RESUMO
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common technique for assessing the pancreas and the biliary system; however, the potential complications have raised concern among endoscopists and patients. Recently, the need of endoscopic ultrasound (EUS) as an additional tool of assessment before the ERCP procedure has been increasing. The need of EUS in developing countries is still a matter of debate regarding the cost, investment, and training. Here, we report the significant impact of EUS on several unselected interesting cases of pancreatobiliary disorders. METHOD: We selected several interesting cases from the patients who underwent EUS at our private hospital in Jakarta, Indonesia. The EUS procedures were performed by one experienced endosonographer and one EUS trainee who are very experienced with transabdominal ultrasound. The equipment was an Olympus JF UCT 180 EUS scope which was connected to an Aloka IPF-1701C ultrasound machine (Tokyo, Japan). RESULTS: Five interesting cases were included from patients who underwent EUS due to pancreatobiliary disorders. The cases included recurrent pancreatitis due to pancreatic stone at the small branch that obstructed the main pancreatic duct, common bile duct (CBD) stone with insignificant duct dilatation, pancreatic head cancer with total obstruction at the distal CBD and portal vein infiltration, pancreas divisum in a young girl, and distal CBD mass that caused obstructive jaundice. CONCLUSIONS: The EUS procedure has shown a significant impact in managing patients with pancreatobiliary diseases. In most developing countries, EUS needs to be evaluated further regarding the cost, investment, and training.
RESUMO
La ecoendoscopía o ultrasonografía endoscópica (USE) permite una buena visualización de la vesícula, vía biliar, del parénquima pancreático y de las estructuras vasculares vecinas a estos órganos. 1,2 Tiene una alta resolución debido a la cercanía del transductor y a las elevadas frecuencias. Junto con otras técnicas de imagen que se están desarrollando, como la tomografía computarizada (TC) helicoidal y la colangiopancreatografía por resonancia magnética (CPRM) son técnicas seguras y que ofrecen resultados prometedores en el estudio de los tumores, permitiendo la estadificación locoregional de éstos, llegar al diagnóstico de cálculos pequeños de la vía biliar principal que no son visualizados por US abdominal y lograr una visualización más fiel de la glándula pancreática y de las estructuras vasculares vecinas. 3,4, 5.
Endoscopic ultrasound is a minimally invasive imaging modality that provides high - resolution images of the extrahepatic biliary tree and the surrounding structures. It has been shown to be accurate for the detection and staging of bile duct and gallbladder cancer, and is especially useful for small tumors. Intraductal techniques, which are still in evolution, may provide even more information about the etiology and extent of biliary structures and mural tumors. EUS has also been shown to be useful for the detection of biliary stones and sludge when transabdominal ultrasound is not diagnostic. In many cases, diagnostic EUS is needed. 1, 2, 3 Endosonography produces detailed images of the pancreas and surrounding blood vessels and provides both accurate detection and staging of malignant lesions and the means for making a tissue diagnosis.The instruments and techniques for endosonography continue improving, and at present EUS can be considered a promising minimally invasive tool for evaluating the pancreatobiliary disorders. 4, 5.
