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Abstract
The diagnostic applications for EUS have grown tremendously over the last decade. Most of the early development involved the use of EUS for upper GI indications. Until recently the rectal applications of EUS have largely remained unexplored. Several recent publications have demonstrated the usefulness of EUS in the evaluation of rectal diseases. There has been a steady increase in the number of patients referred for rectal indications.
This essay describes rectal endosonographic anatomy, highlights the technical aspects of rectal EUS, and summarizes available data on the major clinical indications for rectal EUS including imaging and the staging of rectal cancer.
Endorectal ultrasonography is the most accurate tool for local staging of rectal carcinoma. In addition to providing accurate T- and N- stage, EUS allows assessment of the internal and external anal sphincters. Accurate endosonographic staging directs the optimal method of management of rectal carcinoma, type of resection, and candidacy for neoadjuvant therapy. Repeat sigmoidoscopic and endosonographic imaging may be considered in selected patients following neoadjuvant therapy. EUS guided FNA can be used to detect suspected local recurrence.