Release date: 2016-06-17
Professor Zhang Yutian (first from left) and Professor Li Peng at the 2016 DDW Annual Meeting
On May 21-24, 2016 Digestive Disease Week (DDW) was held in San Diego, USA. This article briefly introduces the progress of ultrasound endoscopy (EUS) and shares it with the same channel.
EUS and diagnosis of celiac vascular disease
Professor Michael introduced the clinical application of endoscopic ultrasound in celiac vascular disease. It demonstrates the value of EUS in this area through a number of cases. The first patient was diagnosed with upper gastrointestinal bleeding, and no repeated hemoscopic examination showed hemorrhagic foci. EUS examination showed that the esophagus was obviously varicose veins, and the EUS varicose vein was built into the intravascular rim. The patient did not have gastrointestinal bleeding again. The second patient was diagnosed with cirrhosis with bile duct obstruction, and biliary bleeding occurred after biliary metal stent placement. The cause is unknown. EUS examination showed obvious varicose veins around the biliary tract, which was inserted into the intravascular rim through the EUS varicose vein, and the gastrointestinal bleeding stopped.
In addition, Professor Michael also introduced the ultrasound-guided puncture (25G) portal vein branch and hepatic vein, and pressure monitoring, which is very helpful for the treatment of patients with portal hypertension.
The role of EUS in tumor diagnosis and biliary diseases
Tumor diagnosis and treatment Dr. Suhag introduced the diagnostic value of EUS for adrenal metastasis of lung cancer. It was found that for patients with abnormal adrenal gland findings by transabdominal CT, EUS puncture results showed that about 50% were caused by metastasis of lung cancer, which is of great value for guiding patients in the next treatment.
Dr. Naveen reported on the celiac ganglion metastasis of digestive tract tumors (mainly pancreatic cancer). It is currently believed that if the EUS examination results show a low echo structure around the celiac trunk, and the tumor cells are found by puncture, and there are nerve structures at the same time without lymphoid tissue, it can be considered as tumor ganglion metastasis. The results of the study show that the rate of celiac ganglion metastasis of digestive tract tumors (mainly pancreatic cancer) exceeds 10%, but the clinical guiding value is still unclear.
Bile duct disease Professor Itoi of Japan showed the participants the application of EUS in biliary puncture. EUS bile duct puncture is generally used when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or impossible. Compared with percutaneous transhepatic biliary drainage (PTCD), there was no significant difference in the incidence of EUS succession and adverse reactions, and EUS could be performed immediately after ERCP failure, which is convenient and safe. In addition, Itoi introduced 2 cases, 1 patient with hepatic hilar cholangiocarcinoma after double plastic stent placement, considering cholangitis, ERCP was difficult again, EUS examination showed intrahepatic bile duct dilatation, and bile duct occlusion was performed under the liver EUS After entering the plastic stent, the patient's fever symptoms improved. The other case was a patient with bile duct stones after the duodenal duodenal resection (Whipple). The hepatic bile duct puncture was performed in the stomach. The lower common bile duct stones were confirmed by angiography. After the balloon was dilated at the lower end of the bile duct, the stones were pushed into the intestine.
EUS and gastrojejunostomy
Professor Mouen introduced the method of gastrojejunostomy in EUS.
For patients with narrow gastric outflow tract and endoscopic passage, the mixed liquid of Meilan and contrast agent can be injected near the stomach after the endoscope passes through the stenosis, and it is searched by EUS under X-ray monitoring. Puncture the intestinal tube filled with liquid; after that, if the blue liquid is visible, the puncture position is correct, the guide wire can be placed along the puncture needle, and the puncture channel is expanded, and the ostomy stent is placed.
For patients with narrow gastric outflow tract and endoscope failure (only guide wire can pass), the operator must insert the dilatation balloon along the guide wire into the jejunum closer to the stomach, and inject the Meilan and contrast agent into the balloon. The mixed liquid, under X-ray surveillance, is searched by EUS and punctures the fluid-filled balloon, and the subsequent steps are the same as "the patient with a narrow outflow of the gastric endoscope through which the endoscope can pass."
The above operations require the high level of skill of the endoscopist. Therefore, clinical applications should be performed by experienced doctors and must be carefully selected.
Source: China Medical Tribune
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