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