title: EUS guidance in gastric pacemaker implantation.
abstract: BACKGROUND
  EUS provides excellent imaging of the gastric wall. The utility of EUS imaging in guiding the placement of a gastric pacemaker was investigated.
  
  
  METHODS
  Fourteen patients underwent gastric pacemaker implantation for refractory gastroparesis at laparotomy. Placement of the lead into the muscle layer of the antrum of the stomach was imaged by intraoperative surface ultrasonography in the first 8 patients and by EUS in the subsequent 6 patients.
  
  
  RESULTS
  Surface US examination of the lead placement revealed reverberation artifacts. The images were uniformly unsatisfactory and the position of the lead in the gastric wall could not be visualized in any patient. In contrast, the lead was clearly and easily identified by EUS as a bright linear echo in the gastric wall. This was observed uniformly in all of the patients evaluated by EUS. Compared with surface US, EUS provided better images of the gastric lead placement as well as less abdominal distension and thus easier closure of the incision.
  
  
  CONCLUSIONS
  EUS is useful in confirming the accurate placement of pacemaker leads within the muscular coat of the stomach.
authors.affiliation: Department of Medicine, Surgery, and Radiology, Kansas University Medical Center, Kansas City, Kansas, USA.
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Jameson
authors.initials: J
authors.lastname: Forster
authors.forename: Irene
authors.initials: I
authors.lastname: Sarosiek
authors.forename: Stanton J
authors.initials: SJ
authors.lastname: Rosenthal
authors.forename: Zhiyue
authors.initials: Z
authors.lastname: Lin
authors.forename: Richard
authors.initials: R
authors.lastname: McCallum
mesh_terms: D019160:Endosonography / Q000379:methods*; D018589:Gastroparesis / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D010138:Pacemaker, Artificial; D025321:Surgery, Computer-Assisted / Q000379:methods*