| 抄録 |
Since the curved linear array echoendoscope became available in early 1990s, endoscopic ultrasonography (EUS) has transformed rapidly from a mere diagnostic imaging modality to an interventional technology for management of various gastrointestinal and mediastinal pathologies. The development of linear echoendoscopes with larger accessory channels has enabled the introduction of more sophisticated novel devices that facilitate performance of technically demanding interventional procedures such as ablation, implantations of therapeutic agents, retrieval, resection, approximation or suturing of tissue. From the initial interventional EUS applications such as EUS-guided fine needle aspiration of fluid, drainage of pancreatic and bile duct, EUS applications have now expanded to include complex EUS-guided interventional procedures such as local injection of chemotherapy drugs or radiotherapeutic agents to treat pancreatic neuroendocrine tumors, adrenal metastases and gastrointestinal stromal tumour, celiac ganglion block/neurolysis, lymphadenectomy, cholangiography, antireflux therapy, pancreatic cyst ablation with or without antitumor agents, and vascular interventions. Recent development of smaller diameter linear echoenedoscopes has facilitated EUS-guided tissue sampling from finer luminal structures. Much of these recent advancements in EUS applications could be attributed to the improvements in the echoendoscope processor, imaging quality, and accessories. With the newer 360º electronic radial scanning ultrasound endoscope armed with tissue harmonic echo, image could now be noise-free with improved spatial and contrast resolution. Recent EUS technology advancements have significantly improved imaging and facilitated comprehensive evaluation of the upper gastrointestinal tract, mediastinum, pancreas, gallbladder, biliary as well as adjacent hepatic areas. Currently being explored is the application of EUS technologies to mitigate risks of injuries associated with transluminal surgery in natural-orifice transluminal endoscopic surgery (NOTES). Limited research conducted recently has shown that EUS-guided NOTES could help surgeons in the proper identification of structures not easily visualize under the standard endoscopic view. With further development, it is anticipated that EUS-guided transluminal access to a surgical target could be made a viable and safer approach for transluminal surgery. |
