Rabinowitz Simon S, Candava Rheu, Kady Blair, Arostegui Dalia, Grossman Evan
Pediatric Gastroenterology Division, Downstate Health Sciences University, 450 Clarkson Ave, Box 49, Brooklyn, NY, 11203, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Downstate Health Sciences University, 450 Clarkson Ave, Box 49, Brooklyn, NY, 11203, USA.
Ultrasound J. 2024 Aug 21;16(1):40. doi: 10.1186/s13089-024-00380-7.
Endoscopic ultrasound (EUS) is a unique example of POCUS, which allows the gastroenterologist to discuss subepithelial pathology immediately after an endoscopy. The challenges that are encountered to create an acoustic interface by adding free water during the endoscopy may be curtailing the full utilization of EUS during endoscopic procedures. Eosinophilic esophagitis (EoE) is a progressive inflammatory condition whose morbidity is related to esophageal wall remodeling. However, in clinical practice, in clinical guidelines, and in many trials, EoE outcomes are based on esophageal eosinophilia and symptoms. Hence, a method to identify and quantitate the thickening of the esophageal wall, could contribute to the management of this disease.
A modification of the approach employed to perform EUS during bronchoscopy was developed. An EUS miniprobe was positioned inside of a water filled balloon sheath. This technique permitted rapid and reproducible images acquisition of the total esophageal wall and its sublayers (mucosa, and submucosa + submucosa, which permitted derivation of the muscle layer). The presented series describes the results from 22 consecutive EoE patients. A full set of measurements from both the mid and distal esophagus were achieved in all EoE patients in an average time of less than 10 minutes.
This pilot study supports further investigations evaluating this economical, convenient, and safe technique to follow EoE patients. In addition, this approach could be potentially employed in all patients who are found to have subepithelial gastrointestinal pathology during routine endoscopic procedures.
内镜超声（EUS）是床旁超声检查（POCUS）的一个独特范例，它使胃肠病学家能够在内镜检查后立即讨论上皮下病变。在内镜检查过程中通过添加游离水来创建声学界面时遇到的挑战，可能会限制EUS在内镜手术中的充分利用。嗜酸性食管炎（EoE）是一种进行性炎症性疾病，其发病率与食管壁重塑有关。然而，在临床实践、临床指南以及许多试验中，EoE的结果是基于食管嗜酸性粒细胞增多和症状。因此，一种识别和量化食管壁增厚的方法可能有助于这种疾病的管理。
开发了一种对在支气管镜检查期间进行EUS所采用方法的改进。将一个EUS微型探头放置在充满水的球囊鞘内。这种技术允许快速且可重复地获取整个食管壁及其各层（黏膜层以及黏膜下层+黏膜下层（可由此推算出肌层））的图像。所展示的系列描述了22例连续EoE患者的结果。所有EoE患者均在平均不到10分钟的时间内完成了食管中段和远端的全套测量。
这项初步研究支持进一步开展调查，评估这种经济、便捷且安全的技术用于随访EoE患者。此外，这种方法可能潜在地应用于所有在常规内镜检查过程中发现有上皮下胃肠道病变的患者。
