Endoscopic ultrasound in diagnosis and treatment of treatment

THE FIRST NATIONAL ULTRASOUND CONFERENCE THE UPDATE: ENDOSCOPIC ULTRASOUND IN THE DIAGNOSIS AND TREATMENT OF GASTROENTEROLOGY DISEASES Prof.Tran Van Huy - Dr.Vinh Khanh Department of Internal Medicine - Hue University of Medicine and Pharmacy OBJECTIVES 1 Overview of endoscopic ultrasound The role of EUS in the diagnosis The role of EUS in the treatment Conclusion hinhanhykhoa.com OBJECTIVES 1 Overview of endoscopic ultrasound The role EUS in the diagnosis The role EUS in the treatment Conclusion ENDOSCOPIC ULTRASOUND The way to progress 1st TTS EUS Probe (1976) • Integrated EUS scopes (1980) • Single frequency scopes (1980) • Variable frequency scopes (1985) • 1st EUS – FNA (1991) • Color Doppler • 1st EUS guided cholangiography (1996) • Large Channel Scopes • 1st EUS guided CD-stomy (2002) Interventional Endosonography (2017) hinhanhykhoa.com ENDOSCOPIC ULTRASOUND Radial For diagnosis Linear Diagnosis and intervention Mini probe 12MHz – 20 MHz RADIAL - LINEAR Radial EUS L Imaging perpendicular to the endoscope Linear EUS L Imaging parallel to the endoscope GI Atlas, Wiley hinhanhykhoa.com Radial EUS Linear EUS OBJECTIVES 1 Overview of endoscopic ultrasound The role of EUS in the diagnosis The role of EUS in the treatment Conclusion hinhanhykhoa.com hinhanhykhoa.com STRONG POINTS OF EUS • Puncture not depend on the pseudocyst depression into the wall of the stomach • Avoid vessels by doppler • Preventing perforation • Observing characteristics of lesion before pseudocyst drainage hinhanhykhoa.com EUS-Guided Pancreatic Pseudocyst Drainage • Villa (2010): The success rate of endoscopic drainage ranges from 87%-97%, mortality rate of 1% and the mortality rate of 10% associated with the surgical treatment • Varadarajalu (2007): The successful rate of endoscopic drainage ranges 100% and treatment 95% The successful rate of endoscopic drainage without EUS 57% and treatment 90% Vila JJ, Carral D, Fernández-Urien I (2010), Pancreatic pseudocyst drainage guided by endoscopic ultrasound World J Gastrointest Endosc; 2(6): 193-197 Varadarajulu S, Wilcox CM, Tamhane A, Eloubeidi MA et al (2007), Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage, Gastrointest Endosc 66: 1107-1119 EUS-Guided Pancreatic Pseudocyst Drainage hinhanhykhoa.com EUS guided Pancreaticobilliary drainage EUS guided hepaticogastrostomy hinhanhykhoa.com EUS guided choledochoduodenostomy EUS guided choledochoduodenostomy hinhanhykhoa.com EUS GUIDED ANTEGRADE STENTING EUS GUIDED BILIARY DRAINAGE Stenting / Bilio-enterostomy Alternative to PTC when ERCP fails • • • • • 1st report – Giovannnini (2002) Duodenal / Gastric / Extra / Intra hepatic approaches Direct stenting / rendezvous / antegrade stenting Large case series – multicenter study of 241 patients 85-90% success, ~10% complications Giovannini et al, Burmester et al (2003), Puspok et al, Kahaleh et al (2010, 2005), Kitano (2010), Gupta (2011), Vila (2011), Bapaye (2013), Dhir (2014), Hara (2014) hinhanhykhoa.com EUS GUIDED BILIARY ACCESS EUS-BD vs PTBD Improved rate of internal stenting, fewer complications Bapaye et al , UEGJ 2013 EUS-CDS or EUS-HGS ? No significant difference by either approach Bapaye et al , UEGJ 2013; Dhir et al GIE 2014 EUS guided stenting vs ERCP stenting Similar outcomes in both groups Dhir et al, GIE 2015 EUS GUIDED PANCREATIC STENTING • Situations when Papillary access is not possible (Post op situations, Tight PD stricture) • 75-80% success (Francois, Giovannini, Deviere (2002, 2005) hinhanhykhoa.com EUS-guided Celiac Plexus Neurolysis (CPN) Gastrointest Endosc 2003; 57:923-930 Gastrointest Endosc 2011;73:267-74 EUS GUIDED CELIAC PLEXUS NEUROLYSIS- CPN EUS-CPN safer, direct & under visual control For Cancer pancreas EUS vs CT guided CPN : 78% vs 26%, p = 0.0001, effect sustained for 24 weeks For chronic pancreatitis EUS guided vs CT guided CPN – 43% > 25%, p < 0.05 Complication Transient diarrhea (20-30%), orthostatic hypotension (10-60%), abdominal pain Most are mild and transient Gunaratnam et al (2001), Gress et al (1999) hinhanhykhoa.com CONCLUSION • Endoscopic Ultrasound is an essential technique in gastroenterology diseases • Endoscopic Ultrasound is a new medical procedure which is highly qualified in diagnosis of gastrointestinal and pancreatico- biliary diseases the THANK YOU AND HAPPY NEW YEAR! hinhanhykhoa.com ... Overview of endoscopic ultrasound The role of EUS in the diagnosis The role of EUS in the treatment Conclusion hinhanhykhoa.com OBJECTIVES 1 Overview of endoscopic ultrasound The role EUS in the diagnosis. .. Interventional Endosonography (2017) hinhanhykhoa.com ENDOSCOPIC ULTRASOUND Radial For diagnosis Linear Diagnosis and intervention Mini probe 12MHz – 20 MHz RADIAL - LINEAR Radial EUS L Imaging... Linear EUS L Imaging parallel to the endoscope GI Atlas, Wiley hinhanhykhoa.com Radial EUS Linear EUS OBJECTIVES 1 Overview of endoscopic ultrasound The role of EUS in the diagnosis The role of