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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 1-2

Controversies in EUS


Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem Und Permanence, Bern, Switzerland

Date of Submission23-Jan-2021
Date of Acceptance03-Feb-2021
Date of Web Publication11-Feb-2021

Correspondence Address:
Dr. Christoph F Dietrich
Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem Und Permanence, Bern
Switzerland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EUS-D-21-00024

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How to cite this article:
Dietrich CF. Controversies in EUS. Endosc Ultrasound 2021;10:1-2

How to cite this URL:
Dietrich CF. Controversies in EUS. Endosc Ultrasound [serial online] 2021 [cited 2021 Mar 3];10:1-2. Available from: http://www.eusjournal.com/text.asp?2021/10/1/1/309176

EUS was introduced >40 years ago as a purely diagnostic procedure. High-end skills of endoscopy and knowledge of ultrasound techniques were needed. For the first time in the history of endoscopy, controlled and safe transmural diagnostic and therapeutic procedures became possible. The introduction of EUS-guided sampling initiated a paradigm shift in visceral medicine and oncology.[1],[2] Therefore, EUS was named the “royal discipline” of endoscopy.[3] The introduction of linear echoendoscopes with larger instrumental channels and the combined development of various new tools and devices enabled a number of new applications of minimally invasive, EUS-guided transluminal interventions of the pancreas, biliary system, and peri-gastrointestinal structures. Examples include EUS-guided drainage of peripancreatic fluid collections, drainage of abscesses of nonpancreatic origin, bile duct access and drainage, gallbladder drainage, pancreatic duct access and drainage, EUS-coeliac plexus block and EUS-celiac plexus neurolysis, fiducial placement and tattooing, solid and cystic tumor ablation, drug delivery and brachytherapy, EUS-gastroenterostomy, access to the stomach in patients with prior gastric bypass to facilitate endoscopic retrograde cholangiopancreatography, angiotherapy, treatment of nonvariceal gastrointestinal hemorrhage, treatment of gastric varices, and other EUS-guided angiotherapy.

New diagnostic ultrasound technologies have been implemented to increase the pretest probability to guide or avoid interventions, namely EUS-elastography[4] and contrast-enhanced EUS.[5] As an example, a small (<15 mm), soft, solid pancreatic lesion is almost never a pancreatic ductal adenocarcinoma (PDAC), whereas stiff solid pancreatic lesions might be malignant or benign.[6] The smaller the lesion, the better the differentiation. In addition, PDAC is generally hypovascular and therefore, hypoenhancing, whereas the differential diagnosis (neuroendocrine neoplasia, metastases, solid serous microcystic neoplasia, intrapancreatic accessory spleen, and others) is often hypervascular and therefore hyperenhancing.[7],[8]

Nowadays, EUS is used as a routine procedure by many disciplines including gastroenterology, surgery, pneumology, and radiology. EUS is an important imaging modality evaluated in meta-analysis and recommended by many panels and guidelines.[1],[2],[9],[10],[11],[12],[13] Despite this success story, there are still controversies about the use of EUS. There are different approaches on the use of EUS instruments (linear vs. radial), orientation (cranial, caudal to the left side), how to handle the instrument, the value of elastography and contrast-enhanced ultrasound (CEUS), the preference of cytology versus histology and also controversies on indications and other issues.

A group of interdisciplinary authors (gastroenterologists, surgeons, radiologists, pneumologists) recently published a series of papers on “how to perform” EUS and “controversies” in EUS and its subspecialties.[4],[5],[14],[15],[16],[17] The experience of writing these papers stimulated the preparation of a questionnaire to better understand the wide variation of the current practice of EUS in different settings and cultures. In addition to epidemiological questions (e.g., age, sex, origin and location of employment) the education, discipline, and research activity are documented. Topics discussed and questions asked include the frequency of transcutaneous US before EUS, the use of elastography and CEUS, the frequency of conventional endoscopy before EUS (mandatory or facultative), education and application of TUS in general, screen orientation of TUS and EUS, the percentage of diagnostic radial and/or longitudinal EUS and the use of miniprobes. The education and use of the above-mentioned EUS-based treatment options including the best use of ultrasound features (“knobology”) are also addressed. The requirement for coagulation tests before EUS-guided sampling, the management of patients taking antiplatelet who need a biopsy and the topic of mandatory antibiotic prophylaxis before certain interventions are also discussed.

The discussion of the combined use of EUS and EBUS techniques (e.g., conventional upper gastrointestinal EUS, endobronchial and endorectal techniques, miniprobes) has been included in this series of papers. In addition, the practical use of strain and shear wave elastography and how to perform contrast-enhanced ultrasound has been tackled.

A close collaboration between the World Federation for Ultrasound in Medicine and Biology and the European Federation of Societies for Ultrasound in Medicine and Biology is proving beneficial for coordinating the projects.

All practicing EUS endoscopists from across the world are invited to participate and answer this questionnaire but also to contribute to evolving reviews discussing standard practice with regard to currently available evidence and personal preference. The analysis of intercultural differences in behavior and application of techniques should act as a stimulus to improve skills and knowledge. A matter of debate is the education in ultrasound and the transcutaneous application before almost any EUS. Some interventionalists are very skilled in US, whereas others are using the US only as an adjunct concentrating on the endoscopic features of this method. Currently, educational issues are a focus of interest including the training via simulators. The reader is kindly invited to contact the group and to give input into the current projects. The interdisciplinary journal “EUS” is dedicated to support and to offer a platform for this fruitful discussion aiming in better knowledge, exchange of experience and friendship.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jenssen C, Hocke M, Fusaroli P, et al. EFSUMB guidelines on interventional ultrasound (INVUS), Part IV-EUS-guided interventions: General aspects and EUS-guided Sampling (Short Version). Ultraschall Med 2016;37:157-69.  Back to cited text no. 1
    
2.
Jenssen C, Hocke M, Fusaroli P, et al. EFSUMB guidelines on interventional ultrasound (INVUS), Part IV-EUS-guided interventions: General aspects and EUS-guided sampling (Long Version). Ultraschall Med 2016;37:E33-76.  Back to cited text no. 2
    
3.
Dietrich CF. Endosonography as theme of this issue-update of endoscopic ultrasound techniques. Z Gastroenterol 2008;46:553-4.  Back to cited text no. 3
    
4.
Dietrich CF, Burmeister S, Hollerbach S, et al. Do we need elastography for EUS? Endosc Ultrasound 2020;9:284-90.  Back to cited text no. 4
    
5.
Saftoiu A, Napoleon B, Arcidiacono PG, et al. Do we need contrast agents for EUS? Endosc Ultrasound 2020;9:361-8.  Back to cited text no. 5
    
6.
Ignee A, Jenssen C, Arcidiacono PG, et al. Endoscopic ultrasound elastography of small solid pancreatic lesions: A multicenter study. Endoscopy 2018;50:1071-9.  Back to cited text no. 6
    
7.
Dietrich CF, Sahai AV, D'Onofrio M, et al. Differential diagnosis of small solid pancreatic lesions. Gastrointest Endosc 2016;84:933-40.  Back to cited text no. 7
    
8.
Braden B, Jenssen C, D'Onofrio M, et al. B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors. Endosc Ultrasound 2017;6:49-54.  Back to cited text no. 8
    
9.
Baron TH, DiMaio CJ, Wang AY, et al. American gastroenterological association clinical practice update: Management of pancreatic necrosis. Gastroenterology 2020;158:67-750.  Back to cited text no. 9
    
10.
Teoh AY, Dhir V, Kida M, et al. Consensus guidelines on the optimal management in interventional EUS procedures: Results from the Asian EUS group RAND/UCLA expert panel. Gut 2018;67:1209-28.  Back to cited text no. 10
    
11.
ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016;83:481-8.  Back to cited text no. 11
    
12.
Fusaroli P, Jenssen C, Hocke M, et al. EFSUMB guidelines on interventional ultrasound (INVUS), Part V-EUS-guided therapeutic interventions (short version). Ultraschall Med 2016;37:412-20.  Back to cited text no. 12
    
13.
Fusaroli P, Jenssen C, Hocke M, et al. EFSUMB guidelines on interventional ultrasound (INVUS), Part V. Ultraschall Med 2016;37:77-99.  Back to cited text no. 13
    
14.
Dietrich CF, Arcidiacono PG, Braden B, et al. What should be known prior to performing EUS? Endosc Ultrasound 2019;8:3-16.  Back to cited text no. 14
    
15.
Dietrich CF, Arcidiacono PG, Braden B, et al. What should be known prior to performing EUS exams? (Part II). Endosc Ultrasound 2019;8:360-9.  Back to cited text no. 15
    
16.
Testoni SG, Healey AJ, Dietrich CF, et al. Systematic review of endoscopy ultrasound-guided thermal ablation treatment for pancreatic cancer. Endosc Ultrasound 2020;9:83-100.  Back to cited text no. 16
    
17.
Rimbas M, Larghi A, Fusaroli P, et al. How to perform EUS-guided tattooing? Endosc Ultrasound 2020;9:291-7.  Back to cited text no. 17
    




 

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