Endoscopic ultrasound (endosonography) considerably expands the spectrum of diagnostics and therapy of the gastrointestinal tract. In tumor therapy, endosonography is a mainstay of diagnostics. The possibility of a targeted internal puncture means that unclear findings can be clarified without complications.
Here you will find further information as well as selected endosonography specialists and centers.
Endoscopic ultrasound (EUS), also known as endosonography (sonography from the inside), is a combination of endoscopy and sonography. An ultrasound probe is located at the tip of the endoscope.
This probe can be placed via the endoscope directly at the area to be examined, for example
can be guided directly to the area to be examined. The examination not only allows a detailed view of the wall of the gastrointestinal tract, but also of the neighboring organs and structures, such as
Ultrasound has the highest resolution of all technical devices used in medicine. For example, it is the only method that can visualize the five layers of the wall of the gastrointestinal tract (minimum thickness 2 mm).
This is of enormous importance in the assessment of tumors for the therapeutic procedure.
Various medical associations have included endosonography as an essential diagnostic method in their recommendations for the diagnosis of tumors
are included. Endosonography can help doctors to assess the extent of such tumors. This assessment is of crucial importance for the subsequent cancer therapy.
Fig. 1: Endosonographic findings of a small malignant tumor that is limited to the first layer and was removed endoscopically
Fig. 2: Locally advanced malignant gastric tumor with growth beyond the wall and evidence of enlarged lymph nodes. The patient was pre-treated with chemotherapy and subsequently underwent successful surgery
Doctors must determine whether the tumor is operable, i.e. whether it can be removed using an endoscopic procedure or primarily by surgery.
Alternatively, the tumor could initially be reduced in size using chemotherapy or radiation. This is an option, especially for larger tumors with already detectable enlarged lymph nodes. It serves to reduce the tumor to a state that allows a curative operation.
Another focus of endosonography is the diagnosis of the pancreas and bile ducts. For patients with
sometimes no diagnosis can be made with conventional ultrasound or computer tomography. In these cases, endosonography can provide clarity.
It can detect the smallest pancreatic tumors (from 3 mm). At this stage, this aggressive tumor is still curable.
Endosonography can also detect small gallstones or tumors in the bile duct and thus enable early treatment.
Fig. 3: Patient with unclear upper abdominal symptoms with no evidence of a tumor on computed tomography (CT) and conventional ultrasound. Endosonography revealed a small tumor. The patient underwent surgery and is cured
Fig. 4: Patient with recurrent right-sided upper abdominal complaints with normal liver values. Endosonography revealed a small stone in the bile duct immediately in front of the orifice. The stone was removed endoscopically
Fig. 5: Special endosonography with tissue detection by measuring elasticity. Malignant tumors are coded in blue. In this case, an endosonographic puncture was performed in an enlarged lymph node - the metastasis of a malignant tumor was confirmed in the tissue examination
The repertoire of interventional endosonography also offers extended diagnostic and therapeutic options. Targeted punctures, which are guided by endosonography, can be used to diagnose unclear findings
can be clarified.
The cell material obtained with the puncture needle is subjected to microscopic examination. This allows a diagnostic classification of the findings in almost 90-95% of cases. It makes the therapeutic decision much easier and can possibly prevent surgery.
Endosonography can also be used to puncture regions that are not accessible from the outside or can only be reached at high risk. These include
Safe handling of the puncture technique has paved the way for endosonographic therapy. Patients with acute or chronic inflammation of the pancreas can be treated using endosonography. They often have a painful accumulation of fluid, which may also be infected,
In this case, the accumulation of fluid is drained internally into the stomach or small intestine. This means that these patients can be spared an operation.
Fig. 6: Patient with pain due to the formation of a cyst following inflammation of the pancreas. Endosonographic puncture of the cyst and creation of an internal drain from the cyst into the stomach
Newer therapeutic approaches include the internal drainage of a congested bile duct system in patients with incurable pancreatic tumors .
where endoscopic internal drainage is not possible.
Fig. 7: Patient with jaundice due to bile outflow obstruction caused by a malignant tumor of the pancreas. The outflow into the small intestine is impaired due to a constriction caused by the tumor and the prosthesis in the small intestine. The bile ducts are relieved by creating a new internal drain into the small intestine
These patients can be spared a painful external drainage of bile, which impairs their quality of life, for the rest of their lives.
Endosonography is usually performed on an outpatient basis if it is a diagnostic procedure without a tissue sample.
In most cases, endosonographic punctures require one day of inpatient monitoring. If internal drainage of fluids, cysts or inflammatory foci is planned, these are carried out during an inpatient stay.
The prerequisite for an endosonography is the patient's consent after an informative discussion and the presence of current blood coagulation values. The examination is comparable to a gastroscopy. The endoscope with the transducer at the tip has a diameter of approx. 1 cm and is inserted into the oesophagus under visual control.
Endosonography is completely painless. Like a gastroscopy or colonoscopy, it is usually performed under anesthesia. During the examination, the patient's vital parameters (blood pressure, pulse, oxygen in the blood) are monitored.
The examination takes between 5 minutes (diagnostics) and 45 minutes (therapy), depending on the requirements. If the endosonography was performed with sedatives, a follow-up observation of 1-2 hours is required. During this time, the patient is connected to a monitoring device.
Discussion of the findings and discharge take place when the patient is fully conscious again. Even if the patient is supposedly fit again, they are still unfit to drive for the rest of the day. It therefore makes sense for patients to organize a pick-up.
Serious complications are rare during endosonography and usually only occur after punctures or therapeutic procedures. These are bleeding or infections.
After a diagnostic endosonography, swallowing difficulties may occur for 1-2 days in rare cases.
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