Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania, Craiova, Dolj 200349, Romania.
World J Gastroenterol. 2011 Feb 14;17(6):691-6. doi: 10.3748/wjg.v17.i6.691.
Endoscopic ultrasound (EUS) has recently evolved through technological improvement of equipment, with a major clinical impact in digestive and mediastinal diseases. State-of-the-art EUS equipment now includes real-time sono-elastography, which might be useful for a better characterization of lesions and increased accuracy of differential diagnosis (for e.g. lymph nodes or focal pancreatic lesions). Contrast-enhanced EUS imaging is also available, and is already being used for the differential diagnosis of focal pancreatic masses. The recent development of low mechanical index contrast harmonic EUS imaging offers hope for improved diagnosis, staging and monitoring of anti-angiogenic treatment. Tridimensional EUS (3D-EUS) techniques can be applied to enhance the spatial understanding of EUS anatomy, especially for improved staging of tumors, obtained through a better assessment of the relationship with major surrounding vessels. Despite the progress gained through all these imaging techniques, they cannot replace cytological or histological diagnosis. However, real-time optical histological diagnosis can be achieved through the use of single-fiber confocal laser endomicroscopy techniques placed under real-time EUS-guidance through a 22G needle. Last, but not least, EUS-assisted natural orifice transluminal endoscopic surgery (NOTES) procedures offer a whole new area of imaging applications, used either for combination of NOTES peritoneoscopy and intraperitoneal EUS, but also for access of retroperitoneal organs through posterior EUS guidance.
内镜超声（EUS）最近通过设备技术的改进得到了发展，对消化系统和纵隔疾病的临床诊断具有重要影响。目前最先进的 EUS 设备现在包括实时声弹性成像，这可能有助于更好地对病变进行特征描述，提高鉴别诊断的准确性（例如，对淋巴结或局灶性胰腺病变）。对比增强的 EUS 成像也已投入使用，用于局灶性胰腺肿块的鉴别诊断。最近开发的低机械指数对比谐波 EUS 成像有望改善诊断、分期和对抗血管生成治疗的监测。三维 EUS（3D-EUS）技术可用于增强 EUS 解剖结构的空间理解，特别是通过更好地评估与主要周围血管的关系，提高肿瘤的分期。尽管所有这些成像技术都取得了进展，但它们不能替代细胞学或组织学诊断。然而，通过使用实时 EUS 引导下的 22G 针放置的单纤维共聚焦激光内窥显微镜技术，可以实现实时光学组织学诊断。最后但同样重要的是，EUS 辅助的自然腔道内镜外科（NOTES）手术为成像应用提供了一个全新的领域，用于NOTES 经皮腹腔镜检查和腹腔内 EUS 的联合，也用于通过后 EUS 引导进入腹膜后器官。
