DIAGNOSTIC FACILITIES

Endoscopic Ultrasound

One of the latest tools that the gastroenterologist has at his or her disposal is endoscopic ultrasound. This very new equipment is used both in diagnosis and in treatment.

A miniature ultrasound transmitter or transducer is fitted at the tip of an endoscope and introduced into the oesophagus (with the patient under sedation) just as a normal endoscope. With the ultrasound switched on and depending on the type of ultrasound transducer fitted, the gastro enterologist can see, on a screen, ultrasound pictures of the organs surrounding the oesophagus and the stomach and even into and around the pancreas. Both 360 degree directional scans can be carried out.

If the doctor identifies and abnormality he or she can take a sample using a needle in the tip of the endoscope and send this sample off for further investigation. The location and size of any abnormality can be pictured and mapped and with the result of the biopsy, doctors can make more precise decision over treatment regimes. After a short period of recovery a patient can leave and treatment can begin within a day or two of the test results being obtained.

This procedure is often far faster and certainly less distressing to a patient than open surgery carried out to obtain the same samples and diagnosis. The equipment can also be used to treat some conditions affecting the pancreas.

Two case histories to illustrate the capabilities of Endoscopic Ultrasound at The Wellington Hospital by Dr Ray Shidrawi.

Case History No 1

A 73 year old man from Switzerland was diagnosed with cancer of the stomach and underwent a subtotal gastrectomy in October 2005. Recently, he developed symptoms of gastro-oesophageal acid reflux and weight loss. He underwent two gastroscopies in Geneva that were reported as normal. An abdominal CT was also reported as normal. At preliminary endoscopy at the Wellington, he had a large gastric residue suggestive of gastric outlet obstruction and a stricture of the gastro-jejunal anastomosis without evidence of mucosal recurrence. A radial EUS examination identified thickening of the peritoneum resulting in extrinsic compression at the anastomosis. Subsequent biopsy of this thickened area confirmed a local recurrence of his disease and he underwent enteral stenting to allow feeding. He is now undergoing chemotherapy, is managing a pureed/soft diet and is maintaining his weight.

Case History No 2

A 52-year-old man complained of paroxysmal severe vomiting for the past two years. He has been extensively investigated in the past, including laboratory investigations during an attack, two CT scans, 4 gastroscopies, abdominal ultrasound, abdominal MRI scan and had been seen by several specialists over this period. Notably, he underwent a cholecystectomy eight years ago. Radial EUS confirmed the presence of a small gallstone impacted at the distal end of an undilated common bile duct. He subsequently underwent therapeutic ERCP and endoscopic sphincterotomy to extract gallstone debris that had accumulated within his biliary tree since his cholecystectomy. He has not had any further severe vomiting since his ERCP carried out at The Wellington GI unit.