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By Frank G Gress; et al

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The ultrasound transducer is located just distal to the tip of the catheter, 2–3 mm distal to the four pressure recording sites. The catheter/ultrasound acquisition system allows capturing of a 360-degree view of the esophagus. (b) Muscle cross-sectional area is obtained by subtracting areas from the outer and inner rings (outer ring is the outer border of the esophagus and inner ring is the outer border of the esophageal mucosa). (Source: Dogan et al. 2007. 2 Ultrasound images of the lower esophageal sphincter (LES) and esophageal body in healthy subjects and patients with high-amplitude esophageal contractions (HAEC), diffuse esophageal spasm (DES), and achalasia of the esophagus.

1). Normal anatomy of the bile duct and gallbladder with linear echoendoscope The bile duct is visualized with a linear echoendoscope from either the duodenal bulb or the second portion of the duodenum. The transducer of the echoendoscope is advanced across the pylorus. Once in the bulb the balloon can be filled slightly with water to maintain a stable position. Initially the tip of the echoendoscope is impacted at the apex of the bulb; to achieve this, the big wheel is turned downwards. 5). The cut section of the visualized bile duct is in the region of the common bile duct or the common hepatic duct.

When filling the gastric lumen with the patient on their left side, the fundus and body will fill preferentially due to gravity. If the area of interest is in the antral wall, positioning the patient on their right side may be necessary to safely fill the gastric lumen with water for imaging. Filling of the gastric lumen with water places the patient at risk of aspiration; therefore, precautions should be taken to protect against an aspiration event. 1). If only a focal area needs to be examined, the use of a water-filled balloon can be used, especially for evaluating non-mucosal lesions such as subepithelial tumors.

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