What is endoscopic ultrasound used for and how does it work?

What is endoscopic ultrasound used for and how does it work?

تاريخ النشر : 28-01-2025

تحديث في : 28-01-2025

الموضوع: أمراض الجهاز الهضمي

الوقت المقدر للقراءة : 1 min

Endoscopic ultrasound (EUS) is an advanced technique that combines endoscopy and ultrasound to provide highly detailed and accurate analysis of conditions affecting the digestive system, bile ducts, and pancreas.

We explore the topic with Dr. Giuseppe Dell’Anna and Dr. Guglielmo Albertini Petroni, experienced gastroenterologists and endoscopists, who are responsible for this procedure at the endoscopic ultrasound service of the Gastroenterology and Digestive Endoscopy Unit at Policlinico San Donato. The unit reopened in November 2023, reaffirming itself as a vital resource for patients.

Endoscopic ultrasound: what is it for?

During the endoscopic ultrasound (EUS) procedure, a flexible endoscope equipped with an ultrasound probe at its tip is inserted into the digestive tract, allowing the physician to perform an endoscopic ultrasound.

This approach provides a clear, close-up view not only of the walls of the esophagus, stomach, duodenum, and rectum but also of nearby organs such as the pancreas, bile ducts, gallbladder, and lymph nodes. It overcomes the limitations of traditional transabdominal ultrasound, which can be hindered by intestinal gas or limited ultrasound wave penetration.

Thanks to its high resolution and ability to approach structures closely, EUS has become a critical method for diagnosing complex gastrointestinal conditions, such as:

  • Pancreatic tumors;
  • Pancreatic cystic lesions;
  • Biliary tract disorders;
  • Epithelial and subepithelial lesions of the gastric and intestinal walls.

The precision of this technique also enables dedicated screening, identifying and characterizing small tumors, enlarged lymph nodes, or precancerous lesions (e.g., mucinous pancreatic cysts) often undetectable by other diagnostic methods.

Beyond improving diagnostic quality, EUS allows for targeted interventions such as:

  • Guided biopsies;
  • Cyst or fluid collection drainage;
  • Minimally invasive anastomoses between the bile ducts and the digestive tract in cases of obstructive jaundice or gastroduodenal anastomoses in cases of gastric or duodenal stenosis.

This provides patients with minimally invasive therapeutic options, reducing the need for more invasive traditional surgeries.

Diagnostic and operative echoendoscopy: how they are performed?

Diagnostic endoscopic ultrasound (EUS) is an outpatient procedure, meaning that the patient does not need to be hospitalized and can return home the same day.

To make the examination more comfortable and reduce discomfort, sedoanalgesia is administered: a combination of light sedation and analgesics that relaxes the patient and reduces the perception of pain.

This type of anesthesia keeps the patient in a semi-conscious state, without experiencing anxiety or discomfort during the examination, with a quick recovery at the end of the procedure.

In contrast, operative procedures require hospitalization and are performed under general anesthesia. Patients must arrive fasting and follow instructions to discontinue any anticoagulant or antiplatelet therapy, as per the center's protocol.

"One year after the reopening of the service, the team at Policlinico San Donato has optimized the preparation and management of patients, ensuring reduced waiting times and high-quality care," says Dr. Dell’Anna.

Endoscopic ultrasound for the diagnosis of tumors

An endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is a medical procedure used to collect a small tissue sample from an organ or a suspicious mass for microscopic analysis. It is employed to diagnose various conditions, including tumors and infections.

EUS has become the reference method for performing fine needle biopsies (FNB) on hard-to-reach lesions, such as those in the pancreas, bile ducts, lymph nodes, or submucosa.

Thanks to its high ultrasound resolution, it is now possible to obtain tissue for histological diagnoses and molecular biology evaluations. This approach has enhanced the effectiveness of personalized cancer treatments and contributed to research on predisposing genetic mutations.

“After a year of activity, our team has expanded its capabilities in sample collection and analysis, continually improving the accuracy of gastroenterological diagnoses and personalized treatments,” says Dr. Albertini Petroni.

Operative echoendoscopy: minimally invasive and innovative

Another success of the past year involves operative endoscopic ultrasound (EUS), which has proven to be a minimally invasive option for managing complex biliopancreatic conditions, such as complications from pancreatic and biliary tumors.

Thanks to endoscopic ultrasound, the diagnostic and therapeutic approach to many complex conditions has significantly improved. In numerous cases, this procedure has not only enabled accurate diagnosis but also allowed for direct intervention on particularly severe and debilitating symptoms, including:

  • Malignant jaundice, often caused by tumors obstructing the bile ducts;
  • Cholecystitis;
  • Gastroduodenal obstruction, which can hinder normal eating and cause severe discomfort for patients.

Through endoscopic ultrasound, physicians are able to manage and alleviate these symptoms, significantly improving patients' quality of life and, in some cases, avoiding more invasive surgical procedures.

Innovative techniques have included the use of advanced metal stents (LAMS, Lumen Apposing Metal Stent), enabling less invasive treatment of patients with biliopancreatic complications.

The results of this first year have been extremely positive, with numerous cases successfully resolved thanks to this technology, which has reduced the need for more invasive surgeries.

Endoscopy Ultrasound Service at the Policlinico San Donato

Activated in November 2023 within the Gastroenterology and Digestive Endoscopy Unit, led by Prof. Vito Annese, the Diagnostic and Operative Endoscopic Ultrasound (EUS) Service has established its role in the diagnosis and treatment of gastrointestinal diseases.

Over 200 diagnostic and operative endoscopic ultrasounds have been performed. Of these, approximately 80 involved the digestive tract, and 120 were biliopancreatic endoscopic ultrasounds.

More than 100 endoscopic ultrasounds with biopsies were carried out, some of which were followed by ERCP to treat malignant jaundice. Additionally, the team performed about 30 operative endoscopic ultrasounds with the placement of LAMS.

These figures demonstrate the growing importance of the service and patients' trust in the benefits of endoscopic ultrasound at the IRCCS Policlinico San Donato.

Endoscopic ultrasound is establishing itself as an essential tool for gastrointestinal health, offering patients personalized solutions and a faster, safer therapeutic pathway.

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