| Invited Lecture (JGES) |
| Sat. November 3rd 11:20 - 12:00 Room 12: Kobe International Conference Center Main Hall |
| Future perspective of EUS | |||
| Robert H. Hawes | |||
| Florida Hospital Institute for Minimally Invasive Therapy | |||
|
|||
|
|||
| There are 3 main domains for EUS: 1. Imaing 2. Tissue acquisin 3. Therapeutic Imaging: Over the last 10 years, the importance of EUS as an imaging modality have diminished. This is a result of improvements in CT and MRI and changes in the TNM staging of cancers, especially of the esophagus and pancreas. In the future, hopefully there will be improvements in transducer and processor technology that will improve image quality and depth of penetration and advanced in contrast agents that will unmask lesions that are invisible without contrast enhancement. Tissue Acquisition: EUS has now established itself as an important modality for tissue acquisition, especially for the pancreas and lymph nodes. Up to now, EUS FNA (fine needle aspiration) cytology, with or without ROSE (rapid on-site evaluation), represented the primary method to establish a diagnosis. In the future, it will be important to maintain the very high diagnostic accuracy for EUS but in addition, larger volumes of tissue will be required in order to perform staining for molecular markers. The future for oncology is personalized treatment which requires specific characterization of the cancer. Preliminary studies show that the new EUS FNB (fine needle biopsy) needles (22 and 19 gauge) acquire sufficient volume in fewer passes when compared to conventional FNA needles. Therapeutics: The last decade has seen significant progress in bringing therapeutic EUS into mainstream clinical practice. EUS guidance is now the standard of care for pancreatic fluid collections. Recent studies suggest that EUS is the best rescue procedure for failed ERCP and may become the standard of care for biliary drainage in malignant obstructive jaundice. EUS has been shown to be a good alternative to providing access to the papilla in some patients with altered anatomy and can provide access to the pancreas where ERCP is impossible (disconnected duct syndrome). There is great potential for EUS guided treatment of neoplastic cysts of the pancreas. Summary: The future is bright for EUS in the three main domains of imaging, tissue acquisition and therapeutics. Its potential is limited only by limiting our imagination. |
|||
| Page Top | |||