Review
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World J Gastroenterol. Feb 14, 2011; 17(6): 691-696
Published online Feb 14, 2011. doi: 10.3748/wjg.v17.i6.691
State-of-the-art imaging techniques in endoscopic ultrasound
Adrian Săftoiu
Adrian Săftoiu, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania, Craiova, Dolj 200349, Romania
Author contributions: Săftoiu A solely contributed to this paper.
Supported by “Utility of EUS and OCT for the minimal invasive evaluation of tumour neo-angiogenesis in the patients with digestive cancers” financed by the Romanian Ministry of Education and Research - National University Research Council (UEFISCSU - Ideas Program), No. 239/2007
Correspondence to: Adrian Săftoiu, MD, PhD, Professor, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania, 2-4 Petru Rares Str., Craiova, Dolj 200349, Romania. adrian.saftoiu@webmail.umfcv.ro
Telephone: +40-251-522458 Fax: +40-251-310287
Received: April 23, 2010
Revised: May 28, 2010
Accepted: June 5, 2010
Published online: February 14, 2011
Abstract

Endoscopic ultrasound (EUS) has recently evolved through technological improvement of equipment, with a major clinical impact in digestive and mediastinal diseases. State-of-the-art EUS equipment now includes real-time sono-elastography, which might be useful for a better characterization of lesions and increased accuracy of differential diagnosis (for e.g. lymph nodes or focal pancreatic lesions). Contrast-enhanced EUS imaging is also available, and is already being used for the differential diagnosis of focal pancreatic masses. The recent development of low mechanical index contrast harmonic EUS imaging offers hope for improved diagnosis, staging and monitoring of anti-angiogenic treatment. Tridimensional EUS (3D-EUS) techniques can be applied to enhance the spatial understanding of EUS anatomy, especially for improved staging of tumors, obtained through a better assessment of the relationship with major surrounding vessels. Despite the progress gained through all these imaging techniques, they cannot replace cytological or histological diagnosis. However, real-time optical histological diagnosis can be achieved through the use of single-fiber confocal laser endomicroscopy techniques placed under real-time EUS-guidance through a 22G needle. Last, but not least, EUS-assisted natural orifice transluminal endoscopic surgery (NOTES) procedures offer a whole new area of imaging applications, used either for combination of NOTES peritoneoscopy and intraperitoneal EUS, but also for access of retroperitoneal organs through posterior EUS guidance.

Keywords: Endoscopic ultrasound; Real-time sono-elastography; Contrast-enhancement; Tridimensional (3D); Hybrid imaging; Endoscopic ultrasound-guided fine needle aspiration