Initial experience with endoscopic ultrasound

Abstract

Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4±20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n=165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n=6), Gall stones (n=12), Biliary ascarrisis (n=22), Choledocholithiasis (n=42), Acute Pancreatitis (n=9), Chronic Pancreatitis (n=15), Pancreatic pseudocysts(n=4) (B) Malignant Pathologies : GB Carcinoma(n=4), Cholangiocarcinoma (n=29), Capancreas (n=9 ), Periampullary carcinoma ( n=12).Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n=9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n=2) for restaging or recurrence after chemoradiation and 21% (n=4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, 07 were for staging of gastric carcinoma, 04 were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and 02 for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.