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ENDOSONOGRAFIA
EUS
Dr. Altin CEKODHIMA Dr. Emrah ALPER
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CFARE ESHTE ENDOSONOGRAFIA?
Jane sonda ultrasonografike ne forme lineare dhe radiale te bashkengjitura ne endoskop me pamje anesore ose ballore. ( ekoendoskop )
Ekoendoskopet lidhen me aparaturat standarte te US(ekos) dhe japin imazhe ultrasonografike
Ne aparaturat Endosonografike perdoren software te doplerit qe perdoren ne USG per te matur rrymen, elasticitetin, harmonine e indeve, dhe imazhe me lende kontrastuese te eneve te gjakut.
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LLOJET E ENDOSONOGRAFISE Endosonografia radiale ; perdoret per qellimet diagnostike jep pamje ballore endoskopike eshte me e lehte ne perdorim jep pamje imazherike te ngjashme me tomografine e
kompjuterizuar 360°
Endosonografia lineare ; perdoret per qellime terapeutike dhe intervencioniste jep pamje laterate endoskopike eshte me e veshtire ne perdorim dhe kerkon
sedacion jep pamje te ngjashme me ultrasonografine 130°
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EUS DİAGNOSTİKE(PREJ VITIT 1980 DERI NE DITET E SOTME);
Me pamjet imazherike, marrjen e biopsise ne lezionet e vrejtura dhe stadifikimin e tumoreve ka nje perdorim te gjere si me poshte:
Vleresimin e paretit dhe te lumenit te traktit gastrointenstinal
Organet qe kufizohen me lumenin gastrointenstinal (mediastini, hapesira perirektale, tiroidet, hapesira celiake etj)
Parenkima e pankreasit dhe strukturat qe kufizojne parenkimen
Vijat biliare extrahepatike
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EUS TERAPEUTIKE(PREJ VITIT 2000 NE DITET E SOTME);
Bllokun dhe neurolizen e plexusit celiak
Cistogastrostomine
perdorim ne faze eksperimentale
Drenazhet gastrobiliare dhe koledokoduodenal
Markimet tumorale
Brakioterapine intratumorale
Terapine me antikorpe intratumorale
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PERPARESITE E EUS;Nuk ka pengese per shkak te obezitetit dhe gazrave
Struktura anatomike qe ekzaminohet eshte shume afer sondes. ( mund te ekzaminohen dhe lezione shume te vegjel)
Valet ultrasonografike qe perdoren kane frekuence shume te larte (5- 20 MHz)
Te jep mundesi per marrje imazhesh dhe biopsi ne struktura anatomike qe nuk mund te arrihen ne menyre transabdominale
Avantazhet e tjera te USG standarte ( dallimi cistik-solid, pa radiacion, dhe pamjet real time etj)
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PORTAL KONFLUENS
KARACİĞER
PORTAL VENÖZ SİSTEM
SPLENİK VEN
SUPERİOR MEZ. VEN PORTAL VEN
PANKREAS
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PANKREAS BAŞI
KOLEDOK
PANKREATİK KANAL
PANKREAS BAŞI
PORTAL VEN
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PANKREAS GÖVDESİ
PANKREAS GÖVDE SUP MEZ ARTER
RENAL VEN
SPLENİK VEN
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Ekzaminimi dhe marrje biopsie e limfadenopative te mediastinit
Stadifikimi lokal sipas shtresave dhe infiltrimit I tumoreve te ezofagut
Marrja e biopsise se lezioneve subepiteliale te paretit e ezofagut
Stadifikimi lokal I tumoreve gastrike
Marrja e biopsise se lezioneve subepiteliale te paretit gastrik
FUSHA E PERDORIMIT
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MİDE CA MALİGN LAP
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MİDE LEIMYOSARKOM
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ÖZÖFAGUS LEIOMYOM
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GIST
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KESENİN MİDEYE BASISI
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GASTRİK LENFOMA
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PERİGASTRİK KOLLATERALLER
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FUSHA E PERDORIMITEkzaminimi I natyres se obstruksionit te
koledokut dhe nese nevojitet marrja e biopsise per ekzaminim citologjik
Diagnostikimi I gureve te koledokut (koledokolitiazis)
Klasifikimi lokal I tumoreve te koledokut
Drenazhimet koledoko-duodenal
Drenazhimet gastro- biliare
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DİSTAL KOLANJİO CA
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KOLEDOK TAŞLARI
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KESE TÜMÖRÜ
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KR PANKREATİT DİSTAL KOLEDOK BASISI
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İNTRAHEPATİK KLATSKİN TM
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FUSHA E PERDORIMITKlasifikimi lokal I tumoreve te rektumit
Ekzaminimi dhe drenimi I absceve perirektale
Ekzaminimi I abseve dhe fistulave perianale
Klasifikimi lokal dhe marrja e biopsive te tumoreve te prostates
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REKTUM CA
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FUSHA E PERDORIMITMarrja e biopsive nga masat e Pankreasit
Stadifikimi lokal I kancerit te pankreasit
Aspirimi I kisteve dhe tumoreve kistike te pankreasit
Drenimi gastrik I pseudokisteve te pankreasit
Drenimi gastrik I absceve peripankreatik
Diagnostikimi I hershem I pankreatitit kronik.
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PANKREAS BAŞ TM
KİTLE
KOLEDOK
PORTAL VEN
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SPLENİK VEN İNVAZE TM
KİTLE
SPLENİK VEN DİSTALİ
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PANKREATİK KANAL TM
PANKREATİK KANAL
KOLEDOK
KİTLE
PORTAL VEN
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VASKÜLER İNVAZYON (LİNEER)
SPLENİK ARTER
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VASKÜLER İNVAZE TM
KİTLEİNVAZYON SEGMENTİ
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SPLENİK VEN TROMBÜSÜ
SPLENİK VEN
TROMBÜS
PANKREASSUP MEZ ARTER
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PANKREAS GÖVDE KİTLE
KİTLE
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PANKREAS TM BİOPSİ
KİTLE
İĞNE
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DÜZENSİZ PANKREATİK KANAL
PANKREATİK KANAL
PANKREAS
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KR PANKREATİT
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FUSHA E PERDORIMITNeurolize e pleksusit celiak
Vendosja e markerit radjoterapik
Brakiterapi (radioactive iodine seeds (125I)
Injektimi I agjenteve Anti-Tumorale (5 fluorouracil (200 mg/m2/day, for 5 days, mixed
lymphocyte culture (Cytoimplant), anti-tumor viral therapy (ONYX-015)
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ÇÖLİAK NÖROLİZ
ÇÖLİAK ARTER
AORTA
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MASAT SOLIDE TE PANKREASIT
Percaktohet:Perberja ( masa, ekogjeniteti, nekroza)
Infiltrimi vaskular dhe raportin me: ( vena portae, vena mezenterica sup, arteria mezanterica sup, arteria splenica, arteria celiacae)
Raporti me organet fqinje ( koledoku, duodeni, pareti gastrik, hepari)
Gjendrat lymphatice perreth ( celiak, periaortik, peripancreatic, hilear, mediastinal)
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VLERA DIAGNOSTIKEEUS`ja eshte menyra imazherike me
sensitive jo kirurgjikale ne diagnostikimin e masave malinje ose beninje te pankreasit.
Ka nje sensitivitet diagnostikimi 85 – 100 %, dhe specifitet 92 – 98 %.
Sensitiviteti ne klasifikim eshte 90 – 97 %.Sensitiviteti ne vleresimin e invazionit
vaskular eshte 85 – 97 %
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VLERA E PERDORIMIT TE EUSPerdorimi i endosonografise dhe FNA-se ne
diagnostikimin dhe klasifikimin e dyshimeve te tumorit te pankresit ka nje kosto efikasitet te larte
Ne diagnostikimin e masave solide te pankreasit, EUS – FNA ka nje sensitivitet 95 % dhe specifitet 92 % , dhe percaktim 94.1 %
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DISAVANTAZHET E EUS;Hapesire te kufizuar ekzaminimi ( max 7 cm)Ka perdorim te kufizuar ne crregullimet e teresise anatomike ( operacionet GIS etj)Eshte e pamjaftueshme ne ndarjen e benign – malign ( ka
parashikim te larte)Ndjehet nevoja e biopsise ( nevojitje e EUS – FNA)Eshte e pamjaftueshme ne dallimin e mases me inflamacionin
( krijon probleme ne klasifikimin e tumoreve)Eshte e pamjaftueshme ne dallimin e limfadenopative reaktive
– malign ( ka parashikim te larte)Ne klasifikimet e tumoreve te Pankreasit, GIS superior dhe
Rektale ka nevoje per ekzaminime te tjera ( CT, MRI, PET etj. ) duhet te perdoret bashke me to
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SI MUND TE ZGJIDHIM NJE PJESE TE DIZAVANTAZHEVE?
Mund te zgjidhim problemet qe rrjedhin nga permasat e ekoendoskopit dhe prishjeve anatomike duke perdorur probe mini qe kalojne brenda endoskopit standart. ( qe perdoren aktualisht)
Duke perdorur agjent kontrasti ultrasonik mund te ekzaminojme vaskularitetin intratumoral.
Mund te perdorim Elastografine per te matur elasticitetin e
indeve. ( perdoret ne pak qendra dhe kerkon pervoje.)
Mund te perdorim se bashku agjentin kontrastues dhe elastografine.