Gastroenterology patients no longer have to travel to Charlotte, Winston-Salem or Durham to benefit from endoscopic ultrasound (EUS) – the most modern and minimally invasive technique used to assess digestive issues. The imaging-guided procedure is now performed locally by Dr. Vinay Patel, a specially trained gastroenterologist who joined Northeast Digestive Health Center in 2013.
“We wanted to provide a service to our patients and the community that wasn’t there before,” Dr. Patel said. “Now, patients don’t have to travel elsewhere to have their advanced therapeutic procedure done. We have the technology and expertise to do it locally.”
As one of only five physicians in the region trained in EUS technology, Dr. Patel has performed more than 500 procedures during his fellowship at the University of Louisville and through his role as EUS director at Carolinas HealthCare System NorthEast, which purchased and houses the equipment.
EUS technology is far-reaching and used for a variety of treatments, including assessing tumors, determining the stage of cancer and if it has spread, identifying stones and masses in the bile duct, draining pseudocysts or other abnormal collections of fluid, evaluating abnormal imaging studies and guiding treatment.
Dr. Patel noted that EUS does not take the place of imaging modalities such as a CT or MRI, but rather it provides a more dynamic and refined view with the opportunity to provide tissue diagnosis and therapeutic intervention immediately.
“If someone has cancer in the esophagus, rectum, stomach, small bowel, pancreas or biliary tree, we can stage it locally, identify it, provide immediate tissue diagnosis and direct therapy,” he said. “Before the patients leave – more often than not – they know exactly what kind of cancer it is, what stage it is and what the next plan of treatment is.”
Additionally, Dr. Patel is using EUS technology for pain intervention and relief through precise targeting of medication. “If a Stage 3 pancreatic cancer patient has pain, we’re able to use EUS to affect the nerves with a neurolysis or a block and help control severe pain and reduce the patient’s narcotic requirement.”
EUS procedures can take as little as 20 minutes or as long as 90 minutes, Dr. Patel said, and there is very low risk of complication. “With this procedure, I never tell a patient how long it’s going to take because I want to be thorough. We are done only when I am satisfied that all the information needed has been gathered.”
In the recent case of a 34-year-old woman, the EUS findings and subsequent treatment was swift and may have helped prevent a longer hospital stay and worsening infection. Just eight weeks after giving birth, the patient developed acute upper abdominal pain and fever. When she arrived at the hospital, she was septic with cholangitis. A CT scan indicated the bile duct was enlarged, but didn’t show the reason why.
“We did an EUS, and in just a few seconds, we were able to tell that there was a stone obstructing the bile duct. We switched her over to an ERCP, took out the stone and relieved the obstruction, thereby treating the infection,” Dr. Patel said. “EUS helped direct the patient’s therapy and likely shortened the course of an infection-related hospitalization.”
Staying on the forefront of new technology is important to the physicians at Northeast Digestive Health Center, but only if the technology helps patients. “There are so many new things coming out – different types of needles, balloons, techniques and technologies – but we have to see what best works for our patients,” Dr. Patel said. “Just because we know how to do something doesn’t mean we should do it, especially if it’s not beneficial or if the risk far outweighs the benefit.”
With EUS, all signs point to continuing advancements. “Although endoscopic ultrasound technology has been around for more than 30 years, it’s only recently become interventional,” he said. “It will continue to evolve and we’re excited to see where this technology takes us to help our patients and improve their outcomes.”