Endoscopic ultrasound: Anatomy of the normal esophagus
- Frank G Gress, MD
Frank G Gress, MD
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
Endoscopic ultrasound (EUS) is an endoscopic technique that provides highly accurate imaging of mucosal, submucosal, and periluminal structures. It is often used for the preoperative staging of gastrointestinal (GI) malignancies such as esophageal, gastric, pancreatic and rectal cancers for which it has an accuracy of 90, 88, and 90 percent, respectively, when performed with experienced hands [1-4].
EUS provides high-resolution imaging of the GI tract by its unique ability to differentiate the histologic layers of the GI tract wall [5-9]. The most commonly used echoendoscopes operate across a broad range of frequencies ranging from 5 to 20 MHz, with a variable depth of penetration and resolution. These echoendoscopes produce an image of the GI tract wall consisting of five sections or layers. A discussion of high frequency EUS with ranges >20 MHz revealing a nine-layer GI tract wall is covered elsewhere (see "High-frequency catheter endoscopic ultrasonography"). These layers correspond to the five distinct histologic layers of the gut wall:
●The innermost, medial layer (lumen) is known as the superficial mucosal layer
●The second layer corresponds to the lamina propria or deep mucosa
●The third layer is known as the submucosaTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Snady H. Role of endoscopic ultrasonography in diagnosis, staging, and outcome of gastrointestinal diseases. Gastroenterologist 1994; 2:91.
- Colin-Jones DG, Rösch T, Dittler HJ. Staging of gastric cancer by endoscopy. Endoscopy 1993; 25:34.
- Yasuda K, Mukai H, Fujimoto S, et al. The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc 1988; 34:1.
- Snady H, Bruckner H, Siegel J, et al. Endoscopic ultrasonographic criteria of vascular invasion by potentially resectable pancreatic tumors. Gastrointest Endosc 1994; 40:326.
- Kimmey MB, Martin RW, Haggitt RC, et al. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 1989; 96:433.
- Wiersema MJ, Wiersema LM. High-resolution 25-megahertz ultrasonography of the gastrointestinal wall: histologic correlates. Gastrointest Endosc 1993; 39:499.
- Tio TL, Tytgat GN. Endoscopic ultrasonography of normal and pathologic upper gastrointestinal wall structure. Comparison of studies in vivo and in vitro with histology. Scand J Gastroenterol Suppl 1986; 123:27.
- Bolondi L, Casanova P, Santi V, et al. The sonographic appearance of the normal gastric wall: an in vitro study. Ultrasound Med Biol 1986; 12:991.
- Tio TL, Tytgat GN. Endoscopic ultrasonography in analysing peri-intestinal lymph node abnormality. Preliminary results of studies in vitro and in vivo. Scand J Gastroenterol Suppl 1986; 123:158.
- Caletti GC, Bolondi L, Zani L, Labò G. Technique of endoscopic ultrasonography investigation: esophagus, stomach and duodenum. Scand J Gastroenterol Suppl 1986; 123:1.
- Lux G, Heyder N. Endoscopic ultrasonography of the pancreas. Technical aspects. Scand J Gastroenterol Suppl 1986; 123:112.
- Kremkau FW, Taylor KJ. Artifacts in ultrasound imaging. J Ultrasound Med 1986; 5:227.
- Snady H. Artifacts and techniques of endoscopic ultrasonography in investigating gastrointestinal pathologies and therapeutic options. In: Methods in Disease: Investigating the Gastrointestinal Tract, Preedy V, Watson R (Eds), Greenwich Med Media, London 1998. p.141.
- Grech P. Mirror-image artifact with endoscopic ultrasonography and reappraisal of the fluid-air interface. Gastrointest Endosc 1993; 39:700.
- Bolondi L, Caletti G, Casanova P, et al. Problems and variations in the interpretation of the ultrasound feature of the normal upper and lower GI tract wall. Scand J Gastroenterol Suppl 1986; 123:16.
- Eloubeidi MA, Tamhane A, Lopes TL, et al. Cervical esophageal perforations at the time of endoscopic ultrasound: a prospective evaluation of frequency, outcomes, and patient management. Am J Gastroenterol 2009; 104:53.