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13 & 14 December 2010 , Fourth Annual Course Hotel Okura Amsterdam, the Netherlands

13 & 14 December 2010 , Fourth Annual Course Hotel Okura Amsterdam, the Netherlands. Baltahasar Geeraerts Symposium 2010. What is the role of EUS in cholelithiasis?. Paul Fockens, MD PhD Professor of Gastrointestinal Endoscopy, Academic Medical Center, University of Amsterdam.

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13 & 14 December 2010 , Fourth Annual Course Hotel Okura Amsterdam, the Netherlands

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  1. 13 & 14 December 2010, Fourth Annual Course Hotel Okura Amsterdam, the Netherlands

  2. Baltahasar Geeraerts Symposium 2010 What is the role of EUS in cholelithiasis? Paul Fockens, MD PhD Professor of Gastrointestinal Endoscopy, Academic Medical Center, University of Amsterdam

  3. EUS in cholelithiasis • History • Instruments • EUS for cholecystolithiasis • EUS for choledocholithiasis • Conclusions and future of EUS in gallstones

  4. History of EUS in clinical practice • Started as a technique to image organs outside GI-tract (US, start of ERCP, no CT, no MR) • Staging of luminal tumors quickly followed (esophagus, stomach, colorectum) • Next major breakthrough: EUS-guided FNA • 2009: non-invasive staging by excellent CT & MR • 2010+: EUS for early diagnosis and guided Rx

  5. EUS in cholelithiasis • History • Instruments • EUS for cholecystolithiasis • EUS for choledocholithiasis • Conclusions and future of EUS in gallstones

  6. Instruments & Accesories High-end US processors (Aloka, Hitachi. ...) • Elastography • Tissue Harmonic Imaging • Contrast Enhanced EUS • .......

  7. Instruments & Accesories • 360° Radial array vs. Linear array

  8. EUS in choledocholithiasis

  9. EUS in cholelithiasis • History • Instruments • EUS for cholecystolithiasis • EUS for choledocholithiasis • Conclusions and future of EUS in gallstones

  10. EUS in cholecystolithiasis • Transabdominal US is standard for galbladder stones • EUS may be useful in case of: • Multiple very small stones (sludge) • Poor imaging because of obesity • Indication for EUS in cholecystolithiasis • Strong suspicion of gallbladder stones with negative non-invasive imaging

  11. EUS in cholecystolithiasis • 35 pts with biliary type pain and negative US • EUS showed suspicion of stones in 18pts (52%) • 15/17 proven during surgery • 13/15 symptomfree at one year FU

  12. EUS in cholecystolithiasis

  13. EUS in cholelithiasis • History • Instruments • EUS for cholecystolithiasis • EUS for choledocholithiasis • Conclusions and future of EUS in gallstones

  14. EUS in choledocholithiasis • Imaging of CBD is not so difficult anymore with excellent new equipment • Experience is important (50-100/year) • EUS only in low-probablility for CBD-stones? • Should every ERCP for stones be preceded by EUS? • How about acute pancreatitis?

  15. EUS in choledocholithiasis

  16. EUS in choledocholithiasis

  17. EUS in choledocholithiasis • ERCP vs. EUS +/- ERCP • 65ptswith elevated LFT’s or dilated CBD (8 or 10mm) • ERCP: 7/32 pts (22%) with CBD-stones • EUS +/- ERCP: 9/33pts (27%) CBD-stones • 1pt in each group recurrent symtoms

  18. EUS in choledocholithiasis • 4 trials selected (423pts) • In EUS group, ERCP was avoided in 74% • EUS significantly reduced risk of ERCP associated complications

  19. EUS in choledocholithiasis risk of acute pancreatitis

  20. EUS in cholelithiasis • History • Instruments • EUS for cholecystolithiasis • EUS for choledocholithiasis • Conclusions and future of EUS in gallstones

  21. Conclusions & future use • EUS is most sensitive technique for CBD-stones, more sensitive than MRCP • EUS is invasive and requires expertise • Restriction of ERCP to (very) experienced seems imminent (raise req/yr from 40100) • Combine EUS with ERCP in: • Unexplained obstrcutive jaundice • All pts referred for treatment of CBD-stones

  22. 13 & 14 December 2010, Fourth Annual Course Hotel Okura Amsterdam, the Netherlands

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