Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastr...Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunityto target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.展开更多
The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitali...The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitalizations.Angiodysplasia is the commonest cause of obscure GI bleeding,particularly in the elderly.Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients.Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds.Deep enteroscopy has also an added advantage of therapeutic potential.Computed tomography is helpful in identifying extra-intestinal lesions.In cases of difficult diagnosis,surgery and intra-operative enteroscopy can help with diagnosis and management.The treatment is dependent upon the aetiology of the bleed.An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy.Small bowel bleeding can be managed by conservative,radiological,pharmacological,endoscopic and surgical methods,depending upon indications,expertise and availability.Some patients,especially those with multiple vascular lesions,can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.展开更多
Background:Walled-off pancreatic necrosis(WOPN)is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound(EUS)or magnetic resonance imaging(MRI),which can ...Background:Walled-off pancreatic necrosis(WOPN)is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound(EUS)or magnetic resonance imaging(MRI),which can clearly visualize necrotic debris.The effectiveness of abdominal ultrasound(USG)in detecting solid debris in WOPN is not clear.Methods:A total of 52 patients(37 males,mean age 38.9612.6 years)with symptomatic WOPN were prospectively studied using EUS,MRI and USG.These investigations were done at a mean of 11.765.5 weeks of onset of acute pancreatitis and within two days.Results:WOPN was detected by EUS&MRI in all patients,whereas USG could not detect it in 4(7.6%)patients(3 had predominantly solid WOPN,whereas one had air foci in WOPN).USG,MRI and EUS could detect solid debris in all patients with detectable WOPN.EUS and USG detected<10%debris in 10(20%)patients,whereas MRI detected<10%debris in 14(27%)patients.EUS and USG detected 10–40%debris in 33 patients whereas MRI detected 10–40%debris in 30(58%)patients.More than 40%debris was better characterized on EUS and MRI with both detecting>40%debris in 8 patients(15%)compared to 5(11%)patients having>40%debris on USG.EUS detected collaterals around WOPN that were not detected on USG or MRI.Conclusion:USG can characterize the majority of WOPN,with accuracy comparable to that of EUS/MRI.However its limitations are the inability to detect collaterals around WOPN and characterize collections with high solid content or air.展开更多
文摘Endoscopic ultrasound(EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunityto target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.
文摘The small intestine is an uncommon site of gastro-intestinal(GI)bleeding;however it is the commonest cause of obscure GI bleeding.It may require multiple blood transfusions,diagnostic procedures and repeated hospitalizations.Angiodysplasia is the commonest cause of obscure GI bleeding,particularly in the elderly.Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients.Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds.Deep enteroscopy has also an added advantage of therapeutic potential.Computed tomography is helpful in identifying extra-intestinal lesions.In cases of difficult diagnosis,surgery and intra-operative enteroscopy can help with diagnosis and management.The treatment is dependent upon the aetiology of the bleed.An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy.Small bowel bleeding can be managed by conservative,radiological,pharmacological,endoscopic and surgical methods,depending upon indications,expertise and availability.Some patients,especially those with multiple vascular lesions,can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician.
文摘Background:Walled-off pancreatic necrosis(WOPN)is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound(EUS)or magnetic resonance imaging(MRI),which can clearly visualize necrotic debris.The effectiveness of abdominal ultrasound(USG)in detecting solid debris in WOPN is not clear.Methods:A total of 52 patients(37 males,mean age 38.9612.6 years)with symptomatic WOPN were prospectively studied using EUS,MRI and USG.These investigations were done at a mean of 11.765.5 weeks of onset of acute pancreatitis and within two days.Results:WOPN was detected by EUS&MRI in all patients,whereas USG could not detect it in 4(7.6%)patients(3 had predominantly solid WOPN,whereas one had air foci in WOPN).USG,MRI and EUS could detect solid debris in all patients with detectable WOPN.EUS and USG detected<10%debris in 10(20%)patients,whereas MRI detected<10%debris in 14(27%)patients.EUS and USG detected 10–40%debris in 33 patients whereas MRI detected 10–40%debris in 30(58%)patients.More than 40%debris was better characterized on EUS and MRI with both detecting>40%debris in 8 patients(15%)compared to 5(11%)patients having>40%debris on USG.EUS detected collaterals around WOPN that were not detected on USG or MRI.Conclusion:USG can characterize the majority of WOPN,with accuracy comparable to that of EUS/MRI.However its limitations are the inability to detect collaterals around WOPN and characterize collections with high solid content or air.
