Contrast-enhanced endoscopic ultrasound

Area of Science:

• Medical Imaging
• Gastroenterology
• Endosonography

Background:

• Initial European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines in 2004 focused on contrast-enhanced ultrasound (CEUS) primarily for liver applications.
• Subsequent development of novel applications, particularly in endoscopic ultrasound (EUS), necessitated an update to the EFSUMB guidelines.
• Growing interest in CEUS and its integration into EUS has expanded its clinical utility and indications.

Purpose of the Study:

• To provide an overview of current and potential clinical applications of contrast-enhanced endoscopic ultrasound (CE-EUS).
• To review established and emergent indications for CE-EUS, acknowledging areas with insufficient evidence for general recommendation.
• To introduce various contrast-enhanced techniques used in EUS, including color Doppler (CEHMI-EUS) and high-resolution low mechanical index (CELMI-EUS).

Main Methods:

• Review of updated European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines from 2011.
• Focus on clinical applications of contrast-enhanced endoscopic ultrasound (CE-EUS) across various settings.
• Discussion of different contrast imaging techniques: contrast-enhanced high mechanical index endosonography (CEHMI-EUS) and contrast-enhanced low mechanical index endosonography (CELMI-EUS).

Main Results:

• The updated guidelines incorporate new knowledge and applications of contrast-enhanced ultrasound (CEUS) within endoscopic ultrasound (EUS).
• CE-EUS indications are categorized into established and emergent, with the latter requiring further evidence.
• The article details the use of CE-EUS with both color Doppler (CEHMI-EUS) and advanced high-resolution techniques (CELMI-EUS).

Conclusions:

• Contrast-enhanced endoscopic ultrasound (CE-EUS) has evolved significantly beyond its initial liver-focused applications.
• The updated EFSUMB guidelines reflect the expanding role and diverse applications of CE-EUS in clinical practice.
• Further research is needed for emergent CE-EUS applications to establish broader clinical recommendations.