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  Most popular articles (Since September 24, 2013)

 
 
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REVIEW ARTICLE
Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound
Roy Liu, Douglas G Adler
July-September 2014, 3(3):152-160
DOI:10.4103/2303-9027.138783  
Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.
  13,728 1,422 25
REVIEW ARTICLES
Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: What needle is the best?
Jesse Lachter
January-March 2014, 3(1):46-53
DOI:10.4103/2303-9027.124313  PMID:24949410
Basic technique for endoscopic ultrasound (EUS) of solid lesions has developed during 30 years of EUS, as endoscopes and accessory equipment, particularly needles, have been developed. Systematic high-quality examinations require understanding and planning. Needles used for EUS-guided fine needle aspiration (FNA) have gone through many improvements; some 18 characteristics of any needle are presented and these come under consideration whenever choosing the best needle for each procedure. The bright future of EUS and FNA for solid lesions currently still leaves much room for continued developments.
  11,670 901 1
TRAINING COURSES
Standard imaging techniques for assessment of portal venous system and its tributaries by linear endoscopic ultrasound: A pictorial essay
CS Rameshbabu, Zeeshn Ahamad Wani, Praveer Rai, Almessabi Abdulqader, Shubham Garg, Malay Sharma
January-March 2013, 2(1):16-34
DOI:10.4103/2303-9027.117724  
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
  10,246 1,643 2
REVIEW ARTICLES
When to puncture, when not to puncture: Submucosal tumors
Wajeeh Salah, Douglas O Faigel
April-June 2014, 3(2):98-108
DOI:10.4103/2303-9027.131038  PMID:24955339
Subepithelial masses of the gastrointestinal (GI) tract are a frequent source of referral for endosonographic evaluation. Subepithelial tumors most often appear as protuberances in the GI tract with normal overlying mucosa. When there is a need to obtain a sample of the mass for diagnosis, endoscopic ultrasound (EUS) - guided fine-needle aspiration (FNA) is superior to other studies and should be the first choice to investigate any subepithelial lesion. When the decision is made to perform EUS-guided FNA several technical factors must be considered. The type and size of the needle chosen can affect diagnostic accuracy, adequacy of sample size and number of passes needed. The use of a stylet or suction and a fanning or standard technique during EUS-guided FNA are other factors that must be considered. Another method proposed to improve the efficacy of EUS-guided FNA is having an on-site cytopathologist or cytotechnician. Large or well-differentiated tumors may be more difficult to diagnose by standard EUS-FNA and the use of a biopsy needle can be used to acquire a histopathology sample. This can allow preservation of tissue architecture and cellularity of the lesion and may lead to a more definitive diagnosis. Alternatives to FNA such as taking bite-on-bite samples and endoscopic submucosal resection (ESMR) have been studied. Comparison of these two techniques found that ESMR has a significantly higher diagnostic yield. Most complications associated with EUS-FNA such as perforation, infection and pancreatitis are rare and the severity and incidence of these adverse events is not known. Controversy exists as to the optimal method in which to perform EUS-FNA and larger prospective trials are needed.
  7,544 1,393 9
TRAINING COURSES
Portal venous system and its tributaries: A radial endosonographic assessment
Malay Sharma, C.S Ramesh Babu, Shubham Garg, Praveer Rai
July-September 2012, 1(2):96-107
DOI:10.7178/eus.02.008  PMID:24949345
The use of Color Doppler in endosonography has enabled detailed real-time assessment of the abdominal vasculature. Standard stations are used during the routine evaluation on endosonography. However, the imaging techniques do not describe the vascular imaging of the portal venous system and its tributaries, in detail. This article demonstrates the normal findings on the portal venous system and its tributaries using radial endosonography.
  7,183 849 -
REVIEW ARTICLES
Endoscopic ultrasound-guided fine needle aspiration: How to obtain a core biopsy?
Lorenzo Fuccio, Alberto Larghi
April-June 2014, 3(2):71-81
DOI:10.4103/2303-9027.123011  PMID:24955336
Endoscopic ultrasound (EUS)-guided fine needle aspiration has emerged as the procedure of choice to obtain samples to reach a definitive diagnosis of lesions of the gastrointestinal tract and of adjacent organs. The obtainment of a tissue core biopsy presents several advantages that can substantially contribute to the widespread diffusion of EUS utilization in the community and in countries where cytology expertise may be difficult to be achieved. This article will review the EUS-guided fine needle biopsy techniques developed so far, the clinical results, their limitations as well as their future perspective.
  5,190 1,110 6
REVIEW
Role of endoscopic ultrasound in treatment of pancreatic cancer
Xiaozhong Guo, Zhongmin Cui, Zhigang Hu
October-December 2013, 2(4):181-189
DOI:10.4103/2303-9027.121238  PMID:24949393
Endoscopic ultrasound (EUS) can help diagnose diseases with high accuracy because it overcomes the limitations of gastrointestinal gas and abdominal fat. The emergence of curved linear-array echoendoscopy has significantly promoted the applications of the technique to new levels. The advancement has appeared from EUS imaging to EUS-guided fine needle aspiration, drainage and injection. Computed tomography and magnetic resonance imaging present certain limitations for diagnosing pancreatic tumors due to the specificity of the location of such growths. In addition, traditional chemotherapy does not show ideal results because pancreatic cancer (PC) exhibits hypovascular characteristics. Interventional EUS can overcome these limitations and has potential to become the mainstream method of PC local treatment in the future. This paper reviews the use of interventional EUS in the treatment of PC based on previous studies.
  4,328 1,480 9
TRAINING COURSE
Imaging of peritoneal ligaments by endoscopic ultrasound (with videos)
Malay Sharma, Praveer Rai, Chittapuram Srinivasan Rameshbabu, Baiju Senadhipan
January-March 2015, 4(1):15-27
DOI:10.4103/2303-9027.151317  PMID:25789280
Double layered peritoneal folds or ligaments act as conduits for the passage of blood vessels in intraperitoneal organs and also provide a pathway for the spread of disease. It is difficult to identify these normal peritoneal folds at imaging. Computed tomography is the most common imaging modality used to detect diseases of the peritoneum. The ultrasound (US) has been also used for evaluation of diseases involving ligaments. Endoscopic ultrasound (EUS) is being increasingly used both for diagnostic and interventional purposes in abdomen. In this article, we have described the normal EUS anatomy of the peritoneal ligaments.
  5,087 709 4
CASE REPORTS
Esophageal duplication cyst in an adult masquerading as submucosal tumor
Vinita Chaudhary, Surinder Singh Rana, Vishal Sharma, Amit Raj Sharma, Ritambhra Nada, Rajesh Gupta, Usha Dutta, Kartar Singh, Deepak Kumar Bhasin
July-September 2013, 2(3):165-167
DOI:10.4103/2303-9027.117675  
Gastrointestinal duplications usually manifest in children and may involve the esophagus in 20% cases. Esophageal duplication cysts are a rare cause of dysphagia in adults. We report the case of a 35-year-old male who presented to us with progressive dysphagia of 6 months duration. Contrast enhanced computed tomography showed a soft-tissue lesion in right lateral wall of distal thoracic esophagus. On endoscopic ultrasound, a heterogeneously echotextured lesion with anechoic component present at intramural location in the lower esophagus was noted. The patient underwent surgical excision of the lesion and histopathology confirmed the diagnosis of esophageal duplication cyst.
  5,155 363 2
TRAINING COURSE
Techniques of imaging of nodal stations of gastric cancer by endoscopic ultrasound
Malay Sharma, Praveer Rai, Chittapuram Srinivasan Rameshbabu
July-September 2014, 3(3):179-190
DOI:10.4103/2303-9027.138793  
Nodal staging is of crucial importance in the management of gastric cancer (GC). The available modalities of nodal imaging in GC do not provide a high sensitivity and specificity of lymph node status. Comparative study of endoscopic ultrasonography (EUS) and multislice spiral computed tomography in GC has shown greater accuracy of EUS for N staging. EUS is not used routinely in patients with GC as it is not available at all centers, and its accuracy is operator dependent. Standard techniques of identification of nodal station (as suggested by Japanese Research Society for the Study of Gastric Cancer) by EUS have not been described so far. Identification of each nodal station by EUS requires adequate knowledge of anatomy as well as understanding the proper technique to perform EUS. This review presents a method to identify the regional nodal stations of GC by linear EUS and hence will help in appropriate N staging of GC.
  4,497 892 2
MEETING REPORT
Endoscopic ultrasound forum summary from the asian pacific digestive week 2012
Pradermchai Kongkam, Benedict M Devereaux, Ryan Ponnudurai, Thawee Ratanachu-ek, Anand V Sahai, Takuji Gotoda, Suthep Udomsawaengsup, Jacques Van Dam, Nonthalee Pausawasdi, Somchai Limsrichemrern, Dong-Wan Seo, Shomei Ryozawa, Yoshiki Hirooka, Yongyut Sirivatanauksorn, Siyu Sun, Sundeep Punamiya, Takao Itoi, Bancha Ovartlanporn, Ichiro Yasuda, Tiing Leong Ang, Hsiu-Po Wang, Khek Yu Ho, Heng Boon Yim, Kenjiro Yasuda, Christopher J.L Khor
January-March 2013, 2(1):43-60
DOI:10.4103/2303-9027.117721  
  4,864 381 3
EDITORIAL
Endobronchial ultrasound: First choice for the mediastinum
Felix J. F. Herth
October-December 2013, 2(4):179-180
DOI:10.4103/2303-9027.121235  PMID:24949392
  2,371 2,590 1
REVIEW ARTICLES
How good is fine needle aspiration? What results should you expect?
Pierre Eisendrath, Mostafa Ibrahim
January-March 2014, 3(1):3-11
DOI:10.4103/2303-9027.127122  PMID:24949404
Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.
  3,799 798 5
ORIGINAL ARTICLES
The role of EUS and EUS-guided FNA in the management of subepithelial lesions of the esophagus: A large, single-center experience
Birol Baysal, Omar A Masri, Mohamad A Eloubeidi, Hakan Senturk
September-October 2017, 6(5):308-316
DOI:10.4103/2303-9027.155772  PMID:26365993
Background: Referral for endosonographic evaluation of subepithelial lesions seen in the gastrointestinal (GI) tract is fairly common. Although rarely studied separately in details, esophageal lesions have some unique differences from other GI sites and might deserve some special considerations regarding follow-up and management. Materials and Methods: All cases referred for endoscopic ultrasound (EUS) evaluation of subepithelial esophageal lesions at Bezmialem University Hospital, a tertiary center in Istanbul, Turkey were retrospectively reviewed. Data were collected for patient and lesion characteristics as well as for pathology results and follow-up if available. Lesions were subcategorized according to their size, location, and final diagnosis. Results: A total of 164 EUS examinations were identified. In 22.5% of cases, the lesion could not be identified by EUS. Of the remaining cases, 57.6% had a lesion larger than 1 cm in size. Extramural compression was the diagnosis in 12% and leiomyoma in around 60%. Thirteen patients had follow-up examinations with only two showing an increase in size after 12 months. Sixty-five EUS-guided fine needle aspirations (EUS-guided FNAs) were performed, with around 50% having nondiagnostic samples and 94% of the remaining samples confirming the presumptive diagnosis. Conclusions: The majority of subepithelial lesions in the esophagus are benign with extremely low malignancy potential. EUS examinations performed for lesions smaller than 2 cm as well as FNAs taken from lesions smaller than 3 cm might have minimal impact on their ultimate management and outcome. More than one FNA pass should be attempted in order to improve the yield.
  4,058 408 2
REVIEW ARTICLES
To fine needle aspiration or not? An endosonographer's approach to pancreatic cystic lesions
David Yiu-Kuen But, Jan-Werner Poley
April-June 2014, 3(2):82-90
DOI:10.4103/2303-9027.124307  PMID:24955337
Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is an established diagnostic tool in the management of pancreatic cystic lesions (PCLs). Due to the proximity to the target lesion, the fine diagnostic needle travels through only minimal normal tissues. The risks of bleeding, pancreatitis and infection are small. Valuable diagnostic morphological information can be obtained by EUS before the use of FNA. The additional cytopathologic and cyst fluid analysis for the conventional markers such as amylase, carcinoembryonic antigen (CEA) and CA19.9 improves the diagnostic capability. Pancreatic cyst fluid CEA concentration of 192 ng/mL is generally the most agreed cutoff to differentiate mucinous from non-mucinous lesion. A fluid amylase level of <250 IU/L excludes the diagnosis of pseudocyst. Technical tips of EUS-FNA and the limitations of the procedure are discussed. Promising technique and FNA needle modifications have been described to improve the diagnostic yield at the cytopathologic analysis. The use of novel cyst fluid proteomics and deoxyribonucleic acid-based biomarkers of the PCLs are reviewed. Although it is considered a safe procedure, EUS-FNA is not a routine in every patient. Recommendations of the role of EUS-FNA at various common clinical scenarios are discussed.
  3,426 914 2
Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: Adverse events and avoiding them
Larissa L Fujii, Michael J Levy
January-March 2014, 3(1):35-45
DOI:10.4103/2303-9027.123006  PMID:24949409
Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and its ability to acquire tissue outside of the gastrointestinal lumen impart risks that are not associated with routine endoscopic procedures. In this review, we discuss the risk of perforation related to the echoendoscope itself and adverse events related to FNA of solid masses including infections, bleeding, pancreatitis and pancreatic duct leak, bile duct leak and tumor seeding. We also provide tips on how to avoid the most common adverse events related to EUS-FNA.
  3,643 687 6
Endoscopic ultrasound features of chronic pancreatitis: A pictorial review
Surinder Singh Rana, Peter Vilmann
January-March 2015, 4(1):10-14
DOI:10.4103/2303-9027.151314  PMID:25789279
As endoscopic ultrasound (EUS) is the most sensitive imaging modality for diagnosing pancreatic disorders, it can demonstrate subtle alterations in the pancreatic parenchymal and ductal structure even before traditional imaging and functional testing demonstrate any abnormality. In spite of this fact and abundant literature, the exact role of EUS in the diagnosis of chronic pancreatitis (CP) is still not established. The EUS features to diagnose CP have evolved over a period from a pure qualitative approach to more advanced and complicated scoring systems incorporating multiple parenchymal and ductal EUS features. The rosemont criteria have attempted to define precisely each EUS criterion and thus have good inter-observer agreement. However, initial studies have failed to demonstrate any significant improvement in the inter-observer variability and further validation studies are needed to define the exact role of these criteria. The measurement of strain ratio using quantitative EUS elastography and thus allowing quantification of pancreatic fibrosis seems to be a promising new technique.
  3,161 1,152 3
TRAINING COURSE
Techniques of imaging of the aorta and its first order branches by endoscopic ultrasound (with videos)
Malay Sharma, Praveer Rai, Varun Mehta, CS Rameshbabu
April-June 2015, 4(2):98-108
DOI:10.4103/2303-9027.156722  PMID:26020043
Endoscopic ultrasonography (EUS) is a useful modality for imaging of the blood vessels of the mediastinum and abdomen. The aorta acts as an important home base during EUS imaging. The aorta and its branches are accessible by standard angiographic methods, but endosonography also provides a unique opportunity to evaluate the aorta and its branches. This article describes the techniques of imaging of different part of the aorta by EUS.
  3,416 883 2
REVIEWS
Endosonography-assisted diagnosis and therapy of gastrointestinal submucosal tumors
Jintao Guo, Zhijun Liu, Siyu Sun, Sheng Wang, Nan Ge, Xiang Liu, Guoxin Wang, Wen Liu
July-September 2013, 2(3):125-133
DOI:10.4103/2303-9027.117655  
Submucosal tumors (SMTs) are usually discovered fortuitously during routine endoscopy, including various non-neoplastic and neoplastic conditions. Endoscopic ultrasound (EUS) is considered to be the best imaging procedure to characterize SMTs and to determine the need for further treatment. In this review, the following issues will be addressed: The role of EUS in diagnosis for SMTs, tissue diagnosis for SMTs and the influence of EUS on endoscopic resection techniques for SMTs.
  3,474 805 15
EDITORIAL
Role of endoscopic ultrasound for pancreatic cystic lesions: Past, present, and future!
Manoop S Bhutani
October-December 2015, 4(4):273-275
DOI:10.4103/2303-9027.170400  PMID:26643692
  911 3,246 9
REVIEW ARTICLES
EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer
Leticia Perondi Luz, Mohammad Ali Al-Haddad, John A DeWitt
October-December 2014, 3(4):213-220
DOI:10.4103/2303-9027.144515  
Patients with pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) can develop abdominal pain that can be debilitating. Celiac plexus neurolysis (CPN) is a chemical ablation of the celiac plexus that can be used to treat pain caused by pancreatic malignancy. It can be performed by an anterior or posterior approach, and also can be done percutaneously or under guidance of transabdominal ultrasound, computed tomography, intra-operatively or most recently under linear endoscopic ultrasound (EUS) guidance (EUS-CPN). EUS is well-suited for identification of the celiac plexus due to the close proximity of the gastric wall to the origin of the celiac artery. EUS-CPN is now widely practiced, and different EUS approaches have been developed in order to improve the efficacy of this technique. Our objective is to review the use of EUS-CPN in PDAC, including a description of different techniques, review of its efficacy, predictors of pain response, and describe its limitations and safety, as well as new developments.
  3,114 780 9
When to puncture, when not to puncture: Pancreatic masses
Julio Iglesias-Garcia, Jose Lariño-Noia, J Enrique Domínguez-Muñoz
April-June 2014, 3(2):91-97
DOI:10.4103/2303-9027.123007  PMID:24955338
Endoscopic ultrasound (EUS) has evolved to become a crucial tool for the evaluation of pancreatic diseases, among them solid pancreatic lesions. However, its ability to determine whether a lesion is malignant or not is difficult to establish based only in the endosonographic image. EUS-guided fine needle aspiration (EUS-FNA) allows obtaining a cytological and/or histological sample from pancreatic lesions, with a high overall accuracy and low complication rates. Although the clinical usefulness of EUS-FNA for pancreatic diseases is widely accepted, the indications for tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic accuracy and complications of EUS-FNA, focusing on its current indications.
  2,946 907 5
ORIGINAL ARTICLES
Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy
Hussein Hassan Okasha, Mona Mansour, Khaled Ahmed Attia, Hany Mahmoud Khattab, Amr Yahia Sakr, Mohamed Naguib, Wael Aref, Ahmed Abdel-Moaty Al-Naggar, Reem Ezzat
January-March 2014, 3(1):58-62
DOI:10.4103/2303-9027.121252  PMID:24949412
Objective: The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy. Patients and Methods: This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. Results: Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. Conclusion: Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.
  3,282 567 7
Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: Medium-term assessment of outcomes and complications
Pui Yung Ng, Ditlev Nytoft Rasmussen, Peter Vilmann, Hassem Hassan, Victor Gheorman, Daniela Burtea, Valeriu Surlin, Adrian Saftoiu
October-December 2013, 2(4):199-203
DOI:10.4103/2303-9027.121245  PMID:24949396
Objective: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications of EUS-guided PPC drainage in a medium-term follow-up of 45 weeks. Materials and Methods: A retrospective review was conducted for 55 patients with symptomatic PPC from December 2005 to August 2010 drained by EUS. Medium-term follow-up data were obtained by searching their medical history or by telephonic interview. Results: A total of 61 procedures were performed. The symptoms that indicated drainage were abdominal pain (n = 43), vomiting (n = 7) and jaundice (n = 5). The procedure was technically successful in 57 of the 61 procedures (93%). The immediate complication rate was 5%. At a mean follow-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality. Conclusion: EUS-guided drainage is an effective treatment for PPC with a successful outcome in most of patients. Most of the complications require minimal invasive surgical treatment or repeated EUS-guided drainage procedures.
  3,016 707 15
REVIEWS
Transrectal ultrasound - Techniques and outcomes in the management of intestinal endometriosis
Lucio G.B Rossini, Paulo A.A.G Ribeiro, Francisco C.M. Rodrigues, Sheila S Filippi, Rodrigo de R. Zago, Nutianne C Schneider, Luciano Okawa, Wilmar A Klug
April-June 2012, 1(1):23-35
DOI:10.7178/eus.01.005  PMID:24949332
The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration.
  3,225 445 -
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