Endosonography

Covering the full spectrum of endoscopic ultrasound, Endosonography, 4th Edition, by Drs. Robert Hawes, Paul Fockens, and Shyam Varadarajulu, is a comprehensive, one-stop resource for mastering both diagnostic and therapeutic EUS procedures. Leading global authorities guide you step by step through both introductory and advanced techniques, covering everything from interpretation and accurate diagnosis to treatment recommendations. High-quality images and an easy-to-navigate format make this updated reference a must-have for both beginning and experienced endosonographers. Features completed updated content throughout, including new sections on high-intensity focused ultrasound, through-the-needle biopsy, benign pancreatic masses, and gastro-jejunostomy. Includes perspectives from new contributors who provide global experience and knowledge. Contains new and enhanced illustrations that correlate with high-quality endoscopic images. Covers cutting-edge techniques for performing therapeutic interventions, such as drainage of pancreatic pseudocysts and EUS-guided anti-tumor therapy, as well as fine needle aspiration (FNA) procedures.

Following the development of gray-scale imaging, real-time scanning, Doppler examination, and high-frequency sonography, endosonography is one of the latest major breakthroughs in the history of diagnostic ultrasound. Although early attempts at inserting ultrasound transducers in natural cavities of the body can be traced back more than two decades, only in the past few years has technology allowed the development and commercialization of effective, easy-to-use endosono scopic probes. Because the transducer can be placed in direct contact with or close to lesions, high frequencies (up to ~2 MHz) can be used, yielding cross-sectional images of unsurpassed resolution. The availability of specially designed intracorporeal probes for specific natural cavities that are routinely explored by conventional (optical) endoscopy or palpation has significantly expanded the diagnostic applications of sonography. Transrectal and transvaginal examinations are now performed routinely in many institutions, and virtually all sonographic equipment manufac turers have in their line of products at least one endorectal and one endovaginal transducer. Most endosonoscopic probes connect to existing scanners, and for radiology departments, the invest ment for transrectal or transvaginal scanning will usually be limited to the purchase of the specific probe. In this book, clinical applications of endosonography (excluding transesophageal echocardio graphy) are covered by European and North American experts. Current equipment and techniques of examination are described in detail to help newcomers get started in the field of endosonography.

Endosonography—by Drs. Robert H. Hawes, Paul Fockens, and Shyam Varadarjulu—is a rich visual guide that covers everything you need to effectively perform EUS, interpret your findings, diagnose accurately, and choose the best treatment course. World-renowned endosonographers help beginners apply endosonography in the staging of cancers, evaluating chronic pancreatitis, and studying bile duct abnormalities and submucosal lesions. Practicing endosonographers can learn cutting-edge techniques for performing therapeutic interventions such as drainage of pancreatic pseudocysts and EUS-guided anti-tumor therapy. This updated 2nd edition features online access to the fully searchable text, videos detailing various methods and procedures, and more at www.expertconsult.com. You’ll have a complete overview of all aspects of EUS, from instrumentation to therapeutic procedures. Gain a detailed visual understanding on how to perform EUS using illustrations and high-quality images. Understand the role of EUS with the aid of algorithms that define its place in specific disease states. Locate information quickly and easily through a consistent chapter structure, with procedures organized by body system. Access the fully searchable text online at www.expertconsult.com, along with 60 procedural video clips, 300 downloadable PowerPoint slides, and 400 downloadable images, and regular updates reflecting the latest findings. Stay abreast of the most recent studies thanks to downloadable tables that summarize new information, updated on a quarterly basis. Master the technique of systematically performing EUS, then download the hundreds of slides and videos available online to teach and train the newer generation of endoscopists. Find coverage relevant to your needs with detailed chapters, illustrations, and videos on how to perform EUS for the beginner; a new section on international EUS and technical tips on how to handle difficult FNAs for the advanced user; a totally revised chapter on cytopathology for the pathologist; and a chapter on EBUS and EUS dedicated to the mediastinum for the pulmonologist. Get a clear overview of everything you need to know to establish an endoscopic practice, from what equipment to buy to providing effective cytopathology service. Tap into the expertise of world-renowned leaders in endosonography, Drs. Robert H. Hawes, Paul Fockens, and Shyam Varadarajulu.

It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

More than 25 years ago, when ultrasound diagnostic methods were first intro duced into gynecology and obstetrics, few of the pioneers of these techniques sus pected what importance sonographic diagnosis was destined to assume. It was soon recognized that the organs of the lesser pelvis could be visualized to much greater advantage by inserting probes into the natural bodily orifices than by abdominal sonography. Full exploitation of the physical properties of ultra sound had to wait, as so often in the history of sonography, for technological ad vances. Endosonography in the form available to us today combines the advantages of endoscopy and sonography. The next light-reflecting surface, once the limit of en doscopy, represents no barrier to ultrasound. A whole range of both diagnostic and therapeutic procedures can be sonographically guided. Blood flow in vessels lying deep in the lesser pelvis can now be measured by means of vaginal duplex sonography.

A must-have reference for both beginning and experienced endosonographers, Endosonography, 5th Edition, coves the full spectrum of endoscopic ultrasound (EUS) in a single, convenient resource. Concise, easy-to-navigate chapters keep you abreast of changes in this dynamic field, and nearly 150 procedural videos reinforce techniques of common, clinically relevant procedures. Covering both standard and newer techniques, this authoritative reference covers everything you need to know—from basic applications to advanced interventions. Guides you step by step through both introductory and advanced techniques, covering everything from interpretation and accurate diagnosis to treatment recommendations. Employs a user-friendly, templated format to cover all topics from basic applications to advanced interventions, with procedures organized by body system. Includes a new chapter on Endo-Hepatology, and an increased focus on using EUS for interventions. Features 20 new procedural videos covering topics such as esophageal and gastric cancer; mediastinal lesions and lung cancer; pancreatic tumors; and bile duct, gallbladder, and ampullary lesions. Covers recent improvements and new applications in guided fine-needle EUS for diagnosis and cancer staging. Features high-quality images with correlative illustrations, diagnostic algorithms, examination checklists, and key points boxes throughout. Provides nearly 150 how-to-videos of both diagnostic and therapeutic procedures performed by expert endosonographers that demonstrate effective techniques and the proper use of equipment. Provides practical information on establishing an endoscopic practice, from what equipment to buy to effective cytopathology services.

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

This book brings together lessons learned in the clinical use of anorectal endosonography and manometry in paediatrics. In contrast to adult medicine, where they are virtually indispensable for specialists dealing with colo-proctology, in paediatrics endoanal ultrasound and anorectal manometry are still the prerogative of very few international centres. This book collects the results of a Workshop organised at the Paediatric Surgery Unit of Bologna, entitled "International Seminar on Endosonography and Anorectal Manometry in Paediatrics", and presents contributions from leading European experts. Focusing on the paediatric age group, this volume fills a gap in the paediatric gastroenterology literature, and will benefit all specialists wishing to use these methods in the management and treatment of common clinical problems, e.g. chronic constipation.