PROLEGOMENON OF DIAGNOSTIC ENDOSCOPIC ULTRASOUND

PROLEGOMENON OF DIAGNOSTIC ENDOSCOPIC ULTRASOUND FROM SCENE DOCK TO STAGECRAFT Vincent De Wilde, MD, AGAF gastroenterologist / academic consultant Ghent University

AZ Sint – Jan Ruddershove, 10 B-8000 Bruges

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dedicated to scepticism

PREFACE Endoscopic ultrasound, introduced into clinical practice during the early eighties as transintestinal or endoluminal ultrasonography, progressively matured from a purely B-mode diagnostic aid to a multifaceted tool with interventional properties and a bright future ahead.

‘knowledge is power, but enthusiasm pulls the switch’ (Francis Bacon)

This publication is intended for those aspiring a solid practice technique in support of the wealth of delineated data that can be acquired elsewhere, and has been inspired by Finagle’s laws of information: 1. the information you have is not what you want.

2. the information you want is not what you need.

3. the information you need is not what you can obtain.

4. the information you can obtain costs more than you want to pay.

The other motive to write this treatise is the old-fashioned belief that motivation, time investment, organisation, imagination, and good old hard graft are essential to turn every investigation into a self-assured delight in favour of the patient, protecting against rut and routine.

Genuine performing confidence is the crystal of hard work, in its turn favoured by discipline under the motto: ‘amplius agere opus est’1.

Having full and real-time control over the ultrasound process, often disapprovingly called operator dependency, will more than ever demonstrate its extreme value in terms of decision making amongst times of ‘artificialising’ intelligence, metaphorically spoken.

May this monograph be a worthwhile, ancillary companion during a prosperous journey as an endosonographer.

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‘the more effort, the better’

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CONTENTS 6

INTRODUCTION

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CHAPTER 5: SAFETY, COMPLICATIONS AND COAGULATION

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CHAPTER 1: GENERAL PRINCIPLES AND BASIC FUNCTIONALITY

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CHAPTER 6: BODY SHOP

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CHAPTER 7: REPORTING

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CHAPTER 8:

- Short history - Physics of ultrasound - Basic functionality - Frequency - Gain - Focus - Time Gain Compensation - Artifacts - Other artifacts

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- Appendix 1: list of abbreviations - Appendix 2: philosophy - Appendix 3: literature

CHAPTER 2: MODES, MODALITIES AND TECHNIQUES - Fundamental modes - Tissue Harmonic Imaging - Doppler - FNA/FNB - Elastography - EUS Rosemont criteria - Contrast

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CHAPTER 3: INDICATIONS (CAPITA SELECTA) - Benign pancreatic-biliary disease - Hepatic applications - Subepithelial lesions - Pelvic floor - Portal hypertension - Esophageal cancer - Gastric cancer - Pancreatic cancer - Rectal cancer - Lung cancer

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CHAPTER 4: HANDLING AND KNOBOLOGY - Handling - Knobology - Settings - Minimising potential risks

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