How to Perform Endoscopic Ultrasonography in the Esophagus and Mediastinum

Examination of the esophagus can be challenging because it requires a balance between obtaining good coupling to the esophageal wall while avoiding compressing tissue layers. The new electronic radial echoendoscopes make esophageal imaging easier because they have much better near focus range. Radial EUS of the mediastinum is straightforward because the images correlate with a chest CT scan. When first learning EUS, always use the electronic rotation function to align the EUS image to match the CT (aorta at 5 o’clock, spine at 7 o’clock, etc.). Linear EUS of the mediastinum is a bit more challenging, but in this chapter, we describe the step-by-step “station” approach to achieve complete mediastinal imaging. Because thoracic cancers can metastasize to the left adrenal, we describe the technique for imaging with EUS. The right adrenal can be very challenging to visualize, but the left is straightforward.