Since it was first developed in the 1990s, endoscopic ultrasound (EUS) has been a key tool in the world of gastroenterology and was mainly used as a diagnostic procedure initially.

It is a minimally invasive endoscopic procedure which involves using a special endoscope called an echo endoscope which has an ultrasound probe at the tip. While the probe sits within the lumen of the GI tract, ultrasound is used to see through the mucosal layer to evaluate the deeper layers of the GI tract or structures which are outside of the GI tract but are in close proximity.

EUS can help assess how deep a lesion of the GI tract penetrates, but also allows us to obtain deeper biopsies by guiding a needle into lesions which may arise from deeper layers of the GI tract as mucosal biopsies are often non-diagnostic for submucosal lesions.

Similarly, we can use EUS to guide a needle to biopsy structures outside of the GI tract such as the pancreas, liver, bile duct, and mediastinal, abdominal, or peril-rectal/pelvic lymph nodes.

EUS is the most detailed study when it comes to examining the GI tract, biliary system, and pancreas. It can detect masses or cysts of the pancreas which are often not detected on cross-sectional imaging studies such as CT or MRI.

In recent years, EUS has also been used as a therapeutic procedure, especially since the development of lumen apposing metal stents (LAMS). LAMS are metal mesh stents which are coated in plastic and are dumbbell shaped.

EUS is used to facilitate placement of these LAMS to connect the lumen of the GI tract to the lumen of a nearby organ or structure. They are commonly used for the creation of an endoscopically created cyst gastrostomy for drainage of pancreatic pseudocysts and to facilitate endoscopic necrosectomy for debridement of walled off pancreatic necrotic collections.

Most recently, the FDA has approved the use of LAMS for EUS-guided gallbladder drainage where the stomach or duodenum are connected to the gallbladder lumen and allows the gallbladder to drain into the GI tract.

This is as an alternative to percutaneous drainage and does not require patients to live with an external drain. These EUS guided stents can also be used to drain the common bile duct or can serve as a conduit to access other parts of the GI tract in surgically altered anatomy to facilitate other endoscopic procedures such as ERCP in patients with Roux-en-Y gastric bypass where the excluded stomach can be accessed through the gastric pouch in order for ERCP to be performed in a more traditional manner anatomically.

LAMS can be used to connect the stomach to the jejunum for creation of a gastrojejunostomy in order to bypass the duodenum in the setting of a malignant obstruction. EUS can also be used to help provide more targeted radiation therapy with the placement of fiducials into nearby organs, especially the pancreas.

Here at Marian Regional Medical Center and French Hospital we are proud to offer our patients the most cutting edge technology in the field of Advanced Therapeutic Endoscopy.

This includes luminal and biliary radiofrequency ablation, endoscopic mucosal resection, ERCP, cholangioscopy/pancreatoscopy, intraductal electrohydraulic lithotripsy, full thickness endoscopic resections, luminal stenting, endoscopic suturing, fistula and surgical leak repair, endobariatric procedures (including intragastric balloon placement, revisions of dilation of gastric outlets, dilation of sleeve gastrectomies), as well as the latest technologies in diagnostic and therapeutic EUS in order to meet our patients needs while keeping them close to the comfort of their own home.

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