What is endoscopic ultrasound?

This is an automatically translated article.

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has over 18 years of experience in the field of ultrasound - diagnostic imaging.
Endoscopic ultrasound is an outstanding medical achievement in the field of gastrointestinal endoscopy. This is an advanced and modern technique that plays an important role in the stage diagnosis of gastrointestinal tumors.

1. What is endoscopic ultrasound?

Endoscopic ultrasound is a combination of endoscopic and ultrasound techniques. This is an advanced and modern method, using an endoscope with an ultrasound probe to help diagnose and intervene in lesions of the gastrointestinal tract, bile, pancreas, mucosal and extra-mucosal lesions of the gastrointestinal tract. chemical. In particular, this technique has great significance in diagnosing cancer at an early stage (detecting tumors at an early stage helps cure up to 98-100%) or detecting tumors located deep in the colon. abdominal cavity with minimal invasiveness.
Compared with other imaging methods such as multi-sequence CT or MRI, endoscopic ultrasound is more appreciated. Furthermore, the combination of endoscopic ultrasound with fine-needle aspiration biopsy allows to assess the association with neighboring nodes compared with the tumor, detect tumor invasion into surrounding organs.
Endoscopic ultrasound has a great role and significance in diagnosing esophageal pathology, helping to evaluate the early stage for esophageal cancer, tumor invasion to the layers of the esophagus, and at the same time detect cancer. proximal lymph node metastasis, mediastinal lymph node metastasis.
For the diagnosis of gastric pathology, endoscopic ultrasonography helps in differential diagnosis of early gastric cancer, gastric submucosal tumors, and helps detect metastases in proximal and adjacent lymph nodes. compared with the tumor, detecting the invasion of the tumor into the surrounding organs, liver and spleen metastases.

Currently, in the gastrointestinal endoscopy specialty with the application of endoscopic ultrasound in diagnosis and treatment combined with a number of modern technological devices, which are:
Radial probe: This device gives images 360-degree image around the transducer in a plane perpendicular to the bronchoscope axis. The radial probe is used in the investigation of lesions in the gastrointestinal tract (esophagus, stomach, duodenum) and biliary tract, and lesions in the colon. Using a radial transducer is possible simultaneously for endoscopic imaging and ultrasound imaging. Linear transducer : This device captures a fan-shaped image. Under the guidance of endoscopic ultrasound combined with a linear transducer may allow fine-needle biopsies of suspected lesions. Miniprobe probe: The miniprobe probe uses a high frequency of 20 - 30 MH, which can be inserted into the lesion through biopsy of the endoscopes. Compared with radial and linear transducers, the miniprobe has the highest frequency, which helps to obtain a clear image of each layer of the gastrointestinal tract wall. Thereby helping doctors assess the early stage of cancer, effectively supporting treatment indications.

2.Indications and contraindications

2.1. Indications Diagnosis of lesions and staging of malignancy. In case of need to do pathology: Fine-needle aspiration, biopsy. Intervention Placement of gastric pancreatic cyst drainage. Place drainage of the abscess from the outside into the gastrointestinal tract. Biliary stent placement. 2.2. Contraindications Patient does not cooperate. In case of suspected hollow visceral perforation, coagulopathy, thoracic aortic aneurysm, esophageal stricture, or in patients with acute cardiopulmonary condition unresponsive to indicated drugs.

3. Prepare

3.1. Person performing Specialist Doctor. Anesthesiologist Nursing. 3.2. Vehicle Endoscopic ultrasound apparatus 360° endoscopic probe and side window transducer.

3.3. Medical equipment Syringe Syringe Needle 18-20G Physiological saline Gloves, hat, mask Bean tray set, surgical forceps. Cotton, gauze Emergency equipment for contrast drug accidents. Anesthesia - muscle relaxants. Interventional ultrasound cases: Catheters, tubes, drains, dilatations. 3.4. Patients Before endoscopic gastrointestinal ultrasound, patients need to fast for at least 8 hours. The patient is explained about the procedure to coordinate with the physician. 3.5. Test sheets Test sheets such as blood clots, Prothrombin rate, liver and kidney function test sheets. Imaging results of ultrasound, computed tomography, or magnetic resonance.

4. Steps to take

The patient is invited to the ultrasound room. Lie on the gastroscopy table, lying on your side. The patient is given general anesthesia by the technician, usually under intravenous sedation. Endoscopic ultrasound is divided into 2 types with different purposes, diagnostic ultrasound or interventional ultrasound. Specifically as follows: 4.1. For diagnostic ultrasound At the suspected lesion, the doctor inserts the transducer of the endoscopic ultrasound machine into: esophagus (mediastinum), stomach, duodenum. Combined with endoscopic techniques to reveal lesions. Combined with methods of pumping fluid or aspirating the gastrointestinal tract to reveal the lesions. 4.2. For interventional ultrasound Conduct interventional ultrasound after identifying the lesion. Find the most favorable cross-section and access road. The doctor inserts a needle. Take tissue for pathology: suction with syringe under vacuum pressure Drainage: insert wire through needle into lesion. Use a dimmer to create an inlet socket. Place the drain on the wire.

5. Complications and treatment

Anesthesia complications: it is necessary to have a doctor next to you to prevent and deal with complications that occur. Perforation of hollow viscera or intra-abdominal bleeding: surgeon consultation for surgical treatment. In conclusion, endoscopic ultrasound is a great step forward in the current specialty of gastrointestinal endoscopy. This modern technique is supplementing the limitations of other subclinical diagnostic methods, thereby improving the effectiveness of more accurate and timely disease treatment.
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