Gastrointestinal cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
This is the investigation of choice. The oesophagus starts at the lower border of the cricoid cartilage at the level of the sixth cervical vertebra, approximately 15 cm from the incisor teeth. It is 25 cm in length, entering the stomach at the level of the tenth thoracic vertebra (i.e. approximately 40 cm from the incisors). Endoscopy allows a thorough assessment of the whole oesophagus. The tumour can be visualized directly, a biopsy taken for histology and brushings for cytology. It also allows a thorough evaluation of the stomach, which is particularly important in tumours of the lower third of the oesophagus, and is the most sensitive means of detecting small primary tumours and skip lesions. Endoscopic ultrasound is also a useful tool, allowing direct imaging of the tumour. It is particularly sensitive for determining the depth of invasion and involvement of first station lymph node groups.
Multifocal Branch Duct Intraductal Papillary Mucinous Neoplasm with 3 cm Lesion in Head of Pancreas
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
Endoscopic ultrasound is a useful adjunct to other imaging modalities. Endoscopic ultrasound is helpful for identifying pancreatic cystic neoplasms with features that should be considered for surgical resection. Similar to MRI and CT, endoscopic ultrasound is imperfect at identifying the exact type of pancreatic cystic neoplasm. Endoscopic ultrasound is recommended if the pancreatic cystic neoplasm has either clinical or radiological features of concern identified during the initial investigation or follow-up. Data for endoscopic ultrasound-based differentiation between benign and malignant pancreatic cystic neoplasms are conflicting. In addition, there is considerable inter-observer variation in endoscopic ultrasound-based diagnoses.
Gastrointestinal Endoscopy
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
History does not sit still, and endoscopic evolution will continue with the replacement of much diagnostic endoscopy with capsule endoscopy and virtual imaging. Enhanced resolution using chromoendoscopy and even histological grade images have increased the diagnostic yield of surveillance procedures. Endoscopic ultrasound allows diagnosis and therapy to extend beyond the mucosal surface of the intestine.
Adverse events and mortality: comparative analysis between diagnostic and interventional endoscopic ultrasound
Published in Scandinavian Journal of Gastroenterology, 2020
Giulia Marchetti, Vítor Doria Ricardo, André Orsini Ardengh, Arthur Ferraz de Almeida, Eloy Taglieri, Otávio Micelli-Neto, Rafael Kemp, José Sebastião dos Santos, José Celso Ardengh
Endoscopic ultrasound (EUS) stands out as a resource for the diagnosis, staging and treatment of digestive diseases [1] and is considered safe, effective, and minimally invasive compared with operative procedures with the same purpose [2]. Moreover, EUS is a complex endoscopic procedure used for at least three decades which presents rare adverse events (AE) when performed by experienced specialists [2]. Most AE are described as sporadic observations in individual centers [3–11]. Their modality, severity and period of occurrence are specific to each EUS [12], and the major ones are perforation, bleeding, infection, acute pancreatitis (AP), subepithelial hematomas and neoplastic cell seeding [13]. Few studies are evaluating the immediate, early, and late AE of EUS. There is a lack of data on possible measures that could improve the safety of EUS before, during, and after the procedure. No studies are evaluating the occurrence of AE comparing diagnostic-EUS (D-EUS) and interventional-EUS (I-EUS).
Extranodal Extension in Esophageal Cancer: Does It Belong in the TNM System?
Published in Journal of Investigative Surgery, 2022
Konstantinos S. Mylonas, Dimitrios Schizas
This growing body of literature is making a compelling argument toward incorporating ENE in the TNM staging system of esophageal carcinomas. According to the data herein presented in the Journal of Investigative Surgery, the absolute number of affected lymph nodes did not itself affect survival [1]. Therefore, if ENE was incorporated into the TNM staging system, it should be based on its presence in cases with early pN status, rather than the absolute number of lymph nodes with ENE. We also argue that radiologic evaluation of extranodal extension could provide actionable information to multidisciplinary tumor boards debating whether to administer neoadjuvant chemotherapy or chemoradiation to gray zone lesions such as T1b or T2 [7]. Although no esophageal data are available to date, there is extensive experience in oropharyngeal cancers to draw from [8]. For example, when looking at head & neck SCC (HNSCC), the sensitivity and specificity for computed tomography (CT) were nearly 75% and 85%, respectively compared to 60% and 96% for magnetic resonance imaging. On imaging, infiltration of adjacent fatty tissue constitutes a highly specific marker of ENE, while central node necrosis seems to be highly sensitive [9]. Furthermore, a SUVmax cutoff of 3.0 on positron emission tomography-CT seems to identify ENE in HNSCC with specificity and sensitivity of 94.3% and 81.1%, respectively [10]. Similar imaging performance metrics could be reproducible in esophageal cancer. Additional guidance could be provided using endoscopic ultrasound.
Protocol of early lumen apposing metal stent removal for pseudocysts and walled off necrosis avoids bleeding complications
Published in Scandinavian Journal of Gastroenterology, 2020
Waseem Ahmad, Syed A. Fehmi, Thomas J. Savides, Gobind Anand, Michael A. Chang, Wilson T. Kwong
All patients underwent endoscopic ultrasound (EUS) examination under general anesthesia with a linear echoendoscope to ensure the patient’s PFC was consistent with either PPC or WON, size of collection, amount of solid debris, presence of intervening blood vessels, presence of varices, and whether anatomy was amenable to endoscopic drainage. Doppler ultrasound was used to carefully assess for small and large vessels. EUS was used to choose the site of optimal LAMS placement as far away from vessels as possible within the central portion of the collection. The PPC or WON was accessed using the electrocautery enhanced stent delivery system (Hot Axios, Boston Scientific, Marlborough, MA) under continuous EUS guidance. The size of the stents chosen was either 15 mm × 10 mm or 10 mm × 10 mm, which was at the discretion of the endoscopist. The internal LAMS flange was deployed under EUS-guidance and the luminal flange was deployed under endoscopic guidance. A coaxial plastic pigtail stent was deployed within the LAMS in an effort to minimize LAMS trauma to the far wall of the PFC cavity.
Related Knowledge Centers
- Endoscopy
- Gastrointestinal Tract
- Ultrasound
- Abdomen
- Thorax
- Esophagus
- Stomach
- Duodenum
- Gastroenterology
- Pulmonology