Ultrasound in gastroenterology.

Modern high resolution grey-scale ultrasound scanning is now making a major contribution to the field of diagnostic gastroenterology. The major recent developments in the clinical applications of the technique have been in the diagnosis of gall bladder disease and the differential diagnosis of jaundice. Most authorities now accept that ultrasound should be the primary investigative technique in both these conditions. Ultrasound is probably also pre-eminent in the diagnosis of focal liver disease, nuclear medicine scans having a very questionable role and CT scanning being used primarily on obese patients or those in which unsatisfactory ultrasound scans have been obtained for other technical reasons. The diagnosis of pancreatic disease has been improved considerably by modern radiological techniques, including ultrasound; unfortunately, the diagnostic improvement has not been mirrored by a therapeutic improvement. We must hope that earlier and more accurate diagnosis of pancreatic pathology will lead to more satisfactory treatment in the long term. Ultrasound certainly does not compete with barium studies for investigation of bowel disorders but may occasionally give useful information concerning bowel pathology, usually as an incidental finding when some other organ is examined. One of the major limitations of diagnostic ultrasound imaging remains its reliance on a high degree of operator skill and knowledge. Modern real-time scanners may appear deceptively easy to use but in the hands of an inexpert or untrained operator will almost certainly prove more of a liability than a valuable diagnostic tool.