An inside look: St. Joseph’s Hospital in London is one of few centres in Canada performing endoscopic ultrasound.

For more than 15 years, John Gamba has put up with bouts of light-headedness, numb lips and tongue, confusion, seeing spots, feeling week and other worrisome, often debilitating, symptoms.

Visits to the emergency department and specialists in Sault St. Marie turned up nothing. An ultrasound and CAT scan turned up nothing. The 74-year-old was told it was nothing.  Turns out, it was something.

On his own, Gamba figured out that the episodes coincided with low blood sugar levels but still getting no answers he coped, chalking it up to old age. Finally referred to St. Joseph’s Hospital in London, endocrinologist Dr. Ruth McManus discovered an imbalance between Gamba’s glucose and insulin levels and knew who could pinpoint the source.

The last piece of the puzzle was uncovered at St. Joseph’s Endoscopy Clinic, where a tiny camera at the end of a long tube in the hands of a leading Canadian expert is saving lives.  Gamba is a beneficiary of endoscopic ultrasound (EUS), a novel procedure growing in demand and brimming with possibilities.  St Joseph’s is one of few centres in Canada offering the procedure.

EUS combines endoscopy and ultrasound to obtain images of the digestive tract and surrounding tissue and organs, explains St. Joseph’s gastroenterologist and EUS specialist Dr. Nadeem Hussain.  A flexible tube equipped with a tiny camera and a miniaturized ultrasound probe at the tip is inserted via the mouth or rectum into the body to provide crisp, detailed views as the tube travels inside.

With regular ultrasound, images are taken through the skin and can’t capture fine details of organs, explains Dr. Hussain. “With EUS, it’s like the patient has swallowed a mini-ultrasound machine. The ultrasound probe is so close to the structures it can view tiny abnormalities in and around the esophagus, stomach, large bowel, small intestine, pancreas and other areas.”

Using EUS, Dr. Hussain can guide a special needle into suspicious lesions or cysts to take samples for testing. The information is used to diagnose diseases such as cancer and determine how advanced it is so that treatment can be tailored to the patient.

“We can get at structures that are hard to reach without surgery or a hospital stay. It’s minimally invasive and people can get on with their treatments and lives quickly.”

Still an emerging specialty, EUS holds promise as a way to inject agents to treat cancer and other diseases or control pain, says Dr. Hussain, who performs about 250 EUS procedures a year at St. Joseph’s. With Dr. Brian Yan recently joining the team, the program is growing.

“This is what I live for – helping patients live better and healthier lives,” says a passionate Dr. Hussain, who was pivotal in diagnosing Gamba with a tiny, benign pancreatic tumour. Surgery is expected to completely eliminate his condition.

“Life will improve greatly,” says Gamba’s grateful wife Yolande. “If it wasn’t for Dr. McManus and Dr. Hussain, we’d still be in the dark. We’re thrilled we went to London.”

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