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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(10): E1417-E1426
DOI: 10.1055/a-1922-6500
Review

Practical approach to linear endoscopic ultrasound examination of the rectum and anal canal

Hussein Hassan Okasha
1   Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
,
Katarzyna M. Pawlak
2   Hospital of the Ministry of Interior and Administration, Endoscopy Unit, Department of Gastroenterology, Szczecin, Poland
,
Amr Abou-elmagd
3   Armed Forces College of Medicine, Cairo, Egypt
,
Ahmed El-Meligui
4   Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
,
Hassan Atalla
5   Internal Medicine Department, Hepatology and Gastroenterology Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
,
Mohamed O. Othman
6   Baylor St. Luke’s Medical Center Houston, Texas, United States
,
Sameh Abou Elenin
7   Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
,
Ahmed Alzamzamy
7   Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
,
Reem Ezzat Mahdy
8   Internal Medicine, gastroenterology and Hepatology Department, Assiut University, Assiut, Egypt
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Abstract

Standard endosonographic examination of the rectal area is usually performed with radial endoscopic ultrasound (EUS). However, in recent years, widespread availability of linear EUS for assessing various anatomical regions in the gastrointestinal tract has facilitated its use in the assessment of anorectal disorders. Currently, many rectal and anal diseases, including perianal abscesses, fistulae, polyps, and neoplastic lesions, can be well-visualized and evaluated with linear EUS. The aim of this review is to shed light on the anatomy and systematic examination of the anorectal region with linear EUS and clinical implications for different anorectal pathologies.



Publication History

Received: 06 April 2022

Accepted after revision: 08 August 2022

Article published online:
17 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bapaye A, Aher A. Linear EUS of the Anorectum. In: Akahoshi K, Bapaye A. Practical Handbook of Endoscopic Ultrasonography. Tokyo: Springer Japan; 2012: 155-163
    Google Scholar
  • 2 Tankova L, Draganov V, Damyanov N. Endosonography for assessment of anorectal changes in patients with fecal incontinence. Eur J Ultrasound 2001; 12: 221-225
    CrossrefPubMedGoogle Scholar
  • 3 Bhatia V, Tajika M, Hijioka S. Radial-scanning flexible EUS of the anorectum and pelvis. Endosc Ultrasound 2019; 8: 288-297
    CrossrefPubMedGoogle Scholar
  • 4 Badea R, Dumitrascu DL. The digestive tract. In: Badea R, Dudea SM, Mircea PA. et al. Clinic Ultrasonography Compendium. Bucharest: Medical Publisher; 2004: 274-349
    Google Scholar
  • 5 Santoro GA, Di Falco G. Endoanal and Endorectal Ultrasonography: Methodology and Normal Pelvic Floor Anatomy. In: Santoro GA, Wieczorek AP, Bartram CI. Pelvic Floor Disorders: Imaging and Multidisciplinary Approach to Management. Milan: Springer; 2010: 91-102
    Google Scholar
  • 6 Burdan F, Sudol-Szopinska I, Staroslawska E. et al. Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions. Eur J Med Res 2015; 20: 4-4
    CrossrefPubMedGoogle Scholar
  • 7 Saranovic D, Barisic G, Krivokapic Z. et al. Endoanal ultrasound evaluation of anorectal diseases and disorders: Technique, indications, results and limitations. Europ J Radiol 2007; 61: 480-489
    CrossrefPubMedGoogle Scholar
  • 8 Rifkin MD, Kurtz AB, Choi HY. et al. Endoscopic ultrasonic evaluation of the prostate using a transrectal probe: prospective evaluation and acoustic characterization. Radiology 1983; 149: 265-271
    CrossrefPubMedGoogle Scholar
  • 9 Stewart LK, McGee J, Wilson SR. Transperineal and transvaginal sonography of perianal inflammatory disease. Am J Roentgenol 2001; 177: 627-632
    CrossrefPubMedGoogle Scholar
  • 10 Giovannini M, Ardizzone S. Anorectal ultrasound for neoplastic and inflammatory lesions. Best Pract Res Clin Gastroenterol 2006; 20: 113-135
    CrossrefPubMedGoogle Scholar
  • 11 Rose SC, Kinney TB, Roberts AC. et al. Endocavitary three-dimensional ultrasonographic assistance for transvaginal or transrectal drainage of pelvic fluid collections. J Vasc Intervent Radiol 2005; 16: 1333-1340
    CrossrefPubMedGoogle Scholar
  • 12 Giovannini M, Bories E, Moutardier V. et al. Drainage of Deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy 2003; 35: 511-514
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Choi EK, Kim JH, Jeong SU. et al. Endoscopic ultrasound-guided perirectal abscess drainage without drainage catheter: a case series. Clin Endosc 2017; 50: 297-300
    CrossrefPubMedGoogle Scholar
  • 14 Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Annales chirurgiae et gynaecologiae 1984; 73: 219-224
    PubMedGoogle Scholar
  • 15 Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. British J Surgery 2005; 63: 1-12
    CrossrefPubMedGoogle Scholar
  • 16 Subasinghe D, Samarasekera DN. Comparison of preoperative endoanal ultrasonography with intraoperative findings for fistula in ano. World J Surgery 2010; 34: 1123-1127
    CrossrefPubMedGoogle Scholar
  • 17 Choen S, Burnett S, Bartram CI. et al. Comparison between anal endosonography and digital examination in the evaluation of anal fistulae. British J Surgery 2005; 78: 445-447
    CrossrefPubMedGoogle Scholar
  • 18 Ratto C, Grillo E, Parello A. et al. Endoanal Ultrasound-guided surgery for anal fistula. Endoscopy 2005; 37: 722-728
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 West RL, Zimmerman DDE, Dwarkasing S. et al. Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum 2003; 46: 1407-1415
    CrossrefPubMedGoogle Scholar
  • 20 Buchanan GN, Bartram CI, Williams AB. et al. Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula-in-ano. Dis Colon Rectum 2005; 48: 141-147
    CrossrefPubMedGoogle Scholar
  • 21 Maconi G, Tonolini M, Monteleone M. et al. Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohnʼs disease. Inflamm Bowel Dis 2013; 19: 2737-2743
    CrossrefPubMedGoogle Scholar
  • 22 Halligan S, Stoker J. Imaging of fistula in ano. Radiology 2006; 239: 18-33
    CrossrefPubMedGoogle Scholar
  • 23 Nevler A, Beer-Gabel M, Lebedyev A. et al. Transperineal ultrasonography in perianal Crohnʼs disease and recurrent cryptogenic fistula-in-ano. Colorectal Dis 2013; 15: 1011-1018
    CrossrefPubMedGoogle Scholar
  • 24 Schratter-Sehn AU, Lochs H, Vogelsang H. et al. Endoscopic ultrasonography versus computed tomography in the differential diagnosis of perianorectal complications in crohnʼs disease. Endoscopy 1993; 25: 582-586
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Orsoni P, Barthet M, Portier F. et al. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohnʼs disease. British J Surgery 2003; 86: 360-364
    CrossrefPubMedGoogle Scholar
  • 26 Schwartz DA, Wiersema MJ, Dudiak KM. et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohnʼs perianal fistulas. Gastroenterology 2001; 121: 1064-1072
    CrossrefPubMedGoogle Scholar
  • 27 Siddiqui MRS, Ashrafian H, Tozer P. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and mri for perianal fistula assessment. Dis Colon Rectum 2012; 55: 576-585
    CrossrefPubMedGoogle Scholar
  • 28 American Gastroenterological Association . American Gastroenterological Association Medical Position Statement: Perianal Crohn’s disease. Gastroenterology 2003; 125: 1503-1507
    PubMedGoogle Scholar
  • 29 Wise PE, Schwartz DA. The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities. Gastroenterol Clin North Am 2012; 41: 379-391
    CrossrefPubMedGoogle Scholar
  • 30 Maconi G, Ardizzone S, Greco S. et al. Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohnʼs disease. Am J Gastroenterol 2007; 102: 2214-2219
    CrossrefPubMedGoogle Scholar
  • 31 Tarrant KM, Barclay ML, Frampton CM. et al. Perianal disease predicts changes in Crohnʼs disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol 2008; 103: 3082-3093
    CrossrefPubMedGoogle Scholar
  • 32 Hellers G, Bergstrand O, Ewerth S. et al. Occurrence and outcome after primary treatment of anal fistulae in Crohnʼs disease. Gut 1980; 21: 525-527
    CrossrefPubMedGoogle Scholar
  • 33 Tankova L, Tsankov T, Deredzhian K. et al. [Contrast-enhanced endoanal and transanal sonography for perianal fistulas]. Khirurgiia 2005; 6: 14-17
    PubMedGoogle Scholar
  • 34 Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life 2019; 12: 113-122
    CrossrefPubMedGoogle Scholar
  • 35 Gomollón F, Dignass A, Annese V. et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis 2016; 11: 3-25
    CrossrefPubMedGoogle Scholar
  • 36 Melton GB, Fazio VW, Kiran RP. et al. Long-Term outcomes with ileal pouch-anal anastomosis and Crohnʼs disease: pouch retention and implications of delayed diagnosis. Ann Surgery 2008; 248: 606-616
    CrossrefPubMedGoogle Scholar
  • 37 Ellrichmann M, Wietzke-Braun P, Dhar S. et al. Endoscopic ultrasound of the colon for the differentiation of Crohnʼs disease and ulcerative colitis in comparison with healthy controls. Aliment Pharmacol Therap 2014; 39: 823-833
    CrossrefPubMedGoogle Scholar
  • 38 Roushan N, Ebrahimi Daryani N. et al. Differentiation of Crohnʼs disease and ulcerative colitis using intestinal wall thickness of the colon: A diagnostic accuracy study of endoscopic ultrasonography. Med J Islam Repub Iran 2019; 33: 57-57
    PubMedGoogle Scholar
  • 39 Rustemovic N, Cukovic-Cavka S, Brinar M. et al. A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease. BMC Gastroenterol 2011; 11: 113-113
    CrossrefPubMedGoogle Scholar
  • 40 Hasak S, Kushnir V. Rectal endoscopic ultrasound in clinical practice. Curr Gastroenterol Rep 2019; 21: 18
    CrossrefPubMedGoogle Scholar
  • 41 Roushan N, Ebrahimi Daryani N, Azizi Z. et al. Differentiation of Crohnʼs disease and ulcerative colitis using intestinal wall thickness of the colon: a diagnostic accuracy study of endoscopic ultrasonography. Med J Islamic Rep Iran 2019; 33: 57
    PubMedGoogle Scholar
  • 42 Ong EMW, Ghazi LJ, Schwartz DA. et al. Guidelines for Imaging of Crohnʼs Perianal Fistulizing Disease. Inflam Bowel Dis 2015; 21: 731-736
    CrossrefPubMedGoogle Scholar
  • 43 Lindsey I, Humphreys MM, George BD. et al. The role of anal ultrasound in the management of anal fistulas. Colorect Dis 2002; 4: 118-122
    CrossrefPubMedGoogle Scholar
  • 44 Botti F, Losco A, Viganò C. et al. Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease. J Ultrasound 2015; 18: 19-35
    CrossrefPubMedGoogle Scholar
  • 45 Ardizzone S, Maconi G, Colombo E. Perianal fistulae following infliximab treatment: clinical and endosonographic outcome. Inflamm Bowel Dis 2004; 10: 91-96
    CrossrefPubMedGoogle Scholar
  • 46 van Bodegraven AA, Sloots CE, Felt-Bersma RJ G. et al. Endosonographic evidence of persistence of Crohnʼs disease-associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum 2002; 45: 39-45
    CrossrefPubMedGoogle Scholar
  • 47 Schwartz DA, White CM, Wise PE. et al. Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohnʼs perianal fistulas. Inflamm Bowel Dis 2005; 11: 727-732
    CrossrefPubMedGoogle Scholar
  • 48 Meylemans DVG, Oostenbrug LE, Bakker CM. et al. Endoscopic ultrasound guided versus surgical transrectal drainage of pelvic abscesses. Acta Chirurgica Belgica 2018; 118: 181-187
    CrossrefPubMedGoogle Scholar
  • 49 Spradlin NM, Wise PE, Herline AJ. et al. A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohnʼs perianal fistulas. Am J Gastroenterol 2008; 103: 2527-2535
    CrossrefPubMedGoogle Scholar
  • 50 Sharara AI, Azar C, Amr SS. et al. Solitary rectal ulcer syndrome: endoscopic spectrum and review of the literature. Gastrointest Endosc 2005; 62: 755-762
    CrossrefPubMedGoogle Scholar
  • 51 Sharma M, Somasundaram A. Endoscopic ultrasonography for an ulcer in the rectum. Gastroenterology 2011; 141: e7-e8
    CrossrefPubMedGoogle Scholar
  • 52 Keller DS, Berho M, Perez RO. et al. The multidisciplinary management of rectal cancer. Nature Rev Gastroenterol Hepatol 2020; 17: 414-429
    CrossrefPubMedGoogle Scholar
  • 53 Meyer JE, Narang T, Schnoll-Sussman FH. et al. Increasing incidence of rectal cancer in patients aged younger than 40 years: an analysis of the surveillance, epidemiology, and end results database. Cancer 2010; 116: 4354-4359
    CrossrefPubMedGoogle Scholar
  • 54 Nelson H, Petrelli N, Carlin A. et al. Guidelines 2000 for Colon and Rectal Cancer Surgery. J Natl Cancer Inst 2001; 93: 583-596
    CrossrefPubMedGoogle Scholar
  • 55 Wang Y, Zhou C-W, Hao Y-Z. et al. Improvement in T-staging of rectal carcinoma: using a novel endorectal ultrasonography technique with sterile coupling gel filling the rectum. Ultrasound Med Biology 2012; 38: 574-579
    CrossrefPubMedGoogle Scholar
  • 56 Heneghan JP, Salem RR, Lange RC. et al. Transrectal sonography in staging rectal carcinoma: the role of gray-scale, color-flow, and Doppler imaging analysis. Am J Roentgenol 1997; 169: 1247-1252
    CrossrefPubMedGoogle Scholar
  • 57 Ogura O, Takebayashi Y, Sameshima T. et al. Preoperative assessment of vascularity by color Doppler ultrasonography in human rectal carcinoma. Dis Colon Rectum 2001; 44: 538-546
    CrossrefPubMedGoogle Scholar
  • 58 Kav T, Bayraktar Y. How useful is rectal endosonography in the staging of rectal cancer?. World J Gastroenterol 2010; 16: 691-697
    Google Scholar
  • 59 Stoker J, Bartram CI, Halligan S. Imaging of the posterior pelvic floor. Europ Radiology 2002; 12: 779-788
    CrossrefPubMedGoogle Scholar
  • 60 Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985; 28: 42-46
    CrossrefPubMedGoogle Scholar
  • 61 Assenat E, Thézenas S, Samalin E. et al. The value of endoscopic rectal ultrasound in predicting the lateral clearance and outcome in patients with lower-third rectal adenocarcinoma. Endoscopy 2007; 39: 309-313
    Article in Thieme ConnectPubMedGoogle Scholar
  • 62 Compton C, Fenoglio-Preiser CM, Pettigrew N. et al. American Joint Committee on Cancer prognostic factors consensus conference. Cancer 2000; 88: 1739-1757
    CrossrefPubMedGoogle Scholar
  • 63 Puli SR, Bechtold ML, Reddy JBK. et al. How good is endoscopic ultrasound in differentiating various t stages of rectal cancer? Meta-analysis and systematic review. . Ann Surg Oncol 2009; 16: 254-265
    CrossrefPubMedGoogle Scholar
  • 64 Glancy DG, Pullyblank AM, Thomas MG. The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM). Colorect Dis 2005; 7: 148-150
    CrossrefPubMedGoogle Scholar
  • 65 Anus. In: Amin MB, Edge SB, Greene FL. et al. AJCC Cancer Staging Manual. New York, NY: Springer; 2017
    Google Scholar
  • 66 Brown G, Richards CJ, Bourne MW. et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003; 227: 371-377
    CrossrefPubMedGoogle Scholar
  • 67 Gérard A, Buyse M, Nordlinger B. et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surgery 1988; 208: 606-614
    CrossrefPubMedGoogle Scholar
  • 68 Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 2001; 358: 1291-1304
    CrossrefPubMedGoogle Scholar
  • 69 Martling AL, Holm T, Rutqvist LE. et al. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Lancet 2000; 356: 93-96
    CrossrefPubMedGoogle Scholar
  • 70 Birbeck KF, Macklin CP, Tiffin NJ. et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surgery 2002; 235: 449-457
    CrossrefPubMedGoogle Scholar
  • 71 Torkzad MR, Påhlman L, Glimelius B. Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review. Insights Imaging 2010; 1: 245-267
    CrossrefPubMedGoogle Scholar
  • 72 Peschaud F, Cuenod C-A, Benoist S. et al. Accuracy of magnetic resonance imaging in rectal cancer depends on location of the tumor. Dis Colon Rectum 2005; 48: 1603-1609
    CrossrefPubMedGoogle Scholar
  • 73 MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006; 333: 779-779
    CrossrefPubMedGoogle Scholar
  • 74 Phang PT, Gollub MJ, Loh BD. et al. Accuracy of endorectal ultrasound for measurement of the closest predicted radial mesorectal margin for rectal cancer. Dis Colon Rectum 2012; 55: 59-64
    CrossrefPubMedGoogle Scholar
  • 75 Granero-Castro P, Muñoz E, Frasson M. et al. Evaluation of mesorectal fascia in mid and low anterior rectal cancer using endorectal ultrasound is feasible and reliable: a comparison with MRI findings. Dis Colon Rectum 2014; 57: 709-714
    CrossrefPubMedGoogle Scholar
  • 76 Gall TMH, Markar SR, Jackson D. et al. Mini-probe ultrasonography for the staging of colon cancer: a systematic review and meta-analysis. Colorectal Dis 2014; 16: 1-8
    CrossrefPubMedGoogle Scholar
  • 77 Marusch F, Koch A, Schmidt U. et al. Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study. Endoscopy 2002; 34: 385-390
    Article in Thieme ConnectPubMedGoogle Scholar
  • 78 Tombazzi CR, Loy P, Bondar V. et al. Accuracy of endoscopic ultrasound in staging of early rectal cancer. Fed Pract 2019; 36: S26-S29
    PubMedGoogle Scholar
  • 79 Benson AB, Venook AP, Al-Hawary MM. et al. Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Comprehens Cancer Net 2018; 16: 852-871
    CrossrefPubMedGoogle Scholar
  • 80 Tanaka S, Kashida H, Saito Y. et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digest Endosc 2020; 32: 219-239
    CrossrefPubMedGoogle Scholar
  • 81 Kochhar R, Plumb AA, Carrington BM. et al. Imaging of anal carcinoma. Am J Roentgenol 2012; 199: W335-W344
    CrossrefPubMedGoogle Scholar
  • 82 Leblanc J, Kongkam P. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of recurrent anal cancer after chemoradiation and negative forceps biopsies: a case report. Clin Med Oncol 2009; 3: 59-62
    PubMedGoogle Scholar
  • 83 Artifon ELA, Sakai P, Ishioka S. et al. EUS for locoregional staging of prostate cancer-a pilot study. Gastrointest Endosc 2007; 65: 440-447
    CrossrefPubMedGoogle Scholar
  • 84 Chablaney S, Zator ZA, Kumta NA. Diagnosis and management of rectal neuroendocrine tumors. Clin Endosc 2017; 50: 530-536
    CrossrefPubMedGoogle Scholar