EUS can be used to stage cancers of the esophagus, stomach, rectum, lung and diagnose pancreatic cancer. It allows evaluation of abnormalities in the GI tract wall and adjacent structures. EUS guided FNA biopsy enables cytopathological diagnosis of cancers and nodal metastases. EUS is well-suited for TNM tumor staging as it can assess depth of tumor penetration, locoregional nodal spread and vascular invasion. It also has applications in diagnosis of cholangiocarcinoma, evaluation of pancreatic cysts and masses, and celiac plexus neurolysis for pain relief.

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. EUS

4. EUS Indications

5. EUS: 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; 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). 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. EUS-guided FNA biopsy allows for cytopathological diagnosis of malignant primary tumors and is superior to other imaging modalities for confirmation of nodal metastases

6. EUS Indications (1) 1. Staging of esophageal, gastric and rectal cancer 2. Evaluation of abnormalities of the gastrointestinal wall or adjacent structures (submucosal masses, extrinsic compression) 3. Evaluation of thickened gastric folds 4. Diagnosis (FNA) and staging of pancreatic cancer 5. Evaluation of pancreatic abnormalities (suspected masses, cystic lesions including pseudocysts, suspected chronic pancreatitis)

7. EUS Indications (2) 6. Staging of ampullary neoplasms 7. Diagnosis and staging of cholangiocarcinoma 8. Evaluation of suspected choledocholithiasis 9. Celiac plexus neurolysis for chronic pain due to intra-abdominal malignancy or chronic pancreatitis 10. Lung cancer diagnosis and staging

8. Staging of Esophageal Gastric& Rectal Cancer TNM System

17. Celiac LN in T3 Esophageal Cancer

18. T3 Esophageal Cancer Aorta <invasion <Muscularis Propria LN Azv

22. Normal stomach

23. MALTOMA in stomach:

24. MALTOMA in stomach: MALT involving Muscularis

25. Bi-lobed leomyma in stomach: MALT involving Muscularis

26. Gastric Cancer: T1

27. Gastric Cancer: T1

28. Gastric Cancer: T2

29. Gastric Cancer: T3

31. Rectum: normal

32. Rectal Cancer:T2N0

33. Same Rectal Cancer T3N1: Untreated, 4 months later

34. Rectal ca

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).

36. Abnormalties of GI tract wall The 5 layers

37. Submucosal Gastric Tumor

38. Biopsy this?

39. Gastric Varix: Biopsy not recommended

40. Thickened Gastric Folds Hyperacidic states Hypoproteinemia Lymphoma Eosinophilic gastroenteritis Varices Menetrier’s disease Crohn’s

41. Linitis Plastica

42. MALT Lymphoma

43. Diagnosis and Staging of Pancreatic Cancer

44. Periduodenal Collaterals

45. The Cause: Pancreatic Cancer

46. Rapidly Growing Pancreatic Mass

47. EUS FNA

48. Evaluation of Pancreatic Abnormalties

49. Evaluation of Pancreatic Abnormalties

50. Evaluation of Pancreatic Abnormalties

51. Evaluation of Pancreatic Abnormalties

52. Pancreatic Pseudocyst

53. Chronic Pancreatitis

54. Fatty Infiltration of the Pancreas

55. Pancreatic mass?

60. Benign Adrenal Adenoma !

61. Evaluation of Ampullary Neoplasms

62. Ampullary Carcinoma

63. Ampullary Carcinoma (cont.)

64. Ampullary Adenoma

65. Ampullary Adenoma

66. Diagnosis and Staging of Cholangiocarcinoma

67. Cholangiocarcinoma

68. Another Cholangiocarcinoma

69. Suspected Choledocholithiasis

70. Choledocholithiasis

71. Choledocholithiasis (cont.)

72. Choledocholithiasis (cont.)

73. CBD < < STONE <PD HOP

74. <CBD stone Duod

75. CBD Sludge PV HOP GB Sludge

76. Gallbladder sludge and stone

78. Injection Therapy

79. Celiac Plexus Block

80. Tumor Therapy

81. Alcohol Injection into a Mediastinal Metastasis compressing the Esophagus

82. Lung Cancer

83. ATS Lymph Node Map

84. Surgery and then Recurrence?

85. EUS guided FNA of Area 7 LN

105. Keep in touch!