How to Perform Endoscopic Ultrasonography in the Stomach

Examination of the stomach can be successfully accomplished with one or both of 2 techniques—the water-filled lumen and water-filled balloon technique. It is important to keep the transducer perpendicular to the gastric wall when imaging mucosal or submucosal lesions because tangential imaging will result in overstaging of cancers and incorrect determination of layer-of-origin for submucosal masses. It can be impossible to keep the transducer fully perpendicular in the antrum because of the natural curvature of the stomach. This means that at times, the transducer will be right up against the mucosa. This is less of a problem with the new electronic radial echoendoscopes because they have a very good near focus range. Inevitably, some areas of the antrum will be imaging tangentially and one simply has to recognize the wall layer thickening as artifact.