How to Perform Endoscopic Ultrasonography in the Pancreas, Bile Duct, and Liver

Examination of the pancreas is the most difficult task for the endosonographer. When first learning, we strongly advocate taking a very systematic approach to enable complete evaluation of the pancreas—we call it “the station approach.” It is based on the principle of endoscopically placing the transducer in a particular position within the stomach or duodenum, recognizing the structures seen from that position and then systematically tracing the structures to detect any abnormalities. If one gets lost during the tracing maneuver, then you go back to the original starting point and start over. The body and tail of the pancreas are visualized from the stomach beginning with visualization of the celiac artery or portal vein, and the bile duct and head of the pancreas are visualized from the first and second part of the duodenum. The stations are the same whether you are using a radial or linear echoendoscope. Superb imaging of the pancreas, bile duct, and liver can be achieved by practicing the station approach.