Endoscopic Ultrasound Provides Clearer Picture of GI Disease

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By Eric H. Shen, MD

Maybe you’ve been experiencing unexplained abdominal pain or unintentional weight loss.

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Or maybe your doctor saw something suspicious on a CT scan or other imaging test.

Whatever the reason, you’ve been referred for an endoscopic ultrasound (EUS), and now you’re wondering: “What’s that?”

In short, EUS is an advanced procedure performed by a gastroenterologist used to further evaluate the esophagus, stomach, rectum, or adjacent organs such as the pancreas for abnormalities.  

The procedure is part of the comprehensive gastrointestinal (GI) services offered at the Center for Digestive Health at Penn Medicine Princeton Medical Center (PMC), to aid in the detection and treatment of gastrointestinal disease.

An Advanced Diagnostic Tool

More specifically, EUS is a medical imaging technique that combines the capabilities of endoscopy and ultrasound to obtain detailed images of internal organs within the GI tract and adjacent structures.

This advanced diagnostic tool provides high-resolution visuals of organs such as the esophagus, stomach, pancreas, and surrounding tissues.  

The procedure involves the use of a thin, flexible tube called an endoscope, which is equipped with a light and a small ultrasound transducer at its tip.

During the procedure, the endoscope is inserted through the mouth into the upper digestive tract. The ultrasound transducer emits sound waves that bounce off the organs and tissues, and sends real-time images to a monitor, offering detailed insights into the internal structures.

The proximity of the ultrasound transducer to the target area enhances the clarity and precision of the images, enabling healthcare professionals to detect subtle abnormalities beyond the superficial layers of the organs.

The outpatient test can take up to an hour to perform and is done under moderate sedation with the assistance of an anesthesiologist.

Detection and Staging of Tumors

One of the main reasons doctors use EUS is for the detection and staging of tumors. The procedure enables doctors to visualize tumors or other growths within the GI tract, nearby lymph nodes and adjacent organs and accurately assess the extent of the disease.

This is crucial for planning appropriate treatment strategies, such as surgery, chemotherapy, radiation, or a combination.

Endoscopic ultrasound is also used for:

  • Evaluation of pancreatic conditions. Endoscopic ultrasound offers the most detail when evaluating pancreatic conditions, including chronic pancreatitis and pancreatic cancer.
  • Assessment of liver and gallbladder disease. Beyond the pancreas, EUS is also used to evaluate liver and gallbladder diseases. It can help identify cysts, bile duct stones, or other abnormalities in these organs, contributing to a more comprehensive understanding of the patient’s condition.
  • Guided biopsies. Endoscopic ultrasound not only provides imaging, but also allows for guided tissue sampling. If a suspicious lesion or tumor is identified, gastroenterologists can use the endoscope to biopsy the mass and obtain an accurate diagnosis.

In addition, EUS is used as a screening tool for pancreatic cancer in high-risk patients, including those with a family history of pancreatic cancer and those with BRCA1 or BRCA2 gene mutations, which increase the risk for pancreatic cancer.

The American Gastroenterological Association recommends that high-risk individuals begin screening at age 50 or 10 years younger than the initial age of familial onset.

If you are concerned about your risk for pancreatic cancer, talk with your doctor about screening.

When to See a Doctor

Symptoms of a GI disorder vary depending on the condition and its severity, but in general see a doctor if you have any of the following:

  • Sudden or severe abdominal pain.
  • Nausea or vomiting.
  • Unintentional weight loss.
  • Changes in bowel movements, including constipation, diarrhea, greasy or oily stools, pale stools.
  • Blood in stool.
  • Frequent or severe heartburn.
  • Trouble swallowing.
  • Feeling unusually bloated.
  • Jaundice (most often affiliated with liver or pancreatic disease).

An estimated 60 to 70 million United States residents suffer from some type of GI condition, according to the American Gastroenterological Association.

Fortunately, advanced diagnostic tools such as EUS are enabling doctors to accurately diagnose GI disorders so patients can get the treatment they need.

The Center for Digestive Health at PMC has earned recognition from the American Society for Gastrointestinal Endoscopy (ASGE) as a unit that promotes quality in endoscopy. The ASGE Endoscopy Unit Recognition Program honors facilities that have demonstrated a commitment to specialized training and adherence to ASGE guidelines on privileging, quality assurance and reprocessing, as well as the infection control guidelines of the Centers for Disease Control and Prevention.

To find a gastroenterologist with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org

Eric H. Shen, MD, is board certified in gastroenterology and a member of the medical staff at Penn Medicine Princeton Health.

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