Abstract
Biliary diseases are common, but clinical symptoms are often unspecific and direct access and visualization of the biliopancreatic system for diagnostic purpose is difficult. In the last decades endoscopic ultrasound (EUS) has become a primary method in the gastrointestinal tract. It significantly changed the role of endoscopy in diagnostic imaging in the gastrointestinal tract and adjacent organs. EUS has become an effective diagnostic tool in biliary stone disease as well as in the diagnosis of indeterminate biliary strictures. Furthermore, an EUS-directed transmural approach emerged as a safe and effective alternative to ERCP in patients requiring biliary drainage, in particular as a backup method if standard ERCP-approach fails. Development of new techniques, specific accessories and stents during the last decade led to an enormous step forward in terms of efficacy and safety of an EUS-directed approach. In the current article technical and clinical aspects of EUS-guided diagnostic and therapeutic approaches in different clinical indications will be discussed together with a review of the available data.
Highlights
Biliary diseases are common, but clinical symptoms are often unspecific and direct access and visualization of the biliopancreatic system for diagnostic purpose is difficult.The diagnostic approach to bile duct diseases often poses a challenge to a multidisciplinary team of gastroenterologists, endoscopists, radiologists and surgeons and there is a massive reliance on multimodal imaging-techniques to obtain the correct diagnosis: Transabdominal ultrasound is commonly used as a primary, non-invasive investigative tool with computed tomography (CT) and magnetic resonance imaging (MRI) and MRcholangiopancreatography (MRCP), respectively, utilized for more detailed analyses
endoscopic ultrasound (EUS) allows for precise real time images of important internal organs alongside the GI tract which is mandatory for fine-needle aspiration (FNA) or core biopsy (FNB) as well as for interventional transmural procedures into the surrounding structures, which can be performed in the same session
Biliary strictures continue to be a diagnostic challenge because a significant fraction of them remains inconclusive for malignancy despite a thorough multimodal diagnostic approach including radiology, endoscopy and laboratory tests
Summary
But clinical symptoms are often unspecific and direct access and visualization of the biliopancreatic system for diagnostic purpose is difficult.The diagnostic approach to bile duct diseases often poses a challenge to a multidisciplinary team of gastroenterologists, endoscopists, radiologists and surgeons and there is a massive reliance on multimodal imaging-techniques to obtain the correct diagnosis: Transabdominal ultrasound is commonly used as a primary, non-invasive investigative tool with computed tomography (CT) and magnetic resonance imaging (MRI) and MRcholangiopancreatography (MRCP), respectively, utilized for more detailed analyses. In the last decades endoscopic ultrasound (EUS) has become a primary tool for diagnosis and staging (D&S) of neoplasms in the gastrointestinal tract. It significantly changed the role of endoscopy in diagnostic imaging in- and outside the gastrointestinal tract. EUS combines the endoscopic visualization of the gastrointestinal lumen with the ability to ultrasonographically display the layers of the GI wall and the surrounding structures with high resolution. EUS allows for precise real time images of important internal organs alongside the GI tract (i.e., pancreas and the biliary system) which is mandatory for fine-needle aspiration (FNA) or core biopsy (FNB) as well as for interventional transmural procedures into the surrounding structures, which can be performed in the same session
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