Ponctions guidées sous échoendoscopic difficiles: comment s’en sortir ?

Résumé

Le développement de l’échoendoscopie (EE) a permis de mieux préciser l’extension pariétale et ganglionnaire des tumeurs gastrointestinales et pancréatiques. Néanmoins, l’EE ne peut affirmer le caractère malin ou bénin d’adénopathies, de masses pancréatiques ou de compressions extrinsèques du tube digestif. Le développement depuis plus de 15 ans de l’échoendoscopie sectorielle linéaire, a permis de réaliser des biopsies guidées de telles lésions [1,2, 5, 6, 9, 10, 16–18].

Dans cette mise au point, nous allons étudier successivement, le matériel nécessaire, la technique de ponction et les difficultés que l’on peut rencontrer dans certains cas.

Summary

Endosonography is an established method for staging gastrointestinal malignancies. Endoscopic placement of the ultrasound transducer immediately adjacent to the area of interest has allowed higher ultrasound frequencies to be used permitting greater spatial resolution. This in turn has provided anatomical detail not available with standard transabdominal ultrasound and CT imaging. As an extension of imaging, several case series have described employing endosonography in conjunction with needle aspiration biopsy to sample lesions within and adjacent to the gastrointestinal tract. The technique appears promising and allows cytologic confirmation of metastases to regional lymph nodes. Moreover, in several of these described cases, biopsied lesions were not identified by CT scanning. This added ability to perform endosonography guided fine needle aspiration biopsy may overcome some of the specificity problems associated with EUS in distinguishing benign from malignant lesions (e.g. lymph nodes, pancreatic masses, and gastric ulcers).