Endosonography is one of the accurate imaging methods in medicine that is used to examine the internal organs of the body, especially the digestive system. This method is performed by combining endoscopy and ultrasound and helps doctors to get more accurate images from inside the body. Endosonography plays an important role in the diagnosis of diseases such as cancer, inflammation, and digestive problems, and is usually used in situations where conventional ultrasounds are not sufficient. In this article, we will learn more about how to do it, the uses and benefits of this method. How is endosonography performed? Endosonography is performed using a narrow, flexible device equipped with an ultrasound probe that enters the patient's body through the mouth or anus. This device, which is similar to an endoscope, has a sound wave transducer in its head that can produce accurate images of the internal tissues of the body by sending ultrasound waves to the surrounding organs. The endosonography procedure is usually as follows: ✅ **Patient preparation:** Before endosonography, depending on the desired location (for example, stomach or intestines), the doctor may ask the patient to fast for a few hours or to use certain medications. ✅ **Sedation:** Most of the time, for the comfort of the patient, a sedative or mild anesthesia is given so that he does not feel discomfort during the procedure. ✅ **Inserting the device:** The doctor slowly inserts the endoscope device into the body. If the examination is related to the upper digestive tract, it is entered through the mouth; But if it is related to the lower part (for example, the rectum or prostate), it enters through the anus. ✅ **Preparation of images:** The device sends sound waves to the internal tissues and receives their reflection and converts it into an image. These images are viewed by the doctor on the monitor. ✅ **If sampling (biopsy) is needed:** In some cases, the doctor can take a sample of the suspicious tissue at the same moment to send it to the laboratory for further investigation. The whole process usually takes between 30 and 60 minutes, and the patient can return home after some rest, except in special cases requiring hospitalization. All in all, endosonography is an accurate, relatively minimally invasive and reliable method for examining the internal organs of the body. Using this method, the doctor can obtain valuable information about the condition of tissues and possible lesions without the need for surgery. The difference between endosonography and conventional ultrasound Conventional ultrasound is a non-invasive method that is performed by placing a probe on the surface of the skin and sound waves are sent from the outside of the body to the internal organs. This method is very useful for examining organs such as liver, kidneys, uterus and pregnancy. On the other hand, **endosonography** is a combined method in which the ultrasound device enters the body through an endoscope and looks at the internal organs from a closer distance. This allows for images with much greater clarity and detail, especially of organs such as the pancreas, the inner walls of the stomach, the esophagus, or nearby lymph nodes. Applications of endosonography in medicine Endosonography is one of the most accurate and widely used tools in the diagnosis of diseases, especially in the abdomen, chest and pelvis. This method helps doctors to examine internal organs up close and even take samples from suspicious tissues. For this reason, it has wide applications in gastroenterology, lung, oncology and even urology specialties. #### The most important applications of endosonography: - **Inspection and diagnosis of masses and tumors** - **determining the stage of cancers** - **Inspection of pancreatic diseases** - **Diagnosis of gallstones or gall bladder problems** - **Evaluation of lymph nodes** - **Investigation of esophageal and stomach disorders** - **diagnosis of rectal and prostate diseases** **Guidelines for biopsy (sampling)** In general, endosonography is one of the most advanced internal imaging methods, which, with its high accuracy and ability to see the tissues, plays an important role in the early diagnosis of many diseases. Using this method allows the doctor to make more accurate and effective treatment decisions, without the need for invasive surgeries. Does endosonography hurt? No, **endosonography is usually not painful**, as it is usually done with sedation or mild anesthesia. However, some patients may feel some discomfort, pressure, or nausea when the device is inserted through the mouth or anus, especially in the initial moments. These sensations are usually short-lived and disappear after the process is over. Also, if the endosonography is accompanied by a sample (biopsy), a very small amount of pain or mild discomfort may be felt at the sampling site, which is usually manageable with simple care. In general, this method is considered acceptable and less complicated in terms of tolerance for most patients compared to its high benefits. Advantages and disadvantages of endosonography Endosonography is a precise and advanced method for examining the internal organs of the body, which has many advantages; Including high accuracy in imaging, the ability to see the internal layers of organs, early detection of tumors, and the ability to simultaneously sample suspicious tissues—all without the use of harmful radiation. However, this method also has disadvantages; Such as the need to enter the device into the body (through the mouth or anus), the need to use sedation, the higher cost than conventional ultrasound, and the possibility of rare complications. In general, endosonography is a very effective and reliable option for patients who need a more detailed examination. Who needs endosonography? Endosonography is usually recommended for people whose doctor suspects a problem or disease in their internal organs, especially in the areas of the digestive tract, pancreas, gallbladder, esophagus, or rectum. Patients with unexplained gastrointestinal pain, suspicious masses, sudden changes in bowel movements, unexplained weight loss, or abnormal results on ultrasound or CT scan may require endosonography. Also, people who have a family history of gastrointestinal cancers, or who need further investigation to more accurately assess the stage of cancer progression, are usually referred by their doctor for endosonography. This method is very useful for diagnosing diseases more accurately, making better decisions about treatment, or sampling internal tissues. Diagnosis of liver cancer using endosonography Endosonography can be very effective in diagnosing liver cancer, especially in the early stages or when the lesions are small and deep. Although conventional ultrasound and CT scan are the primary tools for examining the liver, endosonography can better reveal small masses or abnormal changes in liver tissue by providing more detailed images of areas close to the liver, especially from the side of the stomach and duodenum. Also, if a suspicious lesion is observed, the doctor can take a sample (biopsy) from that area at the same time as endosonography, so that the type of cells can be accurately checked in the laboratory. This method is considered a very useful tool in accurate diagnosis and treatment decision making for patients who are at risk of liver cancer or the results of other tests and imaging were not enough. Is endosonography used to diagnose other cancers? Yes, **endosonography is used to diagnose many cancers in different internal organs** and is considered one of the most important and accurate tools in diagnosing and determining the stage of tumor progression. This method is especially used in examining and diagnosing cancers that are located in the areas around the digestive system or the chest. including: - Pancreatic cancer: Endosonography is the best method for early diagnosis of small pancreatic tumors and their biopsy. - **Stomach and esophagus cancer:** To check the depth of tumor penetration in the walls of these organs and to check the spread to the surrounding lymph nodes. - **Rectal and anal cancer:** To determine the stage of cancer and check its penetration into nearby tissues. - Gallbladder and bile duct cancer: diagnosis of obstruction, tumor and inflammation. - **Lung cancer (through endosonography of the trachea - EBUS):** To check the lymph nodes around the trachea and bronchi and sampling them. Overall, endosonography is a powerful tool for accurate and early detection of many internal cancers. By combining imaging and sampling, this method helps doctors make better treatment decisions without invasive surgeries. Summary In general, endosonography plays a very important role in diagnosing all types of cancers of the digestive system, lungs and internal organs. This method, with high accuracy, provides the possibility of examining the depth of tumors and the status of lymph nodes. Also, the ability to take samples at the same time allows the doctor to more confidently diagnose the type and stage of cancer and plan the treatment process.