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EUS and Abdominal Pain
Abdominal pain is a common and perplexing problem faced by health care providers. Conditions run the gamut from irritable bowel syndrome to aggressive malignancies. A patient interview can help guide the evaluation, but often a firm diagnosis is not established after routine imaging. So what role does EUS play in the evaluation?
EUS is a sensitive method to look for biliary tract and pancreatic disease. Tumors invisible to CT scan can be identified and biopsied. Biliary stones are well seen during an EUS examination, and an excellent review on this topic by Dr. Vipul Rathod is included in this edition. As can be seen in Dr. Rathod's report, and exemplified by some recently published articles (1-5), EUS can be equivalent to or superior to other imaging modalities in this regard. Dr. Rathod's article is a continuation of a literature that supports using EUS early on in the evaluation of suspected pancreatobiliary disease, which includes abdominal pain of uncertain etiology.
One reason EUS is so useful in suspected pancreatobiliary disease is the close approximation one can make between the organs of interest (bile duct, pancreas gallbladder) and the ultrasound probe. Visible Human anatomy of a common radial array EUS position (a long view of the bile duct viewed from the posterior aspect) is shown below (Figure 1). This image includes a link to the Visible Human Anatomy data base. Click on it to explore the regional anatomy as seen during EUS.
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Figure 1: Click here to launch Interactive Atlas |
The future of role of EUS in the evaluation of abdominal pain is evolving, but current trends suggest that the utilization of EUS will continue to climb in the evaluation of patients with abdominal pain.
References
1. Massimo Raimondo, Michael B Wallace. Diagnosis of Early Chronic Pancreatitis by Endoscopic Ultrasound. Are We There Yet? J Pancreas (Online) 2004; 5(1):1-7.
2. Ainsworth AP, Rafaelsen SR, Wamberg PA, Durup J, Pless TK, Mortensen MB. Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography? Endoscopy. 2003 Dec;35(12):1029-32.
3. Napoleon B, Dumortier J, Keriven-Souquet O, Pujol B, Ponchon T, Souquet JC. Do normal findings at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone? A prospective follow-up study of 238 patients. Endoscopy. 2003 May;35(5):411-5.
4. Buscarini E, Tansini P, Vallisa D, Zambelli A, Buscarini L. EUS for suspected choledocholithiasis: do benefits outweigh costs? A prospective, controlled study. Gastrointest Endosc. 2003 Apr;57(4):510-8.
5. Sivak MV Jr. EUS for bile duct stones: how does it compare with ERCP? Gastrointest Endosc. 2002 Dec;56(6 Suppl):S175-7.
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