Contrast-Enhanced Endoscopic Ultrasound

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use ofcontrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, newapplications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in theapplication of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result,the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhancedEUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergentCEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CEEUSin various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS.This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced highmechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (knownas contrast-enhanced low mechanical index endosonography or CELMI EUS).