Endoscopy

Endoscopic ultrasound (EUS) combines endoscopy and high frequency ultrasound to create detailed images of the gastrointestinal tract wall and hepatopancreatobility organ, including the esophagus, stomach, duodenum, pancreas, bile ducts, gallbladder and liver. 

It provides high-resolution imaging to spot small masses, cysts, neuroendocrine tumors, gallstones, or ductal strictures. Combining Endoscopic Ultrasound with specific interventional procedures, it provides a conservative treatment for cancer patients. 

Diagnostic procedures: 

• Wall Layers & Tumors: Distinguishes between mucosal lesions, submucosal tumors (e.g., GISTs, lipomas, leiomyomas), and deep tissue abnormalities by identifying the exact layer of origin.
• Cancer Staging: Detects enlarged or suspicious lymph nodes to evaluate for metastatic spread
• Tissue Sampling (FNA/FNB): Allows real-time Fine-Needle Aspiration or Biopsy through the endoscope to collect tissue or fluid samples from suspicious masses, cysts, or lymph nodes under direct ultrasound guidance.
• Fluid Collections & Vessels: Visualizes fluid accumulations (such as pancreatic pseudocysts) and evaluates adjacent vascular structures for blood vessel invasion by surrounding tumors.
• Celiac Plexus Neurolysis/Block: manage severe chronic pain from pancreatic cancer or pancreatitis. 
   

Therapeutic and interventional procedures:

• EUS-Guided Biliary Drainage (EUS-BD): creates an internal bypass/ stent directly from the bile duct into the stomach or intestine when conventional ERCP fails.
• Pseudocyst/ Fluid Collection Drainage: place lumen-apposing metal stents (LAMS) to drain pancreatic fluid collections or necrosis into the stomach.
• EUS-Guided Gallbladder Drainage: Drains an inflamed gallbladder internally in patients unfit for acute cholecystectomy.
• EUS-guided Rendezvous ERCP: a hybrid endoscopic technique used to gain biliary or pancreatic duct access when standard ERCP fails.