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EUS IN LOWER GI PATHOLOGY: EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES INDICATIONS, TECHINIQUE AND NURSES
IMPLICATIONSIMPLICATIONS
Giacomo Giacomo BonannoBonanno--AntoninoAntonino FerraroFerraro
Cattedra di Cattedra di GastroenterologiaGastroenterologia
Azienda Ospedaliero Universitaria PoliclinicoAzienda Ospedaliero Universitaria Policlinico
““ Gaspare Gaspare RodolicoRodolico””
UniversitUniversitàà di Cataniadi Catania
• Role of the nurse
• Appropriate behaviour for procedure evaluations
• Indications
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
OBJECTIVES
• Advanced training in generalendoscopy
• Cognitive and technical skills in EUS
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
ROLE OF THE NURSE
• Documented experience in routine and operative endoscopic procedures in gastroenterology
• Documented experience in management of endoscopic room and in patientcomunication
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
ADVANCED TRAINING IN GENERAL ENDOSCOPY
• Endoscopic ultrasound equipment
• Knowledge of anal-rectal anatomy
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
COGNITIVE AND TECHNICAL SKILLS IN EUS
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
ENDOSCOPIC ULTRASOUND EQUIPMENT
SAE
SAI
• Instructions to the patient for the day of the procedure
• Endoscopic room preparation
• Instrument preparation
• Patient preparation
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
APPROPRIATE BEHAVIOUR IN PROCEDURE EVALUATIONPRE PROCEDUREPRE PROCEDURE
• Monitoring
• Patient reassurance
• Manouvre assistance
• Image archiving preparation
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
APPROPRIATE BEHAVIOUR IN PROCEDURE EVALUATIONDURING PROCEDUREDURING PROCEDURE
• Patient assistance, reassurance and monitoring to avoid complications
• Instrument and accessory clean-up
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
APPROPRIATE BEHAVIOUR IN PROCEDURE EVALUATIONPOSTPOST--PROCEDUREPROCEDURE
• RECTAL PATHOLOGIES
• ANAL-SPHINCTER PATHOLOGIES
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
INDICATIONS
• Rectal carcinoma
• Rectal adenoma
• Submucosal rectal tumours
• Inflammatory bowel disease
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL PATHOLOGIES
RectalRectal CARCINOMACARCINOMAStagingStagingwithwith EUSEUS
uT1 mucosauT2 proper muscularuT3 mesorettouT4 surrounding organsN 0N 1
Hildebrandt Dis.Colon Rectum 1990
• Staging Accuracy
• Post radio-chemiotherapy Accuracy
• Post-operative follow-upAccuracy
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL CARCINOMARECTAL CARCINOMAstagingstagingwithwith EUS: EUS: Objectives
RectalRectalCARCINOMACARCINOMAstagingstagingaccuracyaccuracywithwith EUSEUS
T 85.4 % (60 -90 %) N 79.1% (73 - 83 %)(1436 pt.) (603 pt)
Rosch 1995
T 80 % (55 - 97 %) N 70.7% (43 - 89 %)(1780 pt) (1780 pt)
PUB-MED 1998 -2006 (32 citations)
G. Brown British J Cancer 2004; 91: 23-29
G. Brown British J Cancer 2004; 91: 23-29
• Staging Accuracy
• Post radio-chemiotherapy Accuracy
• Post-operative follow-upAccuracy
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL CARCINOMARECTAL CARCINOMAstagingstagingwithwith EUS: EUS: Objectives
ACCURACY
• T 48-66% OVERSTAGING 32-38%UNDERSTAGING 2-14%
• N 68-77% OVERSTAGING 8-12%UNDERSTAGING 15-20%
Liersch 2003 – Vanagunas 2003
RECTAL CARCINOMARECTAL CARCINOMArere--stagingstagingwithwith EUS after RTEUS after RT--CTCT
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
• Staging Accuracy
• Post radio-chemiotherapy Accuracy
• Post-operative follow-upAccuracy
RECTAL CARCINOMARECTAL CARCINOMAstagingstagingwithwith EUS: EUS: Objectives
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
CARCINOMA DEL RETTO STADIAZIONE CON EUSCARCINOMA DEL RETTO STADIAZIONE CON EUS
• Rectal carcinoma
• Rectal adenoma
• Submucosal rectal tumours
• Inflammatory bowel disease
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL PATHOLOGIES
• Rectal carcinoma
• Rectal adenoma
• Submucosal rectal tumours
• Inflammatory bowel disease
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL PATHOLOGIES
• Rectal carcinoma
• Rectal adenoma
• Submucosal rectal tumours
• Inflammatory bowel disease
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
RECTAL PATHOLOGIES
• Changes in Neoplasia: value of EUS unclear
• Diagnosis of pararectal abscesses: EUS useful
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
EUS IN INFLAMMATORY BOWEL DISEASE
• Fistulas
• Anal incontinence
• Obstetric injury
• Idiopathic IAS degeneration and EAS atrophy
• Inflammatory bowel disease
EUS IN LOWER GI PATHOLOGY: INDICATIONS, EUS IN LOWER GI PATHOLOGY: INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
ANAL PATHOLOGIES
• The role of the nurse is essential toperforme an accurate EUS
• EUS is fundamental for rectalcancer staging and to diagnose analpathologies
EUS IN LOWER GI PATHOLOGY:INDICATIONS, EUS IN LOWER GI PATHOLOGY:INDICATIONS, TECHINIQUE AND NURSES IMPLICATIONSTECHINIQUE AND NURSES IMPLICATIONS
CONCLUSIONS