A Look Back
25 YEARS AGO... from the pages
of The American Journal of Gastroenterology By Lawrence R. Schiller, MD, MACG for the ACG Archives Committee
Endoscopic Ultrasound
I
n January 1997, Dr. Scott Tenner, Dr. Peter Banks, Dr. Maurits Wiersema, and Dr. Jacques Van Dam of Brigham and Women’s Hospital in Boston reviewed the published experience with the then novel technology of endoscopic ultrasound in the pages of The American Journal of Gastroenterology (1). Medical use of ultrasound for diagnostic purposes dates back to 1942 when Karl Dussik, a neurologist at the University of Vienna, attempted to locate brain tumors and the cerebral ventricles with a primitive ultrasound probe (2). Further development occurred in the next two decades, pioneered by Dr. John Julian Wild then working in Minnesota (3). By the mid-1970s, technological advances permitted use of ultrasound imaging in obstetrics, cardiology, and gastroenterology, where it became the standard way to image the gallbladder and its contents.
Whereas transabdominal ultrasound imaging remains the method of choice for visualizing the gallbladder to this day, imaging of the pancreas with transabdominal ultrasound has remained challenging because of the depth of the pancreas within the body and overlying bowel gas. Resolution of ultrasound images depends on the frequency of the sound waves generated by the probe, and the depth of penetration is inversely related to frequency; to make better images, higher frequency, shorter wavelengths must be used closer to the target organ. Endoscopy provided a straightforward way to position the ultrasound transducer within the gastrointestinal tract adjacent to the pancreas. Technological advances led to miniaturized transducers and improved image reconstruction, and they permitted clinical use of what came to be known as endoscopic ultrasound (EUS). Prototypes of EUS scopes
were described in the early 1980s (4), and commercial EUS scopes were available by the early 1990s (5). The review by Tenner, et al. (1) highlighted the emerging use of EUS for the management of many pancreatic disorders in the 1990s. It focused on diagnosis, and EUS still is used for most of these problems to delineate and evaluate pancreatic diseases. Description of therapeutic uses was limited to EUS-guided celiac plexus neurolysis. Nowadays, EUS has become central to the management of pancreatic disorders, including cysts, tumors, and complications of acute and chronic pancreatitis. One can only marvel how EUS has impacted the therapy of pancreatic diseases in the last 25 years, providing safe and effective management alternatives to surgical interventions (6).
References: 1. Tenner SM, Banks PA, Wiersema MJ, Van Dam J. Evaluation of pancreatic disease by endoscopic ultrasonography. Am J Gastroenterol. 1997 Jan;92(1):18-26. 2. Dussik KT. On the possibility of using ultrasound waves as a diagnostic aid. Z Neurol Psychiatr 1942;174:153–68. 3. Shampo MA, Kyle RA. John Julian Wild — pioneer in ultrasonography. Mayo Clin Proc 1997;72:234. 4. DiMagno EP, Buxton JL, Regan PT, Hattery RR, Wilson DA, Suarez JR, Green PS. Ultrasonic endoscope. Lancet. 1980 Mar 22;1(8169):629-31. 5. Gilbert DA, DiMarino AJ, Jensen DM, Katon RM, Kimmey MB, Laine LA, MacFadyen BV, Michaletz PA, Zuckerman G. Status evaluation: endoscopic ultrasonography. American Society for Gastroenterology Endoscopy. Technology Assessment Committee. Gastrointest Endosc. 1992 Nov-Dec;38(6):747-9. 6. Dietrich CF, Braden B, Jenssen C. Interventional endoscopic ultrasound. Curr Opin Gastroenterol. 2021 Sep 1;37(5):449-461.
L-R: Scott M. Tenner, MD, MS, MPH, JD, FACG; Peter A. Banks, MD, MACG; Maurits J. Wiersema, MD, FACG; Jacques Van Dam, MD, PhD, FACG
Inside the Journals | 45
