SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 25 SAGES This position statement is intended as a guide on the use of endoscopic ultrasound (EUS) in practice. It is not intended as a standard of care, nor is it meant to advocate or discourage any modality. The final decision on imaging remains the prerogative of the treating physician. Endoscopic ultrasonography incorporates high-frequency ultrasound into the tip of the endoscope to visualize the gastrointestinal (GI) wall and surrounding structures. Using endoscopy, ultrasound probes are placed close to the target anatomy, thereby enhancing the resolution of the GI wall and adjacent structures. Tissue samples can be obtained, and therapy can be performed by passing instruments under ultrasonographic guidance. Several different EUS devices are available. Most are like standard endoscopic instruments in that they have biopsy channels and video or fibreoptic endoscopic capability. They differ from normal endoscopes by having ultrasound transmission and reception capability at the tip of the instrument. GI indications for EUS, amongst others, include: 1. Diagnosis of choledocholithiasis 2. Evaluation of biliary tree abnormalities 3. Evaluation of GI tract wall or adjacent structure abnormalities 4. Evaluating abnormalities of the pancreas a. Masses b. Pseudocysts c. Chronic pancreatitis 5. Evaluating peri-intestinal adenopathy and masses 6. Gallbladder drainage for acute cholecystitis 7. Staging and marking of GI malignancies (oesophagus, stomach, colon, rectum, pancreas, liver, and biliary tree) 8. Surveillance of certain gastric subepithelial masses (asymptomatic glomus tumours or small (less than 3 cm) gastrointestinal stromal tumours). 9. Endoscopic therapy under ultrasonographic guidance a. Pancreatic cyst drainage b. Coeliac plexus block, e.g., chronic pancreatitis or pancreatic cancer c. Biliary drainage (EUS-BD) d. Liver biopsies e. Stent placement 10. Sampling tissue of lesions by fine needle aspiration (FNA) within or adjacent to, the GI tract wall (EUS-FNA) EUS-FNA Indications: a. Upper GI tract lesions - oesophageal or gastric wall thickening, sub-epithelial lesions, e.g., GI stromal tumours (GISTs) b. Lower GI tract lesions - suspected GISTs, perirectal mass lesions c. Pancreas - solid pancreatic lesions, pancreatic neuroendocrine tumours, cystic pancreatic lesions d. Lymphadenopathy - mediastinal adenopathy, Hodgkin, and non-Hodgkin lymphoma e. Other lesions - bile duct strictures and gallbladder masses, suspected cholangiocarcinoma, in candidates not eligible for liver transplantation (biopsy tract seeding), solid liver lesions, adrenal lesions, and paracentesis. Contraindications to EUS-FNA a. Patients who cannot tolerate sedation, monitored anaesthetic care (MAC), or general anaesthesia. b. Hemodynamically unstable patients. c. Gastrointestinal obstruction d. Abnormal coagulation studies (platelet count ≤ 50,000/uL; international normalized ratio [INR] >1.5) WM Simmonds SAGES Guidelines Sub-Committee Sages position statement on endoscopic ultrasound SAGES This position stat on t e use of en practice. It is no nor is it meant to modality. The fin the prerogative Endoscopic ult high-frequency endoscope to vi (GI) wall and sur endoscopy, ultra to the target ana resolution of the Tissue samples can be performe ultrasonographi Several differe Most are like sta in that they have fibreoptic endos from normal end transmission an of the instrument GI indications fo 1. Diagnosis of 2. Evaluation of 3. Evaluation of structure ab 4. Evaluating a a. Masses b. Pseudoc c. Chronic 5. Evaluating p masses 6. Gallbladder 7. Staging and (oesophagus pancreas, liv 8. Surveillance masses (asy small (less th WM Simmonds SAGES Guidelines Sa stat en