style="font-size:15px;"> 36 Chapter 36Figure 36.1 Gold coil fiducial marker is (a) flexible and (b) has a coiled d...Figure 36.2 Gold coil fiducial preloaded on needle‐carrier delivery device....Figure 36.3 Endoscopic ultrasound image (linear array) of fiducial within an...Figure 36.4 Abdominal radiograph (anteroposterior view) demonstrating three ...37 Chapter 37Figure 37.1 Initial assessment of tumor size by endoscopic ultrasound (EUS) ...Figure 37.2 Endoscopic ultrasound (EUS)‐guided fine needle injection (FNI) o...Figure 37.3 Tumor assessment during weekly injections of chemotherapeutic ag...Figure 37.4 Gross specimen of the resected pancreas in Figure 37.3 revealing...Figure 37.5 Histology from the specimen in Figure 37.4 demonstrating a compl...
38 Chapter 38Figure 38.1 Computed tomography (CT) scan of the pelvis revealing an 8 × 7 c...Figure 38.2 Passage of a 19‐gauge fine needle aspiration (FNA) needle into t...Figure 38.3 A 0.035‐inch guidewire is then coiled within the abscess cavity:...Figure 38.4 Fluoroscopy view revealing dilation of the tract using an endosc...Figure 38.5 Fluoroscopic view revealing the presence of a stent within the p...
39 Chapter 39Figure 39.1 VTI endoscopic Doppler system. (a) A 20‐MHz pulsed‐wave Doppler ...Figure 39.2 Endo‐Dop, 16‐MHz pulsed‐wave, multigated Doppler ultrasound (Dop...Figure 39.3 Illustration of a bleeding peptic ulcer with a non‐bleeding visi...Figure 39.4 Doppler ultrasound (DopUS) in acute peptic ulcer bleeding. (a) E...Figure 39.5 Doppler ultrasound‐guided hemostasis in acute peptic ulcer bleed...Figure 39.6 Atypical peptic ulcer bleeding: recurrent major bleeding from a ...Figure 39.7 Doppler‐negative non‐bleeding visible vessel. Endoscopic image o...Figure 39.8 Atypical appearance of a bleeding gastric varix. Mild active ooz...Figure 39.9 Doppler ultrasound examination of a gastrointestinal stromal tum...Figure 39.10 Dieulafoy lesion in gastric cardia. (a) Active bleeding. (b) Do...Figure 39.11 Dieulafoy lesion in rectum, Doppler with strong arterial signal...
40 Chapter 40Figure 40.1 Compact manometer for EUS‐guided portal pressure measurement....Figure 40.2 EUS‐guided portal pressure measurement apparatus showing noncomp...Figure 40.3 EUS image (a) and schematic (b) of needle puncture of the middle...Figure 40.4 EUS Doppler flow image of the middle hepatic vein demonstrating ...Figure 40.5 EUS image (a) and schematic (b) of needle puncture of the left p...Figure 40.6 EUS Doppler flow image of the left portal vein demonstrating typ...
41 Chapter 41Figure 41.1 Visualization of the left hepatic lobe from the proximal stomach...Figure 41.2 View of liver (on the left) and spleen (on the right) from the p...Figure 41.3 Right lobe biopsies are obtained with the echoendoscope tip plac...Figure 41.4 Close‐up of the tips of the core needles used for EUS‐LB: (left)...Figure 41.5 Comparison of a 19G FNB needle to 19G FNA needle in terms of (a...Figure 41.6 Excellent core of cirrhotic liver obtained with the 19G FNB nee...Figure 41.7 Priming the needle with heparin for wet suction technique.Figure 41.8 (a) Use of tissue sieve (CoreCatcher; ProAct Ltd, Center Hall, P...Figure 41.9 Long liver core is placed in formalin jar without excessive hand...
42 Chapter 42Figure 42.1 Endoscopic imaging of gastric varix.Figure 42.2 Gastric varix seen by endoscopic ultrasonography.Figure 42.3 Gastric varix seen with color Doppler.Figure 42.4 Needle inside the varix.Figure 42.5 Obliterated varix right after treatment.Figure 42.6 Radiographic image of the coil inside the varix.
43 Chapter 43Figure 43.1 Patient 1 with refractory bleeding due to gastric cancer. (a) Bl...Figure 43.2 Patient 2 with bleeding pseudoaneurysm located to the pancreatic...
44 Chapter 44Figure 44.1 EUS‐guided RFA with contrast enhancement control for NET located...
45 Chapter 45Figure 45.1 Access points and routes for EUS‐PDD: 1, transgastric rendezvous...Figure 45.2 Transgastric EUS‐guided rendezvous for MPD drainage. (a) Dilated...Figure 45.3 Transgastric EUS‐PDD. (a) Dilated MPD at the level of the pancre...Figure 45.4 The novel wire‐guided fine‐gauge electrocautery dilator, with a ...Figure 45.5 Algorithm for EUS‐PDD. *, depending on the anatomic conditions a...
46 Chapter 46Figure 46.1 Puncture of gallbladder with 19‐gauge needle with linear echoend...Figure 46.2 Contrast injection within the gallbladder.Figure 46.3 Puncturing of gallbladder with forward‐viewing echoendoscope.Figure 46.4 Looping of guidewire within the gallbladder.Figure 46.5 Tract dilatation with 4‐mm biliary balloon (EUS view).Figure 46.6 (a) Distal flange of AXIOS stent deployed under EUS guidance. (b...Figure 46.7 (a) Luminal view of “black mark” with the AXIOS stent. Once the ...Figure 46.8 (a) Luminal view with SPAXUS stent using the deployment‐in‐chann...Figure 46.9 Direct puncture with the Hot AXIOS into the gallbladder.
47 Chapter 47Figure 47.1 Puncture of the targeted bowel under endosonography.Figure 47.2 Deployment of the lumen‐apposing metal stent into the small bowe...Figure 47.3 Balloon dilatation of the lumen‐apposing metal stent.Figure 47.4 Visualization of the bowel through the fully distended lumen‐app...
48 Chapter 48Figure 48.1 Standard EUS elastographic image. A ROI is used to define the ar...Figure 48.2 EUS‐guided elastography of a malignant lymph node. This image em...Figure 48.3 Pancreatic adenocarcinoma displaying a predominantly heterogeneo...Figure 48.4 Mass forming chronic pancreatitis displaying a predominantly het...Figure 48.5 EUS‐guided elastography from normal pancreas showing a predomina...Figure 48.6 EUS‐guided elastography displaying a blue pattern in a metastati...Figure 48.7 EUS‐guided elastography of a typical benign lymph node.Figure 48.8 Elastographic evaluation of a subepithelial lesion showing a het...Figure 48.9 Metastatic lesion on left adrenal gland, from a lung cancer, dis...
49 Chapter 49Figure 49.1 Principle of contrast harmonic imaging.Figure 49.2 Behavior of microbubbles when exposed to ultrasound beams based ...Figure 49.3 Contrast‐enhanced endoscopic ultrasonography (CH‐EUS) procedures...Figure 49.4 Contrast‐enhanced pattern compared to the surrounding tissue: (a...Figure 49.5 Comparison of contrast‐enhanced patterns in the lesion: (a) homo...Figure 49.6 Detecting a lesion via contrast‐enhanced endoscopic ultrasonogra...Figure 49.7 Distinguishing a mural nodule from a mucous clot using contrast‐...Figure 49.8 Typical contrast‐enhanced endoscopic ultrasonography (CH‐EUS) fi...Figure 49.9 Contrast‐enhanced endoscopic ultrasonography (CH‐EUS) for gastro...Figure 49.10 Distinguishing malignant from benign lymph nodes in contrast‐en...
50 Chapter 50Figure 50.1 EUS‐RFA radiofrequency system. a) EUSRA (STARmed, Goyang, South ...Figure 50.2 EUS‐guided radiofrequency ablation of a pancreatic tail symptoma...Figure 50.3 EUS‐guided radiofrequency ablation of a pancreatic tail symptoma...Figure 50.4 EUS‐guided radiofrequency ablation of a pancreatic tail symptoma...
51 Chapter 51Figure 51.1 Moray micro forceps.Figure 51.2 Overview of nCLE technique.
52 Chapter 52Figure 52.1 (a) Dissected specimen: esophagus, stomach, duodenum, pancreas, ...Figure 52.2 Vascular simulation of aorta and use of the color Doppler featur...Figure 52.3 Simulation of hepatic nodules and lymph nodes. (a) Incision in t...Figure 52.4 Simulation of subepithelial lesions. (a) Serous and muscle layer...Figure 52.5 Ex vivo model for EUS‐FNA of cystic lesions. The cysts were crea...Figure 52.6 Ex vivo model for pseudocyst drainage. The pseudocysts were crea...Figure 52.7 Ex vivo model for dilated hepatocholedochus evaluation. The hepa...Figure 52.8 Ex vivo model for EUS biliary drainage. The dilated biliary trac...
53 Chapter 53Figure 53.1 There is a perigastric varix present within the wall of a necrot...Figure 53.2 (a, b) Hyperechoic and isoechoic solid necrosis within necrotic ...Figure 53.3 (a, b) Clots and blood products within a peripancreatic collecti...Figure 53.4 Lumen‐apposing metal stent placed for cystgastrostomy.Figure 53.5 CT scan demonstrates two LAMS stents from the stomach and duoden...Figure 53.6 (a, b) Endoscopic necrosectomy with rat tooth forceps and retrie...Figure 53.7 CT scan shows local pneumoperitoneum around the cystastrostomy s...Figure 53.8 Over‐the‐scope clip placement for closure of cystgasatrostomy si...Figure 53.9 Purulence and infection as a result of occlusion of LAMS cystgas...
54 Chapter 54Figure 54.1 Fine needle aspiration
