Subscribe to RSS

DOI: 10.1055/s-0045-1809384
Understanding the Basics of Linear Endoscopic Ultrasound: A Step-by-Step Guide to Anatomy and Orientation
Funding None.

Abstract
Linear endoscopic ultrasound (EUS) has evolved into an essential modality for diagnostic and therapeutic gastrointestinal interventions. Despite its growing utilization, the learning curve for mastering linear EUS remains steep, largely due to the complexity of anatomical orientation and image interpretation. This article provides a systematic, step-by-step approach to understanding the basics of linear EUS, focusing on spatial anatomy and procedural technique. Core topics include image orientation, in vivo scope rotation with the “rule of 360,” organ and structure tracing, understanding EUS scanning planes, and a station-wise evaluation strategy. A structured checklist is proposed to enhance procedural quality and prevent anatomical oversight. Additionally, the manuscript emphasizes the often-overlooked aspect of image optimization, detailing key parameters such as frequency, gain, contrast, focus, and Doppler techniques. The article aims to demystify orientation and facilitate accurate structure identification through a systematic approach. The comprehensive yet practical framework outlined in this manuscript is designed to support both novice endosonographers in achieving procedural proficiency. Integrating these fundamental principles into routine EUS practice can enhance overall understanding of the linear EUS, and likely to reduce the learning curve.
Publication History
Article published online:
12 June 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Chavan R, Rajput S. Pictorial essay of linear endoscopic ultrasound examination of pancreas anatomy. J Dig Endosc 2023; 14: 88-98
- 2 Ligresti D, Kuo YT, Baraldo S. et al. EUS anatomy of the pancreatobiliary system in a swine model: The WISE experience. Endosc Ultrasound 2019; 8 (04) 249-254
- 3 Han C, Nie C, Shen X. et al. Exploration of an effective training system for the diagnosis of pancreatobiliary diseases with EUS: a prospective study. Endosc Ultrasound 2020; 9 (05) 308-318
- 4 Hawes Rh, Fockens P, Varadarajulu S. 12 - How to perform endoscopic ultrasonography in the pancreas, bile duct, and liver. In: Hawes RH, Fockens P, Varadarajulu S. eds. Endosonography. 4th ed. Philadelphia, PA: Elsevier; 2019: 129-139.e2
- 5 Burmester E, Leineweber T, Hacker S, Tiede U, Hütteroth TH, Höhne KH. EUS Meets Voxel-Man: three-dimensional anatomic animation of linear-array endoscopic ultrasound images. Endoscopy 2004; 36 (08) 726-730
- 6 DeWitt JM, Levy MJ, Fockens P. Learning EUS tricks from the masters. Gastrointest Endosc 2011; 74 (05) 1116-1118
- 7 Chavan R, Gandhi C, Patel M, Solanki R, Rajput S. Linear endoscopic ultrasound examination of the biliary system and its clinical applications. J Dig Endosc 2023; 14 (04) 211-220
- 8 Committee EFS, Yamao K, Irisawa A. et al. Standard imaging techniques of endoscopic ultrasound-guided fine-needle aspiration using a curved linear array echoendoscope. Dig Endosc 2007; 19: S180-S205
- 9 Burmester E. Radial endoscopic ultrasound–anatomical guiding structures in the upper abdomen. Video Journal and Encyclopedia of GI Endoscopy 2013; 1: 580-583
- 10 Irisawa A, Yamao K. Curved linear array EUS technique in the pancreas and biliary tree: focusing on the stations. Gastrointest Endosc 2009; 69 (02) , suppl): S84-S89
- 11 Palazzo L. How to perform EUS in the pancreaticobiliary area. Minerva Med 2014; 105 (05) 371-389
- 12 Bapaye A, Aher A. Linear EUS of the pancreas, biliary tract and liver. In: Akahoshi K, Bapaye A. eds. Practical Handbook of Endoscopic Ultrasonography. Tokyo: Springer Japan; 2012: 165-205
- 13 Dhir V, Adler DG, Pausawasdi N, Maydeo A, Ho KY. Feasibility of a complete pancreatobiliary linear endoscopic ultrasound examination from the stomach. Endoscopy 2018; 50 (01) 22-32
- 14 Wani S, Keswani RN, Petersen B. et al. Training in EUS and ERCP: standardizing methods to assess competence. Gastrointest Endosc 2018; 87 (06) 1371-1382
- 15 Zander D, Hüske S, Hoffmann B. et al. Ultrasound image optimization (“Knobology”): B-mode. Ultrasound Int Open 2020; 6 (01) E14-E24
- 16 Hwang JH. Principles of ultrasound. In: Hawes RH, Fockens P, Varadarajulu S. eds. Endosonography. 4th ed. Philadelphia, PA: Elsevier; 2019: 2-14.e1