ASGE 2023 Masterclass EUS: Principles, Best Practices & Innovative Paradigms (On-Demand) | February 2023-Kaul_CaseBased Presentations Mediastinal EUS Fiducials Elastography and Contrast Enhanced CE EUS

Kaul_CaseBased Presentations Mediastinal EUS Fiducials Elastography and Contrast Enhanced CE EUS

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This document summarizes a presentation by Dr. Vivek Kaul on various topics related to endoscopic ultrasound (EUS). The presentation covers the role of EUS in evaluating mediastinal pathology, the value of fiducials for stereotactic body radiation therapy (SBRT) and image-guided radiation therapy (IGRT), and the use of contrast-enhanced EUS (CE-EUS) and EUS elastography in evaluating pancreatic and liver lesions and tumor staging.<br /><br />In terms of mediastinal EUS, it is commonly used for indications such as mediastinal adenopathy, metastatic malignancy, primary malignancy (lymphoma), sarcoid, infectious diseases, esophageal cancer staging, fiducials, lung mass tissue diagnosis, and non-diagnostic endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EUS can be performed transesophageally to access mediastinal organs and tissue. The technique does not breach the pleura and is guided by guidelines from the American Society for Gastrointestinal Endoscopy (ASGE).<br /><br />Fiducial placement in EUS involves the use of solid gold markers for precise lesion targeting in various organs such as the pancreas, liver, esophagus, stomach, colorectal region, prostate, lung, mediastinum, adrenal glands, and celiac nodes. The placement can be preloaded or reloadable, and its technical success rate is high. Fiducials can help with image-guided radiation therapy and are commonly used in pancreatic and esophageal cancers.<br /><br />Contrast-enhanced EUS (CE-EUS) and EUS elastography are imaging techniques used to characterize solid pancreatic masses, evaluate tumor staging, monitor response to local ablation therapy, and assess cystic lesions and lymphadenopathy. CE-EUS improves visualization of blood flow in small vessels and can differentiate between different types of pancreatic tumors based on their enhancement patterns. EUS elastography evaluates tissue stiffness or hardness, providing valuable information in distinguishing between benign and malignant tumors.<br /><br />Overall, advanced EUS imaging techniques like CE-EUS and EUS elastography provide complementary information to traditional EUS and can improve diagnostic accuracy in certain cases. However, their widespread adoption remains a challenge, and further studies are needed to evaluate their performance in different clinical scenarios.

Keywords

endoscopic ultrasound

mediastinal pathology

fiducials

contrast-enhanced EUS

EUS elastography

pancreatic lesions

liver lesions

tumor staging

CE-EUS