Enhanced EUS imaging (with videos)

Kumar Krishnan; Manoop S Bhutani; Harry R Aslanian; Joshua Melson; Udayakumar Navaneethan; Rahul Pannala; Mansour A Parsi; Allison R Schulman; Amrita Sethi; Shelby Sullivan; Guru Trikudanathan; Arvind J Trindade; Rabindra R Watson; John T Maple; (ASGE Technology Committee Chair, 2016-2019); David R Lichtenstein; (ASGE Technology Committee Chair)

doi:10.1016/j.gie.2020.06.075

Enhanced EUS imaging (with videos)

Gastrointest Endosc. 2021 Feb;93(2):323-333. doi: 10.1016/j.gie.2020.06.075. Epub 2020 Oct 28.

Authors

Kumar Krishnan¹, Manoop S Bhutani², Harry R Aslanian³, Joshua Melson⁴, Udayakumar Navaneethan⁵, Rahul Pannala⁶, Mansour A Parsi⁷, Allison R Schulman⁸, Amrita Sethi⁹, Shelby Sullivan¹⁰, Guru Trikudanathan¹¹, Arvind J Trindade¹², Rabindra R Watson¹³, John T Maple¹⁴; (ASGE Technology Committee Chair, 2016-2019); David R Lichtenstein¹⁵; (ASGE Technology Committee Chair)

Affiliations

¹ Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.
² Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
³ Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
⁵ Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
⁶ Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
⁷ Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
⁸ Department of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁹ New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, USA.
¹⁰ Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹¹ Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
¹² Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
¹³ Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
¹⁴ Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
¹⁵ Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PMID: 33129492
DOI: 10.1016/j.gie.2020.06.075

Abstract

Background and aims: EUS remains a primary diagnostic tool for the evaluation of pancreaticobiliary disease. Although EUS combined with FNA or biopsy sampling is highly sensitive for the diagnosis of neoplasia within the pancreaticobiliary tract, limitations exist in specific clinical settings such as chronic pancreatitis. Enhanced EUS imaging technologies aim to aid in the detection and diagnosis of lesions that are commonly evaluated with EUS.

Methods: We reviewed technologies and methods for enhanced imaging during EUS and applications of these methods. Available data regarding efficacy, safety, and financial considerations are summarized.

Results: Enhanced EUS imaging methods include elastography and contrast-enhanced EUS (CE-EUS). Both technologies have been best studied in the setting of pancreatic mass lesions. Robust data indicate that neither technology has adequate specificity to serve as a stand-alone test for pancreatic malignancy. However, there may be a role for improving the targeting of sampling and in the evaluation of peritumoral lymph nodes, inflammatory pancreatic masses, and masses with nondiagnostic FNA or fine-needle biopsy sampling. Further, novel applications of these technologies have been reported in the evaluation of liver fibrosis, pancreatic cysts, and angiogenesis within neoplastic lesions.

Conclusions: Elastography and CE-EUS may improve the real-time evaluation of intra- and extraluminal lesions as an adjunct to standard B-mode and Doppler imaging. They are not a replacement for EUS-guided tissue sampling but provide adjunctive diagnostic information in specific clinical situations. The optimal clinical use of these technologies continues to be a focus of ongoing research.

Publication types

Practice Guideline

MeSH terms

Biopsy, Fine-Needle
Endosonography
Humans
Pancreatic Cyst*
Pancreatic Neoplasms* / diagnostic imaging
Pancreatitis, Chronic* / diagnostic imaging