Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree

Abstract

Gastroenterologists increasingly find themselves in the un-enviable position of having to choose the optimal radiographic test to visualize the biliary tree and the liver. This dilemma is compounded by the rapid evolution of the available technologies and their ever-increasing resolution capabilities. Endoscopic ultrasound (EUS) has shown itself to be equally capable of providing detailed imaging of the biliary tree and of surrounding structures; its potential for evaluating liver lesions is just now being realized. EUS-fine needle aspiration (FNA) may supplant some of the existing technologies as it offers a way to sample masses, strictures, lymph nodes, and now certain segments of the liver and periportal regions. This review takes an in-depth look at the role of EUS in evaluating bile duct dilatation, suspected choledocholithiasis, biliary strictures, and polyps and masses of the gallbladder. It also reviews the literature on the exciting and rapidly evolving role of EUS-FNA evaluation of occult, metastatic, and primary hepato-cellular malignancies, as well as periportal lesions. Technologies such as EUS elastography may completely obviate FNA of liver lesions.

Residual gallstone disease — Laparoscopic management

“…An EUS is indicated in the presence of a high index of clinical suspicion with a negative abdominal ultrasound. EUS has proven its feasibility in diagnosing liver and biliary pathologies with a high sensitivity (96.2%) and specificity (88.9%) and has also been shown to be cost effective in avoiding number of ERCPs [19][20][21]. ERCP enjoys significant popularity as a diagnostic and therapeutic tool in managing extrahepatic biliary pathology.…”

The Clinical Utility and Limitations of Serum Carbohydrate Antigen (CA19-9) as a Diagnostic Tool for Pancreatic Cancer and Cholangiocarcinoma

“…Historically, limitations in imaging necessitated the use of tumor markers such as CA19-9 and morbid procedures such as exploratory laparotomy to establish a diagnosis of pancreatic or biliary neoplasia. Significant advances in cross-sectional and endoscopic imaging and sampling since CA19-9 was discovered in 1979 have clearly improved the ability to diagnose diseases of the pancreas and bile ducts in a much less morbid way [8][9][10]. As such, we hypothesized that the sensitivity and specificity of CA19-9 when used by clinicians in the 21st century is possibly lower than previously described.…”

Gallbladder cancer: Can newer insights improve the outcome?

“…Endoscopic ultrasound (EUS) has emerged as an important tool to diagnose early GBC, stage GBC more accurately than CT scan, and provide direct access to GB and lymph nodal tissue through fine needle aspiration. 49 The accuracy of EUS staging is 100% for tumor in situ (Tis), 76% for T1, 85% for T2, and 93% for T3-4. EUS also provides clinicians with the ability to diagnose and manage associated biliary obstruction.…”