Endoscopic Ultrasound: A Clear Vision for Gastroenterologists

By: Matthew L. Carnes, MD
Birmingham Gastroenterology Associates

Gastrointestinal malignancies refer to cancer of the esophagus, stomach, biliary system, pancreas, small and large intestine (colon) and rectum. An estimated 250,000+ people will be diagnosed with a type of gastrointestinal related malignancy in the USA in 2016. While prevention of cancer is the most important treatment, early detection allows for better treatment options and increased survival from this dreadful disease.

In the 1980’s endoscopic ultrasound (EUS) became a novel technology in the armamentarium of gastrointestinal endoscopy to assist in detection of certain malignancies. Since its introduction, more advanced instruments have been developed and its uses has increased exponentially. During the last decade, EUS has also become increasingly available making this procedure more convenient to patients.

The EUS scope is comprised of a normal flexible thin video endoscope with a built-in miniature ultrasound probe. The ultrasound technology is then used to “see through” the walls of the GI tract and closely examine surrounding structures that can difficult to image, such as the pancreas and biliary tract and can also image surrounding lymph nodes. This technology has the ability to take biopsies of abnormal areas in these surrounding organs in order to gain a tissue diagnosis via a technique called fine needle aspiration (FNA). This is important in gaining the accurate diagnosis to aid in making proper decisions on how to best treat the condition. This is also vital in assisting the staging of the disease if it is malignant with a minimally invasive procedure instead of a full scale surgery.

EUS continues to evolve and can offer a means of therapy for certain conditions. EUS can be utilized to deliver medicine to help with debilitating pain that can associated with pancreatic cancer. Targeted injection and placement of small metallic markers called fiducials can be placed into tumors to allow more specific targeting of radiation therapy. It can also be utilized to assist placing of stents which are used to open blockages in the GI tract that can be caused by cancer as well.

A potential diagnosis of cancer is certainly a scary and life-changing event. With ever-expanding knowledge and understanding of these diseases, we all hope to offer the best treatment with intent to cure. The technology of endoscopic ultrasound will certainly continue to evolve and be an important tool in the world of gastrointestinal cancer.