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Results for “Endosonography”

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At least 19 recordsLinked to original sources

PubMed1995

Rectal compliance determined by rectal endosonography. A new application of endosonography.

PURPOSE: The aim of this study was to develop a method for determination of rectal compliance that allows direct measurement of corresponding changes in the rectal cross-sectional area or perimeter and rectal pressure. METHODS: We developed an anal probe for transrectal endosonography. The probe was tested in vitro, and rectal compliance of six healthy patients was determined. RESULTS: In vitro measurements proved the method to be well reproducible. The method allowed calculation of an endosonographic rectal compliance, which correlated well with rectal compliance measured by the standard method. CONCLUSION: Endosonographic determination of rectal compliance is possible, and the endosonographic method may give a more precise and reproducible estimation of rectal compliance.

Adult↗

PubMed1993

[Endosonography in diagnosis and staging of malignant tumors of the stomach. A prospective comparative study between endosonography, computerized tomography and conventional ultrasonography].

78 patients with histologically proven malignant tumors of the stomach (64 carcinomas, 10 non-Hodgkin lymphomas [NHL], 4 sarcomas) were investigated by endosonography (EUS), computed tomography (CT) and conventional ultrasound (US) during TN-staging (TNM-classification/UICC-1987 for carcinomas and NHL, TNMG-classification for sarcomas). In 60 patients (50 carcinomas, 6 NHL, 4 sarcomas) an operative resection was performed and the histological findings were compared with the results of preoperative staging. Demonstration of tumor was successful with EUS in 77 (99%), with CT in 33 (42%) and with US in 18 (23%) cases. The T-stage was correctly determined preoperatively by EUS in 50 (81%), by CT and US only in 15 (24%) and in 7 (11%) patients respectively. The accuracy of EUS in determining the T-stage of carcinomas and NHL amounted to 79% in T1-, 92% in T2-, 92% in T3- and 67% in T4-stage. In gastric sarcomas infiltrative destruction of the gastric wall could be demonstrated with EUS in all patients and with CT in 3 of 4 cases. With EUS and CT two smaller tumors were correctly delineated as submucous tumors while with US this was not possible in any case. In demonstrating local lymph node metastasis EUS achieved a sensitivity of 85%, CT of 29% and US of 13%. The specificity of EUS was 72%, of CT 79% and of US 100%. The overall accuracy for the pN-stage was 79.7% for EUS, 51.6% for CT and 42.2% for US. EUS proves to be an efficient method in the local TN-staging of gastric carcinomas an NHL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system.

Transesophageal endosonography and computed tomography were performed preoperatively in 74 patients with an esophageal carcinoma. The results were correlated with the histology of resected specimens according to the new (1987) TNM classification. Endosonography was superior to computed tomography in the evaluation of the depth of tumor infiltration, especially in the early stages and in nonresectable carcinoma (overall accuracy: endosonography 89%, computed tomography 59%). Endosonography was also more accurate than computed tomography in the assessment of regional lymph node metastases (overall accuracy: endosonography 80%, computed tomography 51%). The incidence of lymph node metastasis increased with the progression of the depth of tumor infiltration. The definitive exclusion factor for endosonography is severe stenosis, which cannot be passed with the instrument (26% of the cases). In these cases computed tomography was superior to endosonography in diagnosing celiac lymph node metastasis (overall accuracy: computed tomography 82%, endosonography 68%).

Adult↗

PubMed1994

Anal endosonography for identifying external sphincter defects confirmed histologically.

Defects of the external anal sphincter have traditionally been diagnosed by palpation, anal manometry and electromyography (EMG), but anal endosonography enables clear imaging of both the internal and external sphincter muscles. A study was performed to validate the interpretation of ultrasonographic images of external sphincter defects using histology as a 'gold standard'. In addition the accuracy of clinical examination, manometry, EMG mapping and anal endosonography in the diagnosis of sphincter defects were compared prospectively. Twelve consecutive patients with faecal incontinence (11 women, one man; mean age 46 (range 30-64) years) who required sphincter repair underwent clinical assessment, anal manometry, concentric-needle EMG mapping and anal endosonography before surgery. The endosonographer was unaware of the history or results of physiological tests and the surgeon performing the repair was blind to the ultrasonographic findings. At operation most or all of the suspected defect was excised and examined histologically. The pathologist was unaware of the endosonographic or operative findings at the time of reporting. Combined operative and histological examination identified an external sphincter defect in nine of the 12 patients. Anal endosonography correctly identified all nine defects and the three normal sphincters. The accuracy of clinical examination was 50 per cent and that of both EMG and anal manometry 75 per cent. In addition, anal endosonography identified a defect of the internal anal sphincter in eight patients. External sphincter defects identified by endosonography have not been previously verified histologically. Precise sphincter assessment is mandatory for the correct management of faecal incontinence. Anal endosonography is more accurate than clinical and conventional physiological methods and also provides information on the internal sphincter.

Adult↗

PubMed1993

Influence of tumor stenosis on the accuracy of endosonography in preoperative T staging of esophageal cancer.

The T stage is an important criterion for determining prognosis in esophageal carcinoma. Endosonography, although established as a highly accurate method in preoperative determination of the T stage, may be less reliable in non-traversable tumor stenoses. In a comparative prospective study, 41 patients with carcinoma of the esophagus were investigated to determine the role of tumor stenosis on the accuracy of endosonography in preoperative T staging. The results were correlated with the histology of the resected specimen. The overall accuracy in T staging with endosonography was 76%, compared with 49% in computed tomography. T staging results of endosonography were good in easily and non-traversable stenoses (92%, 87% respectively), but lower accuracy was obtained in stenoses which could be traversed only with difficulty (46%). Computed tomography was inferior to endosonography in all three groups of patients. The high accuracy of endosonography in non-traversable stenoses might be due to the fact that all tumors were in an advanced stage (T3 or T4). When passage of the echoendoscope proves difficult, the low focal distance between the ultrasonic transducer and tumor may hamper clear visualisation of the wall layers and tumor penetration depth. These limitations of endosonography should stimulate further efforts in improving ultrasonic resolution in these cases.

Adenocarcinoma↗

PubMedDate not supplied

Staging of rectal cancer: a prospective study of digital examination and endosonography before and after preoperative radiotherapy.

Between January 1988 and January 1992, 34 patients with rectal cancer were evaluated both by clinical examination and endosonography before and after pre-operative radiotherapy. Two criteria were correlated with histologic findings: confinement to the rectal wall or spread beyond, the presence of mesorectal lymph node involvement. The 32 patients who underwent endosonography before radiotherapy were staged as: uT2: 4, uT3: 26, uT4: 2 cases. Fifteen days after irradiation, endosonography showed tumour regression in all cases; uT stage was different in 15 patients, uN stage in 4 cases. Comparison of the pre-operative local invasion beyond the rectal wall with postoperative histopathy revealed a correlation with: digital examination after radiotherapy in 20 of the 31 patients with palpable tumours; endosonography before irradiation in 18 of the 32 staged tumours; endosonography after irradiation in 25 of the 32 staged tumours. The presence of mesorectal lymph node involvement determined by histologic examination was correlated with the results of endosonography after radiotherapy for 22 of the 32 staged tumours. Endosonography provides a good assessment of the tumour stage before irradiation. Since radiotherapy alters endosonographic staging of rectal cancer, this staging should be included in survival studies.

Adenocarcinoma↗

PubMed1994

Vaginal endosonography. New approach to image the undisturbed anal sphincter.

PURPOSE: Although anal endosonography provides clear images of anal sphincters, the probe in the anal canal may distort epithelial structures and sphincter muscles may be compressed, producing inaccurate muscle thickness measurements. The aim of this study is to describe a new approach using vaginal endosonography to image the anal canal undistorted. METHODS: Twenty females (10 healthy volunteers and 10 with fecal incontinence) had both anal and vaginal endosonography performed. RESULTS: The undisturbed anorectum, submucosa, anal cushions, and anal sphincter muscles were clearly visualized by vaginal endosonography, and anatomy was described. Although anal and vaginal endosonographic measurements of internal sphincter muscle thickness correlated (r = 0.83; P = 0.01), anal endosonography consistently underestimated the thickness (2.3 +/- 0.5 vs. 3.2 +/- 1.2 mm; mean +/- standard deviation). Anterior internal and external anal sphincter defects were identified accurately with both techniques. CONCLUSIONS: Vaginal endosonography is a new technique that enables accurate imaging of anal sphincters and epithelial structures at rest. In addition to making the diagnosis of anal sphincter defects, it has potential applications in the imaging of anovaginal sepsis and malignancy and possibly in understanding the pathogenesis of anal fissure and hemorrhoids.

Adult↗

PubMed1993

[Rectal endosonography for perirectal and non-tumor rectal changes].

The value of rectal endosonography was retrospectively evaluated in 39 patients with various rectal and perirectal diseases. Endosonography proved to be very helpful in demonstrating or excluding abscesses. In patients with aspecific minor inflammatory rectal diseases, endosonography was not very helpful. Endosonography is complementary to other imaging techniques like CT and MRI in establishing perirectal tumors. Endosonography shows the relationship of the rectal wall with an extrarectal tumor and is capable of demonstrating the extent of smaller tumors. It may contribute to the diagnosis of endometriosis in the rectovaginal space. In patients with anal pain endosonography can play an important role in demonstrating or excluding fistulas, abscesses and other diseases.

Abscess↗

PubMed1991

Preoperative detection of intrathoracic tumor spread of esophageal cancer: endosonography versus computed tomography.

The results of endosonography and computed tomography, using an optimized CT technique, have been compared in the preoperative detection of intrathoracic tumor spread of esophageal cancer. In 22/40 patients with esophageal tumors complete passage of the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stage of esophageal tumor (T1-2). Out of 9 tumors confined to the esophageal wall, 8 were classified correctly by endosonography and only 5 by computed tomography. The results in advanced T3 and T4 tumors (13 patients) were comparable following endosonography and computed tomography. Endosonography is an important means of selecting patients with early-stage cancers in whom a curative resection is still a possibility.

Carcinoma↗

PubMed1992

Anal endosonography: relationship with anal manometry and neurophysiologic tests.

Thirty-seven patients were referred for evaluation of anal function; their clinical diagnoses were traumatic fecal incontinence (13), idiopathic (pudendal neuropathy) fecal incontinence (7), fecal soiling (9), and other (8). In all patients, anal endosonography (sphincter defects and internal sphincter thickness [IST]) and anal manometry (maximal basal pressure [MBP] and maximal squeeze pressure [MSP]) were performed. In 18 patients, neurophysiologic tests (EMG-maximal contraction pattern [MCP], single-fiber EMG [fiber density; FD], and pudendal nerve terminal motor latency [PNTML]) were also performed. Endosonography demonstrated in seven patients both an internal and external sphincter defect (Group 1), in seven patients an internal sphincter defect and in one patient an external sphincter defect (Group 2), and in 22 patients no sphincter defect (Group 3). There was a significant difference among these three groups for MBP and MCP, the lowest being in Group 1. Between the patients with traumatic fecal incontinence and idiopathic fecal incontinence, no differences in IST, MBP, MSP, MCP, FD, and PNTML were found. In two patients with a suspected obstetric trauma, there was an unexpected additional severe pudendal neuropathy. In one patient with a suspected obstetric trauma, no damage of the anal sphincters could be demonstrated. In one patient with suspected idiopathic fecal incontinence, there was an additional, unsuspected defect of the internal sphincter. There was concordance between endosonography and EMG in the mapping of the external sphincter. Clinical diagnoses can be misleading in differentiating between traumatic and idiopathic fecal incontinence; anal endosonography provides unsuspected and additional information about the sphincters; PNTML can reveal unsuspected neuropathy in traumatic fecal incontinence. Therefore, the combination of endosonography and PNTML is promising in selecting patients for surgery.

Adolescent↗

PubMedDate not supplied

Endosonography in the evaluation of patients with Barrett's esophagus and high-grade dysplasia.

Endosonography, which provides high-resolution images of the esophageal wall, could potentially detect carcinoma not visible endoscopically in patients with Barrett's esophagus and high-grade dysplasia. We studied the ability of endosonography to detect early esophageal carcinoma in 9 patients with Barrett's esophagus and high-grade dysplasia who were candidates for esophagectomy. Pre-operative endoscopy and biopsy revealed high-grade dysplasia without evidence of carcinoma in all patients. Pre-operative endosonographic evaluations were compared to the pathologic diagnoses of resected specimens. Post-operatively, 3 of the 9 patients were found to have intra-mucosal carcinoma. Endosonography identified a tumor in only 1 of these 3 patients and over-staged it as invasive carcinoma (T2, N1). In 2 of the 6 patients without intra-mucosal carcinoma, endosonography predicted invasive carcinoma (T2, N0). Endoscopy revealed mucosal nodularity in each of the 3 over-staged patients. We conclude that recommendation of the routine use of endosonography to determine the need for surgery in patients with Barrett's esophagus and high-grade dysplasia would be premature, because the current generation of echo-endoscopes does not reliably differentiate between benign and malignant wall thickening.

Adenocarcinoma↗

PubMed1991

Evaluation of endosonography in sclerotherapy of esophageal varices.

During intravariceal sclerotherapy of esophageal varices with polidocanol in 32 patients with portal hypertension due to liver cirrhosis of various etiologies, endosonographic assessment of both esophageal and gastric intramural vessels was carried out in order to evaluate the usefulness of endosonography in the follow-up of the variceal status. In all cases endosonography demonstrated esophageal and gastric varices; in contrast, only five cases of gastric varices could be demonstrated by endoscopy. Furthermore, different stages of variceal obliteration following sclerotherapy could be demonstrated by means of endosonography, and it was possible to identify incomplete obliteration in about one-third of the patients in whom inadequate sclerotherapy was suspected endoscopically. In addition, the status of gastric varices during sclerotherapy was demonstrated by means of endosonography. Only in cases of adequate sclerotherapy of esophageal varices, as assessed by both endoscopic and endosonographic criteria, were gastric varices plugged. On the basis of these findings endosonography would appear to be a useful technique for the diagnosis and follow-up of esophageal and gastric varices during intravariceal sclerotherapy.

Esophageal and Gastric Varices↗

PubMed1991

Biologic aggressiveness of palpable and nonpalpable prostate cancer: assessment with endosonography.

The biologic aggressiveness of palpable versus nonpalpable prostate cancer was evaluated in 666 patients studied with endosonography over a 24-month period. Biologic aggressiveness was defined by a combined histologic and grade-stage category score. In 314 patients suspected of having prostate cancer 328 biopsies were performed. Carcinoma was detected in 99 patients, by means of both palpation and endosonography (n = 80), endosonography alone (n = 9), and palpation alone (n = 8); two cancers were not detected with either palpation or endosonography. All patients with normal results of digital examination had a combined grade-stage category score lower than 9. Fifty-five of 69 patients (80%) with abnormal results of digital examination and available histologic data had a histologic score of 6 or higher; 38 of these patients (69%) had a combined grade-stage category score of 9 or higher. Although the number of patients is small, these data suggest that nonpalpable cancers are biologically less aggressive than palpable ones and that the advantage of endosonography over palpation in detection of clinically significant cancers is limited.

Adenocarcinoma↗

PubMed1993

Anorectal endosonography in benign anorectal disorders.

Anal endosonography is an excellent method of visualising the anal sphincters and the pelvic floor. In particular, defects in the internal and external anal sphincters can be demonstrated. Thickness of the sphincters can also be measured. Fistulas and abscesses can be visualised. The clinical indications for performing anal endosonography are: (i) Faecal incontinence and soiling, to detect a possible sphincter defect. In combination with anorectal function tests (like anal manometry, rectal compliance, EMG and pudendal nerve latency measurements), the cause of faecal incontinence or soiling can be determined. (ii) Fistulae and abscesses, to detect the extension of the lesion in relation to the anal sphincters and deeper structures. (iii) Constipation, to exclude a hypertrophic sphincter. (iv) Pre- and postoperative in ileo-rectal and ileo-anal anastomosis, to demonstrate or exclude anal sphincter defects. (v) Pre- and postoperatively in all patients who undergo anorectal surgery to be informed about possible anal sphincter abnormalities. Anorectal function tests should also be performed when anal endosonography is done in evaluating possible faecal incontinence. For scientific interest all anorectal disorders like haemorrhoids, fissures and inflammatory bowel disease offer challenges to anal endosonography. In conclusion, anal endosonography is an easy to perform test of great importance in patients with anorectal pathology, especially in patients with faecal incontinence or soiling and patients who need anorectal surgery to be informed about possible sphincter defects.

Anus Diseases↗

PubMed1991

[Endosonography versus computerized tomography in preoperative staging of esophageal cancers].

The results of endosonography and computed tomography--using an optimized technique of CT--in preoperative staging of esophageal cancer are compared. In 22 of 40 patients with esophageal tumors a complete passage by the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stages of esophageal tumors (T1/T2). Out of nine tumors confined to the esophageal wall, eight were classified correctly by endosonography, only five by computed tomography. The results in T3- and T4-carcinomas (13 patients) were comparable for endosonography and computed tomography. Endosonography is of importance in the selection of patients with early stages of cancer, in whom a curative resectability is still possible.

Esophageal Neoplasms↗

PubMed1990

Preoperative TNM classification of esophageal carcinoma by endosonography.

Endosonography was performed preoperatively in 111 patients with an esophageal carcinoma. The results were correlated with the histology of resected specimens employing the new (1987) TNM classification. Endosonography was accurate in assessing the depth of tumor infiltration (overall accuracy: 89%). Early carcinomas could be distinguished from advanced cancer. Extensive stenosis preventing the passage of the instrument was a limiting factor prior to the availability of a small-caliber catheter echoprobe (25% of cases). Endosonography was helpful for diagnosing lymph node metastasis, but was less accurate in defining non-metastatic enlarged lymph nodes (accuracy: 81%, sensitivity 95% and specificity 50%). The incidence of lymph node metastasis increased with the progression of tumor infiltration. Endosonography was also less accurate for diagnosing liver metastases and peritoneal dissemination because of the low depth of penetration of ultrasound. Technical improvements such as a reduction in the diameter of the instrument will further enhance the accuracy of endosonography. Moreover, ES-guided cytology may become helpful for confirming the ES diagnosis of lymph node metastasis.

Adult↗

PubMed1996

[Anal endosonography: the study technic and the correlations between the normal and echographic anatomy].

The authors report on 16 healthy volunteers examined with anal endosonography. The US examinations were performed with a dedicated Bruel and Kjaer 1846 unit equipped with a 7-MHz probe (type 1850) with 360 degrees circular mechanic movement. A rigid plastic cone filled of degassed water is mounted on the probe to ensure the symmetrical representation of the anal canal. A condom with gel on both the internal and the external surfaces is put on the cone. The peculiar anatomy of the single layers which form the anal canal determines their different US patterns. Endosonography was performed on three levels, i.e., deep, intermediate and superficial planes. In the deep plane (at the anorectal junction) anal endosonography demonstrates: epithelial-subepithelial complex (intermediate echogenicity); internal sphincter muscle (low echogenicity), made of smooth muscular fibers; longitudinal muscle (intermediate echogenicity), made of smooth and striated muscular fibers; puborectal muscle (high echogenicity), made of striated muscular fibers, and perineal body, which has a longitudinal shape in men and a transverse shape in women. In the intermediate plane anal endosonography demonstrates: epithelial-subepithelial complex, internal sphincter muscle, longitudinal muscle, and external sphincter muscle (high echogenicity), made of striated muscular fibers. In the superficial plane (distal anal canal extremity), anal endosonography demonstrates: epithelial-subepithelial complex and external sphincter muscle. Internal sphincter muscle thickness was measured and the results follow: while the average thickness was 2.1 mm, we had 1.8 mm in 12 patients under 44 and 2.6 mm in 4 patients over 44 years old. This finding is in agreement with literature data. External sphincter muscle thickness did not vary significantly in the two groups.

Adolescent↗

PubMed1992

Anal sphincter imaging in fecal incontinence using endosonography.

Clinical anal examination, manometry (resting and squeeze pressures), and single-fiber electromyography were compared with endosonography of the anal sphincters in 14 patients with fecal incontinence. Technical aspects of the procedure and normal imaging of the puborectal muscle and both sphincters were defined. Defects in both sphincters were seen in nine patients. The defect is visualized as a clear discontinuity in the muscular ring. Compared with the conventional studies, anal endosonography gave significant information in six patients (four male patients after perianal surgery and two women), showing sphincter defects in five patients and integrity of the sphincters in another one. This information obtained by endosonography was important in understanding the type and extension of the lesion and deciding upon the surgical repair. Anal endosonography is an imaging technique of the sphincters that can assess their integrity in fecal incontinence.

Adult↗