To the Editor:
A 52-year-old white man was referred to the gastroenterology clinic for evaluation of a rectal mass felt on physical examination and confirmed on colonoscopic examination as an external compression. He had a history of locally invasive bladder cancer; bladder resection and ileal conduit were performed a year ago. Magnetic resonance imaging of the pelvis revealed a 1.8 × 2.1 × 2.9-cm mass posterolateral to the rectum on the right side, causing an indentation along the lateral wall of the rectum (Fig. 1). EUS with FNA was planned, but on the day of the procedure, the EUS processor had malfunctioned. An Olympus BF-UC-UC160F-OL8 EBUS endoscope (Olympus America Inc, Center Valley, PA) was used for rectal EUS. The US processor used was the EU-ME1. This revealed a 1.8-cm hypoechoic mass beside the posterior wall of the rectum (Fig. 2). FNA was performed with a 22-gauge needle. Pathology showed malignant cells, urothelial primary (Figure 3, Figure 4). The convex probe-endobronchial US (CP-EBUS) endoscope is used mainly for mediastinal lymph node staging for lung cancer. It has also been used for diagnosis of intrapulmonary tumors, unknown hilar and mediastinal lymphadenopathy, and mediastinal tumors.
1We believe that this is the first case in which a CP-EBUS endoscope has been used in the rectum. The main differences between the CP-EBUS endoscope and the linear echoendoscope are listed in Table 1. There is no channel for air insufflation or water irrigation. Water or air could be delivered through the 2-mm instrument channel. There is 1 wheel for control of up and down deflection of the tip of the endoscope. There is no control for right to left deflection as is available with the EUS endoscope. However, right and left movement can be achieved by clockwise and anticlockwise torque on the endoscope. A possible limitation is a narrow scanning range of 50 degrees versus 180 degrees with the linear echoendoscope. EUS in the rectum is used for local staging of rectal cancer,
- Yasufuku K.
- Nakajima T.
- Chiyo M.
- et al.
Endobronchial ultrasonography Current status and future directions.
J Thorac Oncol. 2007; 2: 970-979
2restaging after chemoradiation,
- Bhutani M.
Recent developments in the role of endoscopic ultrasonography in diseases of the colon and rectum.
Curr Opin Gastroenterol. 2007; 23: 67-73
- Savides T.J.
- Master S.S.
EUS in rectal cancer.
Gastrointest Endosc. 2002; 56: S12-S18
- Napolean B.
- Pujol B.
- Berger F.
- et al.
Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy.
Br J Surg. 1991; 78: 785-788
5detection of recurrent rectal cancer,
- Rau B.
- Hunerbein M.
- Barth C.
- et al.
Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal caner.
Surg Endosc. 1999; 13: 980-984
6subepithelial lesions of the rectum,
- Woodward T.
- Manke D.
Diagnosis of recurrent rectal carcinoma by EUS-guided fine-needle aspiration.
Gastrointest Endosc. 2000; 51: 223-225
- Sasaki Y.
- Niwa Y.
- Hirooka Y.
- et al.
the use of endoscopic ultrasound guided fine-needle aspiration for investigation of submucosal and extrinsic masses of the colon and rectum.
Endoscopy. 2005; 37: 154-180
8and anal sphincter defects.
- Pishavaian A.C.
- Ahlawat S.K.
- Gavid D.
- et al.
Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis.
Gastrointest Endosc. 2006; 63: 331-335
- Deen K.
- Kumar D.
- Williams J.
- et al.
Anal sphincter defects: Correlation between endoanal ultrasound and surgery.
Ann Surg. 1993; 218: 201-205
- Felt-Bersma R.J.
- Cuesta M.A.
- Koorevaar M.
Anal sphincter repair improves anorectal function and endosonographic image A prospective clinical study.
Dis Colon Rectum. 1996; 39: 878-885
11The CP-EBUS endoscope could be used effectively for all the indications described. Because the distal end outer diameter of the CP-EBUS endoscope is much smaller than the curvilinear EUS endoscope, this endoscope makes the procedure less uncomfortable and may require less sedation.
- Ternent C.A.
- Shashidharan M.
- Blatchford G.J.
- et al.
transanal ultrasound and anorectal physiology findings affecting continence after sphincteroplasty.
Dis Colon Rectum. 1997; 40: 462-467
TABLE 1Differences between the CP-EBUS endoscope and the linear echoendoscope
|Olympus GF-UC140P-AL5 (EUS)||Olympus BF-UC160F-OL8 (EBUS)|
|Field of view, deg||100||80|
|Direction of view, deg||55 forward oblique||35 forward oblique|
|Depth of view, mm||3-100||2-50|
|Total length, mm||1575||890|
|Distal end outer diameter, mm||14.2||6.9|
|Channel inner diameter, mm||2.8||2|
|Display mode||B mode, M mode, D mode, flow mode, power flow mode||B mode, color power Doppler mode|
|Scanning method||Electric curved linear array||Electric curved linear array|
|Scanning direction||Parallel to insertion direction||Parallel to insertion direction|
|Frequency, MHz||5, 6, 7.5, 10||7.5|
|Scanning range, deg||180||50|
CP-EBUS, Convex probe-endobronchial US; deg, degrees; EBUS, endobronchial US.
- Endobronchial ultrasonography.J Thorac Oncol. 2007; 2: 970-979
- Recent developments in the role of endoscopic ultrasonography in diseases of the colon and rectum.Curr Opin Gastroenterol. 2007; 23: 67-73
- EUS in rectal cancer.Gastrointest Endosc. 2002; 56: S12-S18
- Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy.Br J Surg. 1991; 78: 785-788
- Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal caner.Surg Endosc. 1999; 13: 980-984
- Diagnosis of recurrent rectal carcinoma by EUS-guided fine-needle aspiration.Gastrointest Endosc. 2000; 51: 223-225
- the use of endoscopic ultrasound guided fine-needle aspiration for investigation of submucosal and extrinsic masses of the colon and rectum.Endoscopy. 2005; 37: 154-180
- Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis.Gastrointest Endosc. 2006; 63: 331-335
- Anal sphincter defects: Correlation between endoanal ultrasound and surgery.Ann Surg. 1993; 218: 201-205
- Anal sphincter repair improves anorectal function and endosonographic image.Dis Colon Rectum. 1996; 39: 878-885
- transanal ultrasound and anorectal physiology findings affecting continence after sphincteroplasty.Dis Colon Rectum. 1997; 40: 462-467
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.