EUS mit Minisonden

Zusammenfassung

Die Minisonden-Endosonografie (MS-EUS) stellt für viele Fragen des endoskopischen Ultraschalls eine Ergänzung zu den größeren Echoendoskopen mit radial oder longitudinal angeordneten Scannern dar. Sie liefert bei hohen Frequenzen – um 20 MHz haben sich bewährt – detaillierte Bilder mit einer Eindringtiefe von ca. 20 mm. Es lassen sich nicht nur Strukturen in der intestinalen Wand, sondern auch ein erheblicher Teil der umgebenden Organe beurteilen. Im Intestinaltrakt hat sich zur Ankoppelung der Einsatz ohne Ballon mit Wasservorlauf bewährt. Die häufigsten Indikationen bei 1007 MS-EUS in 5 Jahren waren in der Klinik der Autoren die Beurteilung des distalen Gallen- und Pankreasgangs (36 %), Ösophagus- und Kardiakarzinome (18 %), submuköse Tumoren und GIST (14 %), andere (32 %). Bei der Beurteilung des distalen Gallengangs erlaubt der extraduktale Schall (EDUS) die Erfassung kleiner pathologischer Strukturen, insbesondere sehr kleiner Steine ohne Gangerweiterung mit einer Sensitivität von 97 % und einer Spezifität von 98 %. Bei Frühkarzinomen liegt die Bedeutung vor allem in der Darstellung einer erhaltenen Submukosaschicht, d. h. im sicheren Ausschluss endoskopisch grundsätzlich nicht mehr resektabler Befunde (T2). Dieser gelang unserer Arbeitsgruppe in allen Fällen. Suspekte prominente Strukturen werden durch die MS-EUS leicht der richtigen Wandschicht zugeordnet oder aber als Impressionen von außen erkannt.

Abstract

With the advent of flexible, high-frequency catheter probes that can be introduced through the working channel of any endoscope, EUS became available as an additional and very powerful diagnostic tool during routine endoscopic procedures. Miniprobes as a supplement to echoendoscopes with radial or longitudinal scanners provide detailed images with a penetration depth of about 20 mm using frequencies of around 20 MHz. Not only structures of the intestinal wall but also a considerable volume of the surrounding organs can be visualised. In the intestine sonographic coupling is best accomplished using bare miniprobes with water filling of the lumen. Out of 1007 miniprobe examinations carried out in the author’s clinic, the most frequent indications involved the distal bile and pancreatic ducts (36 %), carcinoma of the oesophagus or the cardia (18 %), submucosal tumours and GIST (14 %), and others (32 %). For evaluating the distal common bile duct, extraductal EUS (EDUS) allows the visualisation of small pathological lesions, especially intraductal stones without ductal dilatation with a sensitivity of 97 % and a specificity of 98 %. For the staging of early cancers, miniprobe EUS has its significance mainly in showing a preserved submucosal layer, thereby excluding an endoscopically non-resectable T 2 lesion, as was successfully done in all of our cases. Suspicious prominent structures were easily assigned to the correct layer of the wall or identified as external impressions.

Schlüsselwörter

Ösophaguskarzinom - MALT-Lymphom - Gallengangstein - Gallenwege - Endosonografie - Minisonden - Gallensteine

Key words

oesophagal carcinoma - MALT lymphoma bile duct stones - bile duct - endoscopic ultrasound - miniprobes - bile stones

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