bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term. effectiveness[r]
(1)THAWEE Ratanachu-ek, M.D Surgical Endoscopy Unit,
Department of Surgery, Rajavithi Hospital
EUS
Endoscopic Ultrasonography In clinical practice
EndoUltraSonography
Endoscopic ultrasound(EUS)
Endoscopy Ultrasonography
(2)Mucosal lesion
Submucosal lesion
Extraluminal lesion
Endo Ultra Sonography
Why it is developped?
Endoultrasonoprobe
Radial EUS
Convex (Longitudinal) EUS Miniprobe
(3)EUS: Basic principle
Mucosa
Muscularis mucosae Submucosa Proper muscle Sub-,serosa
Border echo Border echo 7.5-12 MHz : 5-layer
20-30 MHz: layer
(4)Endoscopic ultrasound(EUS)
Radial type
Linear (convex) type
1980 2005
Modified from E Burmester, EURO EUS 2005 Diagnosis
EUS-FNA
Therapeutic procedure
EUS: Technical Development
(5) Cancer staging (T,N,M?)
Lung cancer, GI cancer
Giant Gastric folds
Subepithelial tumor
HBP lesions
Retroperitoneal lesions
Colon & Rectum
etc……
EUS: Clinical Practice
Diagnostic applications
Pseudocyst drainage
Pancreatic necrosectomy
Celiac plexus neurolysis/block
Biliary-enteric bypass
Drainage of collection Intervention EUS
(6)EUS: Clinical Practice
Absolute contraindication
Uncorrectable coagulopathy with INR>1.5 Uncorrectable thrombocytopenia with platelet count<50,000/ul
Relative contraindication: Precaution
Biliary obstrcution without prior decompression Bronchogenic duplication cyst
Trajectory to vessel Luminal stenosis Tumor spreading
EUS: Complications
Bleeding
Pancreatitis
Infection
Perforation
Air embolism
(7) Cancer staging (T,N,M?)
Lung cancer, GI cancer
Giant Gastric folds
Subepithelial tumor
HBP lesions
Retroperitoneal lesions
Colon & Rectum
etc……
EUS: Clinical Practice
Diagnostic applications
EUS-FNA is possible in lymph node station :
1, 2, 3, 4, (5 ), 7, 8 and
Remember the adrenal glands !
(8)Cancer staging (T,N,M?)
T4,N1 esophageal cancer
Liver metastasis Panc.head mass FNA
Metastasis liver celiac LN Mass@panc
(9)abutment invasion
encasement
EUS: Pancreatic cancer; Assessment of vascular invasion
Subepithelial Tumor
mucosa
(10)Owens D, Savides T Endoscopicn untrasound, 2009:98-119
SET based on site of origin
DDx of SMT based on
site of origin & Echo pattern: rd
Lipoma
Glomus tumor Panc rest
Goldblum J R et al.; Ann Thorac Surg 1996;62:860-865
(11)DDx of SMT based on
site of origin & Echo pattern: 2nd/4th
Leiomyoma
GIST
GIST
(12)Garcea G, Ong SL, Rajesh A, et al.Cystic Lesions of the Pancreas Pancreatology 2008;8:236-251 Features of common pancreatic cysts
Microcystic with macrocystic varients
Macrocystic with microcystic varients Branches type
P-cyst: Over-lapping Images
Macrocystic Microcystic Oligocystic
MCN SCN IPMN
(13)EUS: aspiration
antibiotic EUS guided pancture 19, 22 G needle
Wash-out the wall
Levy MJ, Wiersema MJ Pancratic neoplasm.Gastrointest Endoscopy Clin N Am 2005;15:117-142
Pseudocyst drainage
Pancreatic necrosectomy
Celiac plexus neurolysis/block
Biliary-enteric bypass
Drainage of collection Intervention EUS
(14)i-EUS: How often?
Siriraj 5.0% Chula 4.8% NKC-Songkla 4.6% Rajavithi 7.4%
i-EUS 204/ total EUS (N) 3807= 5.3%
(N=1300) (N=471)
(N=1253) (N=783)
% of i-EUS:d-EUS/YEAR
Courtesy: Dr.Siriboon,Dr Bancha, Dr.Tassanee,Dr.Thawatchai,Dr.Nonthalee,Dr,Varayut, Dr.Pradermchai
i-EUS: What procedures?
64 (31.3%) 76
(37.0%) 42
(20.5%)
11 11
(15)CGN: Ganglia injection CPN: Single/ Bilateral injection
Celiac plexus Neurolysis(CPN) Block (CPB)
Gunaratnam NT, Sarma AV, Norton ID, et al A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain GIE 2001;54:316–324 Sahai AV, Lemelin V, Lam E, Paquin PC Central vs bilateral endoscopic ultrasound-guided celiac plexus block or neurolysis: a comparative study of short-term
effectiveness Am J Gastroenterol 2009 Feb;104(2):326-9 Epub 2009 Jan
Sakamoto H, Kitano M, Komaki T, et al Endoscopic ultrasound-guided neurolysis in pancreatic cancer Pancreatology 2011;11Suppl 2:52-8 Epub 2011 Apr Sakamoto H, Kitano M, Komata K, et al Am J Gastroenterol 2010;105:2599-2606
Levy MJ, Topazian MD, Wiersema MJ, et al Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block Am J Gastroenterol 2008;103:98–103
BPN (Broad Plexuse Neurolysis)
Covered areas CPN(%) BPN (%)
42
28
34 15
1-3 57 15
Gleeson FC, Levy MJ, Papachristou GI Frequency of visualization of presumed celiac ganglia by endoscopic ultrasound Endoscopy 2007;39:620-4
Not possible up to 20%
Achieve 70%
Choledochoduodenostomy Hepaticogastrostomy
EUS Guided HPB Drainage
Gall bladder drainage*
Bile duct drainage
Biloma drainage
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