What should be known prior to performing EUS exams? (Part II)

Abstract

In “What should be known prior to performing EUS exams, Part I,” the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations. Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available. (1) Does equipment design influence the complication rate? (2) Should we have a standardized screen orientation? (3) Radial EUS versus longitudinal (linear) EUS. (4) Should we search for incidental findings using EUS?

Left or Right Screen Orientation in Endoscopic Ultrasonography?

“…The same problem could be translated during the live congresses or live-streaming procedure; not all of the people attending the live session have the same EUS screen orientation as the operator. This issue was recently addressed by a group of researchers in EUS, concluding that screen orientation probably does not directly affect the performance of EUS [5]. In our opinion, this consideration could be correct in case of experienced endosonographers, and not during the learning curve of endoscopists approaching this technique.…”

Do we need contrast agents for EUS?

“…Routine use of CE-EUS should be encouraged as it offers complementary information over grayscale and elastographic imaging results. [ 81 82 ] The procedure is safe and carries a negligible risk of adverse events to patients. As UCAs are not excreted through the kidneys, they can be safely administered to patients with renal insufficiency.…”

Controversies in EUS: Do we need miniprobes?

“…[ 1 ] In part II, technical controversies on how EUS should be performed were discussed. [ 2 ] In part III and IV, practical issues concerning elastography and contrast-enhanced EUS were raised and discussed from different points of view. [ 3 4 ] An additional paper was dealing with ultrasound-guided thermal ablation treatment for pancreatic cancer.…”