title: Prospective evaluation of a jelly-like conducting medium for catheter US probe imaging of esophageal and duodenal lesions.
abstract: BACKGROUND
  The catheter probe EUS(C-EUS) relies on luminal water for acoustic coupling. However, in tubular structures, such as the esophagus and the duodenum, instilled water drains away rapidly. The use of water-filled balloons is limited by air artifact and other problems. This study evaluated the image quality, the penetration depth, the tumor staging accuracy, and the safety of C-EUS by using carboxymethylcellulose, an edible, nontoxic, transparent jelly-like substance (JC-EUS).
  
  
  METHODS
  Forty patients with an esophageal or a duodenal submucosal lesion or an esophageal carcinoma were evaluated prospectively in a crossover study with both C-EUS and JC-EUS when using a 12-MHz US catheter probe. Based on still images, depth of US penetration and image quality (by using a predefined 1 to 5 scale) were assessed by a blinded, independent endosonographer.
  
  
  METHODS
  JC-EUS was superior in image quality compared with C-EUS overall (mean score: 4.9 vs. 2.6; p <0.001), as well as in each subgroup (esophageal carcinoma, esophageal submucosal lesion, duodenal submucosal lesion). Penetration depth was not significantly different (2.5 cm). Staging was 100% accurate in 14 patients with esophageal cancer who underwent surgery. There was no procedure-related complication.
  
  
  CONCLUSIONS
  JC-EUS is safe, provides superior image quality to C-EUS, and is accurate for local staging of esophageal cancer.
authors.affiliation: Department of Gastroenterology, ChangHua Christian Medical Center, Seattle, WA 98101, USA.
authors.forename: Maw-Soan
authors.initials: MS
authors.lastname: Soon
authors.forename: Anny
authors.initials: A
authors.lastname: Soon
authors.forename: Drew B
authors.initials: DB
authors.lastname: Schembre
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
mesh_terms: D002266:Carboxymethylcellulose Sodium; D018592:Cross-Over Studies; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging*; D006801:Humans; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D002266:Carboxymethylcellulose Sodium