EUS

EUS (Endoscopic Ultrasound):

Diagnostic and interventional EUS services and includes evaluating pancreaticobiliary diseases, neoplasms including sub-epithelial tumors, cancer diagnosis and staging, pseudocyst drainage, peri-rectal pelvic abscesses drainage, Fiducials placement for image-guided radiation therapy, rendezvous access for biliary and pancreatic duct access and drainage in complex disease states that are not feasible by conventional ERCP, gastrogastric anastomosis for gastric remnant/duodenal access for ERCP and other intervention in gastric bypass patients, gastroenteric anastomosis for palliation of malignant gastric outlet obstruction, celiac plexus block and neurolysis for palliative control of debilitating pain related to pancreatic and metastatic diseases.

Celiac and SMA anatomy

Celiac artery and SMA vascular anatomy from descending aorta.

Pancreatic duct

Pancreatic duct anatomy – body of pancreas

Cystic-dilation-of-SBr-in-obstructed-PD

Main pancreatic duct and large cystic dilation of a side branch in patient with obstructing PD stricture from chronic pancreatitis

 

EUS/FNA of suspected malignant bile duct stricture confirmed as cholangiocarcinoma:

07-EUS Cholangioca

Terminal bile duct with stricture and thickened wall and post obstructive proximal dilation

08-EUS Cholangioca FNA

EUS FNA from duodenal bulb with 25 gauge needle in to thickened bile duct/stricture

01-EUS FNA Cholangioca

Rapid On Site Evaluation Diff Quik analysis confirming malignancy, further evident on cell block.

 

EUS guided rendezvous access for obstructed pancreatic duct:

02-EUS Rendezvous access of PD pre 03-EUS Rendezvous access of PD post 2 04-EUS Rendezvous access of PD post 1

 

Pseudocyst Drainage:

 

Double pigtail stents after cystgastrostomy
EUS of large infected pseudocyst/walled off necrosis
Hot Axios stent distal flange deployment in pseudocyst
Proximal flange of Hot Axios stent in gastric lumen and purulent fluid draining.

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