[Mini-probe ultrasound of the upper gastrointestinal tract--1995 state of the art and perspectives. Workshop on Mini-Probe Ultrasound in Gastroenterology, Münster, 28 October 1995]. / Minisonden-Sonographie im oberen Gastrointestinaltrakt-State of the Art 1995 und Perspektiven. Workshop zur Minisonden-Sonographie in der Gastroenterologie Münster, 28.10.1995.

Endoscopic ultrasound (EUS) allows for intraluminal sonographic imaging of the oesophagus, stomach, pancreatobiliary duct system, the papilla of Vater, as well as the colon and rectum. EUS has proved valuable for diagnosis and staging of tumours of the upper intestinal tract. EUS can also provide valuable additional information concerning lesions that cannot be immediately classified. As doing this involves, first, removal of the conventional endoscope and, second, insertion of the echo endoscope, EUS is not suitable for routine examinations. Therefore EUS has remained an independent endoscopic diagnostic modality. Moreover, due to their diameter conventional echoendoscopes cannot be inserted into the pancreatobiliary duct system. Fine calibre high frequency ultrasound probes promise a resolution of less than 2 mm in diameter. The following report is a summary of a one-day workshop which took place in Muenster, Germany on Oct. 28, 1995. Its goal was to define the current state of the art of miniaturised endoscopic ultrasound probes in the field of gastroenterology. During this workshop, possible clinical applications for diagnosis, therapy, as well as follow-up were described and discussed. The potential of miniaturised endoscopic ultrasound probes was explored in terms of possible future technical developments.

[Endosonography in the assessment of pancreatic tumors. A comparison of the endosonographic findings of carcinomas and segmental inflammatory changes]. / Endosonographie in der Dignitätsbeurteilung von Pankreastumoren. Ein Vergleich endosonographischer Befunde von Karzinomen und segmentalen entzündlichen Veränderungen.

AIM OF STUDY: To examine the value of endoscopic ultrasonography in distinguishing malignant and benign tumours of the pancreas. PATIENTS AND METHODS: Endoscopic ultrasonography (EUS) was performed on 130 consecutive patients (35 women and 95 men; mean age 56.6 [38-71] years), 61 with carcinoma of the pancreas (CP), 69 with segmental inflammatory (pseudotumorous) lesions of the pancreas (SILP). The diagnosis was confirmed by histology in 41 cases of CP, by autopsy in 4, by clinical follow-up (4-56 weeks, mean of 7 months) in 16. It was confirmed histologically in 39 cases of SILP, by clinical follow-up in 30 (12-93 weeks, mean of 12 months). All EUS findings were performed and recorded according to a standardized protocol and subsequently compared. RESULTS: There were no significant differences in EUS findings between CP and SILP. Statistical analysis between the two groups revealed any differential diagnostic relevance only with regard to some individual findings: coarse echo-dense deposits were seen by EUS in 16 of SILP cases (23%), but in only 4 of those with CP (7%), and then only in the face of similar changes in the rest of the organ or if there was additional chronic pancreatitis. Absence of demarcation from the duodenal or gastric wall was recorded in 18 cases of CP (30%), but in only 5 of SILP (7%). Lack of demarcation from the portal vein, splenic vein or coeliac artery was noted in 17 cases of CP (28%) and 6 of SILP (9%). Extension of tumour into vessel lumens was seen only in CP, but even here in only 7 cases (11%). CONCLUSION: Despite the high resolution of EUS it does not provide reliable differentiation of benign and malignant lesions of the pancreas in the individual case.

The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice.

Forty-one patients (22 females, 19 males, mean age 74 years, range 41-93) with extrahepatic obstructive jaundice were evaluated by transcutaneous sonography (US), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) within 24 hours of hospital admission. EUS was always performed after US and immediately prior to ERCP, the latter being considered the "gold standard" for this study. EUS findings were documented according to a pre-set data protocol in a blind fashion with respect to ERCP results. Common bile duct (CBD) dilatation was demonstrated by all three methods. Stones in the distal CBD causing obstruction were demonstrated by EUS in 15 out of 16 patients, but in only seven cases by US. In 25 patients, the underlying malignant disease was identified by EUS as well as ERCP, and the level of biliary obstruction was correctly determined by both methods, while with US this was possible only in 17 (89%) and 20 (80%) cases, respectively. In comparison with ERCP, EUS provided a direct image of the tumor and allowed for regional staging in all patients. EUS was superior to US in elucidating the cause of biliary obstruction. EUS provides an additional means to decide quickly on appropriate therapy. At present, a shortcoming of the method is that no therapeutic interventions can be performed during EUS examination.

[Endoscopic ultrasonography--indications and results in diseases of the esophagus and stomach]. / Endoskopischer Ultraschall--Indikationen und Ergebnisse bei Erkrankungen des Osophagus und des Magens.

Based on own experience and on published data we report about indications and efficacy of endoscopic ultrasonography (EUS) in esophageal and gastric diseases. At the present time the following conclusions can be drawn: Submucous tumors can be clearly demonstrated and unequivocally distinguished from extramural compressions. Although the EUS aspect does not allow to differentiate benign from malignant lesions, EUS findings can give hints as to the nature of a submucous tumor (leiomyoma, lipoma, cyst). The main indication for EUS ist local tumor staging. The pT stage of esophageal carcinoma can be assessed correctly in 84% (73 to 92%) and that of gastric carcinoma in 80% (69 to 92%) of the cases by EUS. Especially in early tumor stages, EUS is superior to computed tomography. Regional lymph node metastases can be visualized in 70 to 90% of the cases. EUS is also helpful in the follow-up of patients with operative resection of esophageal cancer and in patients with gastric non-Hodgkin lymphoma during radio-/chemotherapy.

[Endoscopic ultrasound in detection of locoregional lymph node metastases of gastrointestinal tumors]. / Endoskopischer Ultraschall beim Nachweis lokoregionaler Lymphknotenmetastasen gastrointestinaler Tumoren.

The locoregional lymph node status was assessed via EUS and CT in 118 patients (37 female, 81 male, average age 63.1 [37-87] years) who had histologically confirmed neoplasias in the upper GI tract. These investigations were made as part of preoperative tumour staging. Resections were performed subsequently, yielding regional lymph node metastases in 76 cases and in 23 patients only enlarged lymph nodes with benign histological findings. Overall accuracy of findings of regional lymph node metastases was 84% for oesophageal carcinomas with EUS and 57% with CT, 78% for gastric carcinomas with EUS and 46% with CT and 68% for pancreatic and ampullary carcinomas with EUS and 53% with CT. In 2 non-Hodgkin lymphomas of the stomach, paragastral malignant lymphomas were identified via EUS but not via CT. In two further cases both methods yielded false positive results. Locoregionally enlarged lymph nodes with exclusively benign histology were found in 22 of 23 cases via EUS but were misinterpreted as metastases in 15 cases. Hence, EUS is evidently superior to CT in identifying locoregional lymph node metastases. The accuracy, however, does not represent tumour status assessment made possible with the help of endosonographic criteria; rather, it is essentially due to the high degree of sensitivity of the method and the scarcity of completely benign enlargements of lymph nodes in the vicinity of neoplasias.

[Endosonography in diagnosis and staging of malignant tumors of the stomach. A prospective comparative study between endosonography, computerized tomography and conventional ultrasonography]. / Endosonographie in der Diagnostik und im Staging maligner Tumoren des Magens. Eine prospektiv-vergleichende Studie zwischen Endosonographie, Computertomographie und konventioneller Sonographie.

78 patients with histologically proven malignant tumors of the stomach (64 carcinomas, 10 non-Hodgkin lymphomas [NHL], 4 sarcomas) were investigated by endosonography (EUS), computed tomography (CT) and conventional ultrasound (US) during TN-staging (TNM-classification/UICC-1987 for carcinomas and NHL, TNMG-classification for sarcomas). In 60 patients (50 carcinomas, 6 NHL, 4 sarcomas) an operative resection was performed and the histological findings were compared with the results of preoperative staging. Demonstration of tumor was successful with EUS in 77 (99%), with CT in 33 (42%) and with US in 18 (23%) cases. The T-stage was correctly determined preoperatively by EUS in 50 (81%), by CT and US only in 15 (24%) and in 7 (11%) patients respectively. The accuracy of EUS in determining the T-stage of carcinomas and NHL amounted to 79% in T1-, 92% in T2-, 92% in T3- and 67% in T4-stage. In gastric sarcomas infiltrative destruction of the gastric wall could be demonstrated with EUS in all patients and with CT in 3 of 4 cases. With EUS and CT two smaller tumors were correctly delineated as submucous tumors while with US this was not possible in any case. In demonstrating local lymph node metastasis EUS achieved a sensitivity of 85%, CT of 29% and US of 13%. The specificity of EUS was 72%, of CT 79% and of US 100%. The overall accuracy for the pN-stage was 79.7% for EUS, 51.6% for CT and 42.2% for US. EUS proves to be an efficient method in the local TN-staging of gastric carcinomas an NHL.(ABSTRACT TRUNCATED AT 250 WORDS)

Endosonography in chronic pancreatitis--a comparison between endoscopic retrograde pancreatography and endoscopic ultrasonography.

Endoscopic ultrasonography (EUS) and endoscopic retrograde pancreatography (ERP) were prospectively performed in 114 patients, 94 of whom (62 men, mean age 53 years) had inflammatory pancreatic disease, either chronic pancreatitis or status post acute edematous pancreatitis. Twenty patients (14 men, mean age 54 years) who were examined for other reasons and who had a normal ERP served as controls. EUS was performed in most cases with the knowledge of ERP results which had been classified according to the Cambridge classification system of chronic pancreatitis as being grade 0 (normal) or 1-3 (inflammatory changes). Parenchymal and ductal changes on EUS were correlated with the ERP changes. Abnormal EUS features were found in all patients with grade 2 and 3 chronic pancreatitis, in 88% with stage 1, and in 63% of cases with a normal ERP as well. These changes were, however, not detectable in any of the 20 control cases. Among the EUS features of chronic pancreatitis, diffuse changes predominated (stage 1: 75%, 2: 88%, 3: 96%) and consisted mainly of alternating echopoor and echorich areas and of a lobulated parenchymal pattern. In 80% of patients, these findings were combined with an irregular pancreatic margin. Changes of the main pancreatic duct were found in stages 2 and 3 in 81% and 96%, respectively; isolated side branch alterations, as detected mainly in stage 1 chronic pancreatitis on ERP, escaped endosonographic visualization. We conclude that EUS shows inflammatory changes in almost all patients in whom ERP suggests chronic pancreatitis. EUS, however, is also positive in a considerable number of cases with normal ERP but who have a clinical episode of pancreatic inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopic ultrasound in preoperative TN staging of esophageal cancer. A comparative study between endosonography and computerized tomography]. / Endoskopischer Ultraschall im präoperativen TN-staging des Osophaguskarzinoms. Eine vergleichende Studie zwischen Endosonographie und Computertomographie.

In 86 patients with histologically proven oesophageal carcinoma endoscopic ultrasonography (EUS) and computerised tomography (CT) were performed during TN-staging (UICC 1987). 44 patients were operated on and the histological findings were compared with the results of preoperative staging. The T-stage was correctly determined with EUS and CT in 35 (80%) and 24 (55%) patients, respectively. The accuracy of EUS was 75%, 71%, 91% and 67% in stages T1 to T4. The sensitivity of EUS in the diagnosis of lymph node metastases was 91%, that of CT 42%. The specificity of EUS and CT was 64% and 100%, respectively. The accuracy for pN staging (N0/N1) was 84% with EUS and 57% with CT. The presence of local lymph node metastases was closely correlated to the pT-stage (1 patient [14%] with pT1-, 5 patients [71%] with pT2-, 21 patients [95%] with pT3- and 6 patients [100%] with pT4-stage). In 12 out of 34 patients (28%) tumour induced stenosis prevented a complete oesophageal passage of the EUS probe. This fact, however, did not compromise TN-staging significantly. Our study demonstrates that EUS is an efficient method in the locoregional staging of oesophageal carcinoma. Especially in the early tumour stages T1 and T2 and in the demonstration of local lymph node metastases EUS is superior to CT.

[Endosonography in oncology of the upper gastrointestinal tract]. / Endosonographie in der Onkologie des oberen Magen-Darm-Traktes.

Based on our own experience and on data from the literature, we report on the indications for and efficiency of endoscopic ultrasound (EUS) in the oncology of the upper gastrointestinal tract. At the present time the following conclusions can be drawn: Intramural tumors can be clearly visualized and differentiated from extragastric conditions by EUS. Pancreatic tumors smaller than 2 cm can be delineated exactly by EUS and the sensitivity of EUS in demonstrating pancreatic tumors is 90%, a fact which is especially helpful in the early diagnosis of endocrine tumors. Since the endosonographic aspect does not allow us to separate unequivocally benign from malignant alterations, a clear distinction between inflammatory (pseudo) tumors and neoplastic pancreatic lesions based on EUS findings alone is not possible. The main indication for EUS is in regional TN-staging. The pT-stage of esophageal cancers can be determined correctly in 84% (73-92), of gastric carcinomas in 80% (69-92), of pancreatic cancers in 90% (88-92) and of the distal common bile duct and of papilla of Vater in 85% (83-89) of cases. EUS is superior to computed tomography, especially in early tumor stages. The correct EUS-staging of proximal bile duct tumors and of gallbladder cancer is far more difficult, especially when the latter is filled with stones. Local lymph node metastases are visualized by EUS in about 70-90% of cases. EUS is also valuable in evaluation of the anastomosis after operative resection of esophageal or gastric carcinoma, as well as in the follow-up of patients with gastric non-Hodgkin lymphomas during radiochemotherapy.

[Endoscopic ultrasound in the demonstration and staging of non-Hodgkin's lymphomas of the stomach]. / Endoskopischer Ultraschall beim Nachweis und Staging von Non-Hodgkin-Lymphomen des Magens.

Nine patients (five women, four men, mean age 64.2 [49-77] years) with histologically confirmed gastric non-Hodgkin lymphoma (NHL) were investigated before starting therapy and during follow up, using endoscopic ultrasound, computer-assisted tomography and conventional ultrasound. Of ten gastric NHL infiltrations, nine were demonstrable using endoscopic ultrasound, three by computed tomography and two with conventional ultrasound. Accurate assessment of the primary tumour stage was possible in six out of eight cases using endoscopic ultrasound, but in none using tomography or conventional ultrasound. Three of these patients had inflammatory changes in enlarged paragastric lymph nodes and five malignant lymphomatous involvement. The latter was demonstrable by endoscopic ultrasound in all cases, by computed tomography in three cases and by conventional ultrasound in two cases. False positive results were obtained in two cases using endoscopic ultrasound and computed tomography. Regression of the tumour and of paragastric lymph nodes on radio-chemotherapy was demonstrable in two cases, and progression in one using endoscopic ultrasound; the other techniques showed progression of extragastric lymphoma involvement in only one case. Endoscopic ultrasound is an efficient method for demonstration and local staging of gastric non-Hodgkin lymphomas.

[Endoscopic ultrasound in TN staging of stomach cancer. A comparison with computerized tomography and conventional ultrasound]. / Endoskopischer Ultraschall im TN-Staging des Magenkarzinoms. Ein Vergleich mit der Computertomographie und der konventionellen Sonographie.

64 patients with histologically proven gastric carcinoma were investigated by endosonography (EUS), computed tomography (CT) and conventional transcutaneous sonography (US). In 50 patients a resection of the stomach was performed and the histological findings were compared with the results of preoperative staging. In all cases EUS was successful in demonstrating the tumour. With CT tumour visualisation was possible in 17 (35.4%), with US in 7 (14.6%) cases. The pT-stage was correctly determined preoperatively by EUS in 40 (81.6%) with CT and US in only 12 (25%) and 4 (8.3%) patients, respectively. The staging accuracy of EUS amounted to 80% in T1-, 81% in T2-, 100% in T3-, and 67% in T4-stage. The sensitivity in demonstrating lymph node metastases was 81.3% for EUS, 25.8% for CT and 9.7% for US. The specificity in this regard was 72.2% for EUS, 83.3% for CT and 100% for EUS. The overall accuracy for determination of pN-stage was 78% for EUS, 47.9% for CT and 41.7% for US. EUS is clearly superior to CT and US in the locoregional TN-staging of gastric carcinoma.

[Endosonography in tumors of the pancreas and bile ducts]. / Endosonographie bei Tumoren des Pankreas und der Gallenwege.

The sensitivity of EUS in demonstrating pancreatic tumors lies above 90% and tumors smaller than 2 cm in diameter can be visualized. Therefore EUS can be applied e.g. in the early diagnosis of symptomatic endocrine tumors. However, it is not suited as a screening method for pancreatic carcinoma in asymptomatic patients. The EUS findings do not permit a clear differentiation between malignant and inflammatory (pseudo) tumors. The specificity for the demonstration of malignant tumors is 74%. Its main importance is in the locoregional staging of tumors. EUS is superior to all other imaging tools in determining tumor extension and infiltration into the portal or splenic vein. The pT-stage is determined correctly preoperatively in 90% and lymph node metastases (N1) in about 73% (sensitivity 80-90%/specificity 50%) of the cases. Malignant tumors of Vater's papilla (ampullary tumors) and of extrahepatic bile ducts can be demonstrated endosonographically in nearly all cases. However, tumors of the proximal bile ducts, especially of the right hepatic duct are difficult and sometimes impossible to visualize. The value of EUS in bile duct cancer is in local tumor staging. The pT-stage is determined correctly in 80-90%, the sensitivity and specificity for N1-stage is 80-90% and 30% respectively. Comparative studies with other methods are lacking at the present time. The value of EUS in gall bladder tumors is not yet determined. Stones in the gall bladder may hinder the visualization of the gall bladder wall. In one study the pT-stage for gall bladder carcinoma was determined correctly preoperatively in 76.9% and the N1-stage in 80.7% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endosonography in chronic pancreatitis. A comparative study of endoscopic retrograde pancreatography and endoscopic sonography]. / Endosonographie bei chronischer Pankreatitis. Eine vergleichende Studie zwischen endoskopisch-retrograder Pankreatikographie und endoskopischer Sonographie.

EUS and ERP were performed in 114 patients. 94 patients (32 women, 62 men; mean age 53 years; range 29-78 years) had inflammatory pancreatic disease while 20 patients (6 women, 14 men; mean age 54 years; range 28-78 years) without disease of the pancreas served as controls. ERP-findings served as the gold standard and were classified into stages I-III according to the Cambridge classification. On ERP 51 patients had duct changes typical of chronic pancreatitis (CP). Control cases always displayed a homogeneous echo pattern and a regular outer margin of the pancreas. Abnormal EUS findings were present in all patients with ERP-stages II and III and in 88% of patients with ERP-stage I. 63% of patients with a normal pancreatogram, i.e. ERP-stage 0 showed pathological alterations on EUS examination. Diffuse alterations of the echopattern were seen in 75% of CP patients with stage I, in 88% with stage II and in 96% with stage III. Alternating echo-poor/echo-dense areas were present in 50% of stage I, in 88% of stage II, and in 81% of stage III cases, respectively. 38% of stage I, 56% of stage II, and 27% of stage III cases displayed a lobulated appearance of pancreatic parenchyma. In 80% of the patients these findings were combined with an irregularly lined pancreatic surface. This same combination of EUS-findings in proven CP was also present in 30% of patients with completely normal pancreatic ducts, i.e. ERP-stage 0. Changes of the main pancreatic duct in stages II and III were also seen with EUS in 81% and 96%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endosonography of stomach tumors]. / Endosonographie bei Magentumoren.

Based on own experience and on the published literature we report about indications and efficiency of endosonography (EUS) in gastric tumors. The following conclusions can be drawn at the present time. Submucous tumors can be clearly differentiated from extragastric compressions. Although the endosonographic aspect does not allow to formulate an etiologic diagnosis, EUS findings can give hints regarding the nature of the submucous tumor (e.g. leiomyoma, lipoma, cyst). In 75% of cases malignant submucous tumors can be visualized and a correct preoperative staging can be performed. EUS is of special importance in the description of gastric carcinoma. The pT stage can be correctly determined preoperatively in about 80% (69-92%) of cases. Accompanying inflammation in early gastric cancer can lead to overstaging. The sensitivity for local lymph node metastases reaches about 77% (50-88%). Gastric non-Hodgkin lymphomas can be excellently visualized with EUS. The sensitivity amounts to 90-100% and in about 90% of cases the extent of the tumor can be correctly determined preoperatively. The response to radio-chemotherapy of gastric non-Hodgkin lymphomas can be monitored easily with the method. At the present time EUS is the most sensitive imaging tool in visualizing and staging of gastric tumors. Its main advantage is the exact demonstration of intramural and paragastric alterations. However, despite the use of high ultrasonic frequencies and the excellent demonstration of even tiny details with EUS, biopsies for histologic evaluation are still mandatory, especially when dealing with gastric ulcer.

[Endoscopic sonography in esophageal cancer]. / Endoskopische Sonographie beim Osophaguskarzinom.

Esophageal carcinomas are visualized endosonographically as localized thickenings of the gullet wall with disruption of its echo-layers. The pT-stage is correctly assessed by endosonography in 84% (73-92%). In up to 20% overstaging in the early phases may be caused by accompanying inflammation. The sensitivity for diagnosing local lymph node metastases is 80% (69-90%). The method is well suited for monitoring the course during radio-chemotherapy and for detection of a relapse after operation. At the present time endosonography is the most efficient method in the locoregional staging of esophageal carcinomas. Especially in early tumor stages pT1 and pT2 it is clearly superior to computed tomography. In advanced stages (pT4) in up to 40% of cases marked tumor stenosis, that cannot be passed with the ultrasonic probe, prevents endosonographic staging. However, despite its excellent detail resolution the etiology of a circumscribed wall thickening cannot be determined with absolute accuracy by intraluminal sonography. Based on the echo-pattern inflammatory alterations and scar tissue cannot be definitely distinguished from malignant tumors.

[Endoscopic sonography in extrahepatic obstructive jaundice]. / Endoskopische Sonographie bei extrahepatischem Verschlussikterus.

In a prospective study, 37 patients (20 women, 17 men, mean age 75 [41-93] years) with extrahepatic obstructive jaundice were investigated, within 24 hours of admission, by transcutaneous ultrasound (US), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). EUS was always performed after US and immediately before ERCP, and the findings were recorded without any knowledge of the results of ERCP (the 'gold standard'). Dilatation of the common bile duct was demonstrated by all three methods. Concretions in the distal common bile duct causing obstructive jaundice were demonstrated by EUS in 15 out of 16 cases, but in only seven cases by US. All 21 cases with an underlying malignant cause were correctly diagnosed by EUS and ERCP, and the level of the biliary obstruction was accurately determined; using US this was possible in only 15 (70%) and 18 (85%) cases. In comparison with ERCP, which imaged the tumour only indirectly, EUS showed the tumour itself and allowed local and regional staging in all cases. EUS is superior to US for elucidating the cause of biliary outflow obstruction and allows reliable local and regional staging. It is of additional benefit in deciding on appropriate therapy. A disadvantage is the impossibility at present of undertaking surgical therapy during EUS investigations.

[Endoscopic implantation of balloon expandable endoprostheses (Strecker stents) in extrahepatic bile duct stenoses]. / Endoskopische Implantation von ballonexpandierbaren Endoprothesen (Strecker-Stents) bei extrahepatischen Gallengangsstenosen.

22 balloon expandable wire Strecker-stents were implanted endoscopically in 20 patients (eleven women, nine men, mean age 68.3 [44 to 86] years) with malignant (n = 19) and benign (n = 1) bile duct obstruction. In all cases an effective biliary drainage was obtained. To achieve complete drainage repeated balloon dilatation of the inserted stent was often performed. In two cases stent dislocation occurred immediately after implantation. Additional complications were not observed during the first 30 days. During the observation period of maximally 15 months one patient developed an incomplete occlusion of the stent due to tumor compression that could be reversed endoscopically. In a further patient biliary stones caused relapse of cholestatic jaundice. Four patients died from their malignant disease without evidence of stent occlusion. 15 patients continue to live without renewed jaundice. With the mean observation period of 5.5 months (median five months) this corresponds to a patency rate of 95%. The estimated survival rate according to Kaplan-Meier was 87.7% and the estimated mean survival time 11.7 months. These results demonstrate that in patients with extrahepatic bile duct obstruction an effective biliary drainage can be achieved with balloon expandable wire stents. They represent a further progress in the palliative treatment of patients with extrahepatic obstructive jaundice.

[Endosonography in malignant extrahepatic obstructive jaundice]. / Endosonographie bei malignem extrahepatischem Verschlussikterus.

34 patients with obstructive jaundice were investigated consecutively by transcutaneous ultrasonography, endoscopic sonography and endoscopic retrograde cholangio-pancreatography (ERCP). In 20 cases obstruction was due to a tumor, whose location and extent could be visualized by endosonography and ERCP in all cases. By transcutaneous ultrasonography this was possible in only 14 (70%) and 17 (85%) cases respectively. In seven of eight cases the tumor size, in four of five cases metastatic involvement of lymph nodes and in all cases infiltration into neighboring organs or vessels were correctly predicted by endosonography. Both other methods failed in this regard. We therefore conclude that the diagnostic information obtained by endosonography in patients with obstructive jaundice due to malignancy is superior to conventional sonography and ERCP.