While endoscopic ultrasound (EUS) has become established over the past 20 years, real time contrast applications using low mechanical index (MI) were restricted to the transabdominal approach. Recent advances in technology have supported the development of new endoscopic systems making it possible to use CELMI-EUS recently described as prototype. For the determination between contrast media signals versus tissue signals, two ultrasound pulses with a 180° inverted phase are sent out at the same vector line.

The received echo-information of these two pulses are summed up eliminating the linear information of the fundamental (tissue) signals. The nonlinear echo-information of the contrast media can be displayed. CELMI-EUS may improve our understanding of the morphologic imaging methods through additional analysis of functional criteria like perfusion with better characterization of e.g. tumors, lymph node staging and organ infiltration. This improved image documentation will enhance confidence in the method.

Endoscopic ultrasound (EUS) with modern large channel longitudinal scanners has opened up a new dimension in surgical endoscopy. EUS-supported interventions, along with other endoscopic procedures, have the most important role in the treatment of complications of acute and chronic pancreatitis. Here we show EUS-guided pseudocyst drainage using contrast enhancement with SonoVue® to delineate parts of the the spetated pseudocyst.

Correspondence:
Prof. Dr. med. Christoph F. Dietrich
Innere Medizin 2
Uhlandstr. 7
D-97980 Bad Mergentheim
Phone: 07931 / 58 2201
Fax: 07931 / 58 2290
E-mail: christoph.dietrich@ckbm.de

• Dietrich CF, Ignee A, Frey H. Contrast enhanced endoscopic ultrasound with low mechanical index, a new technique. Z Gastroenterol 2005;43:1219-1223.

• Dietrich CF. Contrast-enhanced low mechanical index endoscopic ultrasound (CELMI-EUS). Endoscopy 2009; 41 Suppl 2:E43-E44

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