Interventional applications of endoscopic ultrasound

Raj, Melvin; Chen, Robert Y.

doi:10.1111/j.1440-1746.2006.04214.x

Cited by 13 publications

(6 citation statements)

References 103 publications

(154 reference statements)

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“…Evaluation of complex cystic lesions, location of endocrine tumors, and investigation of the relations with blood vessels and the Wirsung duct are possible only with endoscopic [18] and laparoscopic or intra-operative ultrasound (96% localization sensitivity) [19]. These approaches are also used to guide intra-operative aspiration of cyst fluid for chemical analysis.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Piccolboni

Ciccone

Settembre

et al. 2010

Journal of Ultrasound

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KEYWORDSLiver surgery; Pancreas surgery; Laparoscopic ultrasound.Abstract Introduction: Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. Materials and methods: In the years 2005e2008, 45 patients (aged 42e75 years) were selected for liver resection, and 48 others (aged 14e72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. Results: LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. Conclusions: LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).Sommario Introduzione: L'ispezione laparoscopica in chirurgia del pancreas o del fegato è un approccio ampiamente utilizzato. L'aggiunta dell'ecografia intra-operatoria alla laparoscopia ha di recente ulteriormente migliorato la valutazione chirurgica. Lo scopo di questo studio è stato di valutare l'impatto dell'ecografia intra-operatoria open (IOUS) o laparoscopica (LIOUS) in chirurgia del fegato e del pancreas. pancreas. L'ecografia intra-operatoria è stata effettuata per mezzo di un apparecchio Aloka SSD-550 (Aloka, Tokyo, Giappone), con sonda lineare laparoscopica a punta flessibile e sonda elettronica lineare a T. Risultati: Tra i pazienti epatici, la LIOUS ha evitato inutili laparotomie in sei pazienti (13,3%) ed, insieme alla IOUS, ha consentito di trovare noduli non diagnosticati ed ha cambiato la strategia chirurgica in cinque pazienti (11,1%). Nel gruppo pancreas, la LIOUS ha escluso 7 pazienti (14,4%) dalla chirurgia radicale, per infiltrazione della vena mesenterica, coinvolgimento dei linfonodi celici o para-aortici, micro-metastasi epatiche e peritoneali. In 11 lesioni benigne, ha consentito la definizion...

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Section: Discussionmentioning

confidence: 99%

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Piccolboni

Ciccone

Settembre

et al. 2010

Journal of Ultrasound

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“…For EUS-guided FNA, it is generally believed that the complication rate is less than 0.1-1%. 13 The data here is derived from non-standardized diagnostic and staging pathways. The subjective reporting of EUS effect by multiple referring physicians and surgeons may also bias to more positive outcomes data.…”

Section: Discussionmentioning

confidence: 99%

Experience of Endoscopic Ultrasound in an Australian Tertiary Hospital

Kalade

Desmond

Chen

2006

ANZ Journal of Surgery

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“…However, the role of CPB in the treatment of pancreatitis pain is more controversial compared with pancreatic cancer pain [15] . It has been suggested that in chronic pancreatitis, EUS CPB should be limited to patients whose pain has not responded to other modalities or for the treatment of flares of chronic pain [54][55][56] . Some authors have advocated surgical bypass or resection as the primary treatment of pain in chronic pancreatitis [57] .…”

Section: Cpb For Chronic Pancreatitis Painmentioning

confidence: 99%

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

Michaels

Draganov²

2007

WJG

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Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported, but larger studies are needed to confirm this finding. At this time, the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

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Interventional applications of endoscopic ultrasound

Cited by 13 publications

References 103 publications

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Experience of Endoscopic Ultrasound in an Australian Tertiary Hospital

Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

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