Endoscopic Ultrasound (EUS) is the newest and most effective technology in diagnosing and staging cancers of the lung, esophageal, gastric, rectal and pancreatic cancers. Thanks to gastroenterologist Dr. Pardeep Nijhawan, who has trained in the use of EUS at the Mayo Clinic, York Central Hospital is one of the first community hospitals in Canada offering this state-of-the-art technology to more accurately diagnose a wide variety of gastrointestinal disorders.
“Probably the most important feature of this technology for both patients and physicians is its ability to not only identify cancers and other illnesses, but to more accurately gauge the stage of development of the cancer. This information helps the physician to identify the most effective form of treatment in the quickest and most non-invasive manner,” says Dr. Nijhawan.
For many years physicians have relied upon a variety of imaging modalities to help with staging of malignancies. One of the biggest obstacles in staging cancers pre-operatively has been the limited ability of CT scans to provide enough information to accurately assess the stage of development for esophageal, gastric, hepatic, pancreatic and rectal lesions.
“With the use of EUS we can substantially reduce the need for exploratory surgery, and the associated stress and discomforts for our patients, to confirm and stage cancerous lesions. Once the diagnosis is made, the physician and patient can review their options together knowing exactly where the cancer is located and how far it has progressed,” adds Dr. Nijhawan.
With this additional diagnostic tool added to York Central Hospital’s already impressive array of diagnostic imaging capabilities, the Hospital moves into a select group of Canadian hospitals to offer this new technology to its patients.
Although Endoscopic Ultrasound is now routinely included in treatment and management practices in the United States, only a handful of hospital centres in Canada offer EUS. Over the past few years EUS has become widely accepted across the world for the purpose of staging. The use has increased as the technology has improved and costs have dropped accordingly.
Why EUS? How does it work?
EUS typically portrays the gastrointestinal wall as consisting of five echo layers. The high resolution of the endosonography allows for the differentiation of these layers without the distortion or dissection of the surrounding tissues. With this enhanced ability to view the lesion, the physician can easily assess whether the lesion originates in the gut wall or is a result of pressure from an adjacent structure – an important distinction in identifying the most effective treatment.Until recently endoscopists have had to rely on visual inspection and manual manipulation with the biopsy forceps to evaluate submucosal lesions. The endoscopic appearance alone rarely yields an exact diagnosis, and standard biopsy techniques are usually insufficient to obtain histologic material for diagnosis. With the assistance of EUS, an ultrasound image is obtained which enables the physician to assess the internal architecture of the lesion and to trace the echo layers of the tissue wall to determine in which layer the lesion originated.
Understanding the Benefits of EUS
Although not appropriate for every endoscopic patient, EUS represents a significant break through in endoscopic capability. It is safe, simple and cost effective. Some of the potential uses identified for patients at York Central Hospital include the:
- staging potential tumour involvement of esophageal lesions which are long known to be difficult to evaluate regarding spread into the mucosa, submucosa, muscularis and serosa;
- staging of Barrett’s esophagus to decide which patients need observation, surgery, photodynamic therapy or endoscopic resection;
- presence of lymph node around the esophagus;
- measuring the therapeutic effects of esophageal varices as suggested by several recent studies;
- staging of gastric cancers and potential tumour spread;
- analysis in the depth and pathophysiolgoy of submucosal ulcers;
- staging pancreatic cancer with possible spread locally and to lymph nodes;
- diagnosing vascular infiltration and organ infiltration in pancreatic cancer;
- search for the cause of bile duct and pancreatic duct dilation;
- staging of colon/rectal cancers in terms of potential tumour involvement and spread;
- decision to use EMR for gastric lesions; and
- detecting the presence or absence of lymph node.
York Central Hospital Quickly Becoming Endoscopy Leader
York Central Hospital’s team of three gastroenterologists is one of the most progressive in the country. In addition to the EUS, as well as traditional endoscopic scope capability, the team is also able to offer another leading edge capability, that of Capsule Endoscopy to patients through Dr. Nijhawan’s private office. With access to this extremely comprehensive range of services, York Central Hospital is actively fulfilling its commitment to provide progressive care ‘closer to home’.