linitis Plastica
  29. 42. MALT Lymphoma
  30. 43. Diagnosis and Staging of Pancreatic Cancer
  31. 44. Periduodenal Collaterals
  32. 45. The Cause: Pancreatic Cancer
  33. 46. Rapidly Growing Pancreatic Mass
  34. 47. EUS FNA
  35. 48. Evaluation of Pancreatic Abnormalties
  36. 49. Evaluation of Pancreatic Abnormalties
  37. 50. Evaluation of Pancreatic Abnormalties
  38. 51. Evaluation of Pancreatic Abnormalties
  39. 52. Pancreatic Pseudocyst
  40. 53. Chronic Pancreatitis
  41. 54. Fatty Infiltration of the Pancreas
  42. 55. Pancreatic mass?
  43. 60. Benign Adrenal Adenoma !
  44. 61. Evaluation of Ampullary Neoplasms
  45. 62. Ampullary Carcinoma
  46. 63. Ampullary Carcinoma (cont.)
  47. 64. Ampullary Adenoma
  48. 65. Ampullary Adenoma
  49. 66. Diagnosis and Staging of Cholangiocarcinoma
  50. 67. Cholangiocarcinoma
  51. 68. Another Cholangiocarcinoma
  52. 69. Suspected Choledocholithiasis
  53. 70. Choledocholithiasis
  54. 71. Choledocholithiasis (cont.)
  55. 72. Choledocholithiasis (cont.)
  56. 73. CBD < < STONE <PD HOP
  57. 74. <CBD stone Duod
  58. 75. CBD Sludge PV HOP GB Sludge
  59. 76. Gallbladder sludge and stone
  60. 78. Injection Therapy
  61. 79. Celiac Plexus Block
  62. 80. Tumor Therapy
  63. 81. Alcohol Injection into a Mediastinal Metastasis compressing the Esophagus
  64. 82. Lung Cancer
  65. 83. ATS Lymph Node Map
  66. 84. Surgery and then Recurrence?
  67. 85. EUS guided FNA of Area 7 LN
  68. 105. Keep in touch!

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