The Mighty Weapon in Endoscopy: Endoscopic Ultrasound

I. What is an endoscope ultrasound?

Endoscopic ultrasound is a special endoscope with an ultrasound probe installed at the distal end. Since the advent of endoscopic ultrasound in the 1980s, after more than 20 years of efforts, the technology of ultrasonic gastroscopy has become increasingly mature, especially high-definition longitudinal ultrasound endoscopy, and its application range has continued to expand. With the four unique characteristics of endoscopic ultrasound: "individualization", "real-time dynamic scanning", "multi-dimensionality", and "precise puncture biopsy", it can meticulously examine diseases on the surface of the esophagus, stomach, and intestines. More importantly, it can scan deep-seated and extracavitary organs invisible to the naked eye, such as the liver, pancreas, and biliary tract, at the closest distance, truly realizing accurate diagnosis of difficult-to-diagnose diseases of the entire digestive system.

 II. What are the advantages of endoscopic ultrasound examination?

1. Individualization:

If an endoscopic ultrasound is compared to a camera, simply using a basic "point-and-shoot camera" to capture the characteristics of a disease will lose a lot of details, leading to missed or misdiagnosis. It is precisely because of the heterogeneity in disease diagnosis that clinicians need to set individualized scanning parameters based on individual differences in patients. Therefore, just like using a "single-lens reflex camera", it also relies on the doctor's "skill" and "keen eyes".

2. Real-time scanning:

Compared with traditional imaging methods, the significant advantage of endoscopic ultrasound is that the clinician operates the machine for real-time dynamic scanning. The human body is a living body, and during the examination, slight shaking may cause the lens to flash past, requiring us to be highly sensitive and quickly and accurately find the abnormal area in the image.

Disease diagnosis is like detective work; even with experienced physicians, it is difficult to make a judgment based on a single static image. With the real-time tracking function, endoscopic ultrasound can display the information characteristics of a lesion on the time axis and space axis, truly understanding the overall grasp and understanding of the lesion and making the most accurate judgment.

3. The three eyes of multi-dimensional endoscopic ultrasound

Ultrasonic eye: Endoscopic ultrasound can accurately display the texture characteristics of the scanned area and has a high-definition magnification function, like a microscope. It can magnify the target area without losing image details.

Doctor's eye: "There are no two identical leaves in the world." Relying solely on standardized examinations often leads to omissions. Endoscopic ultrasound uses a variety of scanning techniques by experienced clinicians according to the actual situation and real-time dynamic observation, so that any suspicious lesion has nowhere to hide, truly achieving personalized examination.

Contrast eye: Ultrasound contrast is a function that uses intravenous injection of microbubble contrast agents to achieve microvascular imaging. The contrast agents we commonly use are about 2.5μm in diameter, approximately the same size as red blood cells. Wherever red blood cells can flow, within the detection range of the probe, can be imaged by ultrasound. Therefore, through endoscopic ultrasound contrast, the distribution of microvessels in the target area can be clearly displayed. At present, the clinical value of endoscopic ultrasound contrast still has a lot of room for expansion. Our practical experience shows that by capturing the characteristic information of microvascular distribution and enhancement, the location of origin, boundary judgment, and differentiation of the nature of the lesion can be achieved, and it can also guide ultrasound-guided puncture biopsy, especially for difficult digestive system tumors, which plays an extremely important role.

4. Precise puncture

Under the guidance of endoscopic ultrasound, fine-needle puncture biopsy is a method of inserting a fine needle or creating a channel by opening the surface to remove cancer cells for examination. This technology is a minimally invasive biopsy technique that uses a fine needle as thin as an infusion needle to pass through the digestive tract wall and into the lesions of deep-seated organs. It has the advantages of low risk, convenience, and few complications, and the entire puncture process can be completed in about 20 minutes. Similarly, endoscopic ultrasound can be said to be "360-degree without dead angles and comprehensive." The operating physician can truly achieve targeted and precise puncture according to the characteristics of different areas of the lesion.