Ultrasound catheter probes for endoluminal ultrasonography are widely available. However, their potential effect on clinical management has not been evaluated. AIM; To compare changes in diagnostic and therapeutic management after performing both CPUS and endoscopic ultrasonography (EUS). METHODS: This study was conducted prospectively at three centers. Endosonographers chose theoretical diagnostic and therapeutic plans prior to CPUS and EUS as if these tests were unavailable. CPUS was first performed followed by EUS. Based on the results of each modality, actual diagnostic and therapeutic plans were noted. The pre-CPUS/EUS (theoretical) management plans were compared to the post-CPUS/EUS (actual) plans. CPUS was also compared to EUS in terms of adequacy and technical ease of imaging in addition to image resolution. RESULTS: 63 subjects were enrolled (mean age 61, 34 men). Ultrasonography was indicated for evaluation of small mucosallsubmucosal lesions (48%), stenotic lesions (40%) and large tumors (12%). Lesions of interest were adequately imaged in 82.0% of subjects using CPUS compared to 75.5% with EUS. CPUS failures were due to limited penetration of larger lesions (5 patients), or inability to submerge lesions in water (6 patients). EUS failures were due to nontraversable stenotic lesions (5 patients), distortion secondary to balloon compression (3 patients), or difficulty in localizing smaller lesions (3 patients). With CPUS, image resolution and technical ease of imaging were equal or better than EUS in 68.6% and 82.7% of patients respectively. Post CPUS diagnostic and therapeutic plans differed from the theoretical plans in 67.7% and 35.5% of patients respectively. Comparatively, post EUS plans differed from the theoretical in 64.2% and 41.5% of patients respectively. Changes were generally toward less invasive measures. change in diagnostic plans change in therapeutic plans less invasive equally invassive more less invassive equally invasive more invasive post CPUS 21.3% 52.5% 26.2% 24.6% 73.8% 1.6% post EUS 21.2% 69.2% 9.6% 25.0% 69.2% 5.8% In 15 patients 124.6%) EUS was felt to be needed after CPUS and this accounted for the increase in invasive diagnostic management noted after CPUS. However, in 11 (73%) of these patients, EUS made no additional change in management. CONCLUSIONS: (1) CPUS is necessary for evaluating a variety of stenotic, compressible and smaller lesions. (2) CPUS is often technically easier than EUS and in select cases it can provide information not obtainable by EUS. (3) Changes in diagnostic or therapeutic management plans were made in a majority of patients based on CPUS results. (4) These changes were often towards less invasive management and were comparable to those made after EUS.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging