New Endoscopic Ultrasound is SJRMC's Ultimate Detective
"All I know is that I don't have that pain anymore," said Roger McCan of Plymouth. "And that I'll be able to enjoy my wife's homemade cookies for the big drive down to Florida for the winter. I know that, too."
But what Mr. McCan, who retired from NIPSCO in 1991, didn't know was the origin of "that pain" and why it kept coming and going. He had his gall bladder removed in July and he continued to have pain in his right abdomen. But the pain would occur for about two days, then go away only to return every three to four weeks. This was a pattern Mr. McCan could do without.
A Computed Tomography (CT) scan and an ultrasound were performed, as was a test of Mr. McCan's liver enzymes.
"All of the tests we did came back normal," said Dr. Pankaj Patel, M.D., of Saint Joseph Regional Medical Center's Gastrointestinal (GI) Lab. "There was no explanation for the pain."
But Dr. Patel suspected that the pain was coming from the bile duct and SJRMC had a new detective to confirm his belief – Endoscopic Ultrasound (EUS).
Trained in EUS, Dr. Patel touted its tremendous benefits though the majority of its use has, so far, been confined to academic medical centers. But encouraged by Dr. Patel, SJRMC enthusiastically brought it to the community in September 2006. Since then, nearly 20 EUS procedures have been performed in SJRMC's GI Lab.
EUS combines an ultrasound processor on the tip of an endoscope (the combination is known as an echoendoscope), allowing for improved ultrasound imaging of the GI tract and the abdominal organs adjacent to it. This is a result of the closer proximity of the probe to the organs of interest as compared to transabdominal ultrasound.
"EUS gives us detailed images of structures that surround the esophagus, stomach, duodenum, and rectum," Dr. Patel explained. "The ultrasound aspect is critical because it allows us to see all that is happening in these organs. There can be so much going on that cannot be identified by other imaging technologies."
The EUS procedure is relatively noninvasive and painless. As the echoendoscope is slowly and carefully inserted, air is introduced through it to provide better vision. Interference with breathing does not occur during the procedure. The echoendoscope is carefully advanced into the duodenum (for upper EUS) or the sigmoid colon (for rectal EUS). At this time, after the endoscopic images have been obtained, the GI tract is suctioned to remove air and the echoendoscope is slowly withdrawn and the appropriate structures surrounding the duodenum, stomach, and esophagus are imaged.
Once the appropriate images are obtained, the procedure, lasting between 30 and 60 minutes, is complete.
Because of its unique capabilities, EUS can detect abnormalities or obtain information from the lining of the digestive tract, as well as the layers of the wall of the GI tract and its surrounding structures, including the liver, pancreas, gall bladder, bile ducts, and mediastinal lymph nodes.
With the ability to obtain tissue biopsies, EUS is also used to help detect suspected cancer and/or to evaluate how far a previously diagnosed cancer has spread in order to determine the appropriate therapy, the latter process called staging.
"With our Saint Joseph Cancer Institute, EUS provides the most useful application in cancer treatment," Dr. Patel said. "EUS is the most accurate method of staging pancreatic, gastric, bile duct and rectal cancers. It is very useful in determining the depth of invasion of the cancer and hence provides information that is critical in making a decision about the optimal approach to treatment."
EUS is used to stage cancers of the lungs, esophagus, stomach, bile ducts pancreas, and rectum.
EUS is also used in managing pancreatic cysts and chronic pancreatitis. Recently, EUS was used at Saint Joseph to drain a pancreatic cyst of fluid, assuring the patient it was not cancer. EUS was also recently used at Saint Joseph to stage a rectal cancer as a T3 lesion requiring preoperative radiation and chemotherapy prior to surgical resection.
In Mr. McCan's case, EUS identified a gall bladder stone that had worked its way into his bile duct, as the culprit of his recurring abdominal pain.
"EUS was the best procedure in this case because it is very sensitive to any pathology in the bile duct or pancreas," Dr. Patel explained.
The stone was removed at Saint Joseph, the day after it was seen on EUS, by Dr. Patel using another endoscopic technique known as ERCP. Now, Mr. McCan and his wife are gearing for a comfortable trip south for the winter . . .but not before some unfinished business.
"That Dr. Patel – he's pretty good," Mr. McCan said. "Before we head for Florida, I might have to have my wife make him some of those cookies."
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