Endoscopic ultrasound in the papilla and the periampullary region

Figure 1 Normal radial view. A: Ampulla; B: Periampullary region.

Figure 2 Radial view of normal distal choledochus and wirsung duct.

Figure 3 Linear view of normal papilla and periampullary region. The opening of the choledochal and Wirsung ducts is seen through the papilla.

Figure 4 Biliary stent in the papilla, linear view. A: Acoustic interference in periampullary region due to biliary stent; B: The same patient after stent removal.

Figure 5 Ampullary tubulo-villous adenoma. A: Endoscopic view; B: Tumor restricted to the duodenal wall as shown in radial endoscopic ultrasound; C: No ductal ingrowth. Endoscopic ampullectomy was indicated.

Figure 6 Ampullary carcinoma. A: Ulcerated ampullary tumor revealed by endoscopy; B: Duodenal wall disruption and pancreatic invasion in radial endoscopic ultrasound of the same tumor; C: Tumoral lymph nodes (same patient). Palliative therapy was indicated.

Figure 7 Procedural algorithm for suspected ampullary or periampullary tumor. EUS: endoscopic ultrasound; MRI: magnetic resonance imaging; ERCP: endoscopic retrograde cholangiopancreatography; CT: computerized tomography; US: ultrasound; IDUS: intraductal sonography.

Figure 8 Role of the Endosonography in the ampullary and periampullary pathology. EUS: endoscopic ultrasoun; FNA: fine needle aspiration.

Figure 9 Linear view of periampullary carcinoma obstructing biliary duct.

Figure 10 Periampullary tumor. A: Normal papilla in endoscopic view; B: Radial endoscopic ultrasound (EUS) finding of periampullary tumor; C: Linear EUS view; D: Fine needle aspiration puncture.

Figure 11 Endoscopic ultrasound finding in acute pancreatitis in a patient with normal magnetic resonance imaging. A: Impacted 4 mm stone in the ampulla with radial endoscopic ultrasound; B: Close-up; C: Precut during Endoscopic retrograde cholangiopancreatography in the same patient.

Figure 12 Lineal imaging of distal choledochal lithiasis. A: Stone and acoustic shadow is clearly seen; B: Bulging of the papilla due to impacted stone.

Figure 13 Transverse view of the ampulla with radial transducer in a patient with suspected sphincter of oddi dysfunction. Oddi muscle can be seen.