In March of 1999, Sacred Heart's Endoscopy Lab began performing endoscopic ultrasonography (EUS) that allows physicians to see into and and beyond the wall of the gastrointestinal (GI) tract. EUS combines the techniques of endoscopy and ultrasound examination to obtain images and information about various parts of the digestive tract. Endoscopes are thin, flexible telescopes that allow trained specialists to examine most areas of the gut and to see the lining of the gut on a television monitor. With EUS, doctors learn how far esophageal, colorectal, pancreatic and gastric cancers have advanced. "Staging" the cancers is extremely important to physicians in determining what treatment to recommend. This simple procedure also allows doctors to perform biopsies of lymph nodes and masses.

How is EUS done?
The principle of EUS is simple. An ultrasound probe is miniaturized and mounted on the tip of an endoscope. The flexible endoscope is inserted as usual through the patient's mouth or anus and advanced into the stomach or rectum. At first the endoscopist looks around and takes note of any abnormalities of the lining of the stomach, esophagus, small bowel or rectum, as in regular endoscopy. With a throw of a switch the image changes from the regular 'camera view' to the ultrasound mode. Now, the physician can look through walls. In contrast to regular ultrasound the area of interest is much closer, and the image quality much better.

A Team Approach
Sounds easy, and indeed, patients tolerate it very well. The process takes less than one hour. They receive sedation, remember very little when they wake up in recovery, and go home one or two hours after the test.

Behind the scenes, however, EUS is more complicated. In addition to determining how far the cancer has advanced, EUS is used to obtain biopsies. A team of two nurses, a cytology technician and a pathologist obtains quality tissue samples. A technician from Clinical Engineering keeps the equipment in good working order.

Benefits of EUS
The most frequent reason to do EUS is to help answer the question: Is surgery possible, required or necessary? The next question is: Is it cancer or something else? Obviously, the answers to these questions impact directly on patient care. Studies have shown that EUS can help avoid unnecessary and costly operations that are of no benefit to the patient and are risky. In addition to the above benefits, EUS can also be used to treat cancer pain by a procedure called celiac plexus block.

Spokane: The Northwest EUS Hub
"Spokane needed EUS, and the willingness of Sacred Heart to purchase the equipment was the major reason I came here," says Dr. Klaus Gottlieb, a gastroenterologist with specialized training in ERCP and EUS.

Endoscopic Ultrasound has been a great success in Spokane and Deaconess Medical Center has acquired their own state of the art EUS equipment in March of 2003.

With more than 1,000 EUS exams in Spokane since 1999 Dr. Gottlieb has truly made Spokane the EUS hub of the region.

Asked about the future he says: "I still find that a lot of people, I mean physicians, do not know what EUS can do for them and their patients. This still requires a lot of work."

Indications for Endoscopic Ultrasound