More than an image: Endoscopic ultrasound helps with outcomes, treatments of cancer
The use of endoscopic ultrasound technology is changing the discovery, staging and treatment of several types of cancer.
As a regional leader in cancer care and one of the most advanced cancer care centers in the nation, Via Christ Health recently became one of the few healthcare providers in the region to offer endoscopic ultrasound or EUS. As the first healthcare provider in the area to use da Vinci robotics surgery and the only provider of CyberKnife targeted radiation therapy, Via Christi has an established track record of offering state-of-the-art technologies to treat area cancer patients.
“We acquired this equipment at the request of physicians, who saw this is as a way to provide high-tech care to area patients close to home,” says Suzanne Richards, Via Christi Hospitals in Wichita's manager of Special Procedures Services. According to 2010 National Research Corporation statistics, more people in Wichita prefer to get their cancer treatment at Via Christi.
“This gives patients the option of receiving care from a local physician and of getting a quicker diagnosis. That can potentially change their entire treatment plan,” Richards says.
Almost as soon as Dr. Akshay Gupta joined Kansas Gastroenterology, a private physicians' practice, in July, he was using Via Christi's EUS equipment. Among his first 15 cases within six weeks of usage, he staged a case of esophageal cancer, diagnosed bile duct cancer — a particularly difficult and uncommon cancer to detect, and removed a small precancerous tumor from an elderly patient’s esophagus who wasn't healthy enough to survive a traditional surgery. With EUS' ability to detect cancer in the lymph nodes, he recently diagnosed a case of lymphoma.
With EUS equipment, a small ultrasound device is built into the end of the flexible endoscope, which can be inserted into the patient through the mouth or the rectum. The physician views two monitors — one showing the camera image of the internal organs and the other showing the ultrasound image. A third monitor can be used to capture X-rays.
The benefit of a scope with ultrasound capabilities is that the physician gets more detailed and better visualization of the patient's organs with a view from inside the gastrointestinal tract, rather than from outside the body, Gupta explains. Another benefit is that it can capture images in hard-to-reach areas, where cancer can often go undetected. It's considerably less invasive than exploratory surgery, as well.
It's proven particularly effective in patient outcomes in cases of pancreatic cancer. A study published in the July 2010 issue of GIE: Gastrointestinal Endoscopy, a peer-reviewed journal of the American Society for Gastrointestinal Endoscopy, found that EUS is associated with improved outcomes in patients with localized pancreatic cancer because of its ability to help detect the cancer in early stages, when treatment options can be more effective.
EUS usage goes far beyond its ability to see inside the body, adds Gupta, who was EUS-trained on more than 650 cases during his one-year fellowship of advanced endoscopy at Moffitt Cancer Center in Tampa, Fla.
In recent years, EUS has moved from being a primarily diagnostic imaging technology to one that can deliver treatment and even pain management options. It can be used in biopsies, ablation procedures, and for installing drainage tubes or stents and injecting ablation agents.
During EUS biopsy procedures at Via Christi, a pathologist is present to provide an immediate diagnosis.
In cases such as chronic inflammation of the pancreas or pancreatic cancer, EUS can be used to inject anesthetics and steroids into the celiac ganglia, a nerve mass in the abdomen, to prevent pain signals being transmitted to the brain, Gupta says.
Using EUS, a physician can place markers within a tumor to help a radiation specialist provide targeted radiation treatment.
“With cancer patients, often the most important concern is can the cancer be taken out or removed from the body,” says Gupta. Using EUS, a cancer can be staged and a better treatment plan can be developed. For example, sometimes a patient may undergo surgery and during surgery the surgeon may find that the cancer has already spread to adjacent organs, and can’t be resected. “EUS can prevent these instances by providing this vital information preoperatively.”
Most EUS procedures have about a 1 percent risk of complications, Gupta says. The patient is sedated, and a procedure can last from between 30 minutes to two hours, with the average procedure lasting one hour.
Via Christi EUS procedures are done at its hospital on St. Francis, which is also home to its year-old Cancer Institute. The EUS unit is mobile, allowing Gupta and other physicians to use it in an operating room, the endoscopic unit or even an intensive care unit.
“It really is an effective technology and it gives us another tool to diagnose and provide therapeutics for our patients,” Gupta says.