Endoscopic Ultrasound Enables More Accurate Diagnosis of GI Cancers at WHS Washington Hospital

Endoscopic Ultrasound Enables More Accurate Diagnosis of GI Cancers at WHS Washington Hospital
By Nancy Kennedy

At Washington Health System, a diagnostic imaging technology is making it possible for residents of the community to receive state-of-the-art diagnostic cancer care, close to home. The technology, endoscopic ultrasound or EUS, provides a far more informative image of internal organs than standard ultrasound, facilitating earlier detection and more accurate diagnosis of colorectal, gastric, esophageal and pancreatic cancer and other gastrointestinal diseases. “Until now, people who needed to have this procedure had to travel into the city to one of the big medical centers,” says Manhal M. Tannous, M.D., a gastroenterologist on the medical staff of WHS Washington Hospital. “It’s very helpful for the patient to be able to remain in their own community to receive care. It reduces stress and costs and makes the entire experience easier.”

Conventional ultrasound uses sound waves and their echoes to produce pictures of organs, using a wand-like probe called a transducer that a technician passes over the skin. An endoscopic ultrasound probe differs in that the transducer is in the tip of the endoscope, allowing it to be placed internally. A computer converts the echoes from the sound waves into images for physicians to view. While conventional endoscopy only provides a view of the innermost lining of the digestive tract or its wall, the addition of ultrasound allows the physician to see beyond that wall to visualize all five layers of the GI tract as well as surrounding tissue and organs. From a clinical perspective, this means that an abnormality below the surface of the digestive tract wall can be further evaluated under EUS, helping doctors better understand its nature.

EUS provides detailed visualization and precise information that guides treatment decisions, and is very useful in the diagnosis and staging of gastrointestinal cancer. (Staging refers to the identification of how far the cancer has progressed, from Stage 1 through Stage 4). “With EUS, we are able to reach hard-to-reach organs such as the pancreas which is tucked in behind other structures,” Dr. Tannous explains. “The EUS probe gives us ultrasound inside the body instead of outside. Plus, we are able to take biopsies with it. By improving the detection of cancer, the EUS is leading to better outcomes.” Dr. Tannous and his colleagues have been using EUS for a year now and are pleased with its capacities.

The EUS procedure involves mild sedation and is performed as an outpatient procedure. There is no incision, no pain and minimal risk of complications. “With any procedure, there is risk. But with EUS that risk is low,” Dr. Tannous says. EUS is also useful in locating common bile duct stones and evaluating masses in the lining of the GI tract or in the stomach folds. EUS can also be used for therapeutic applications, such as tissue sample collection, cyst drainage or biopsy of lymph nodes, making it an ideal minimally invasive alternative to exploratory surgery.

Dr. Tannous joined Washington Health System in August 2017. He is board-certified in both Internal Medicine and Gastroenterology; he completed a residency in Internal Medicine at Cleveland Clinic Health System and a fellowship in gastroenterology including training in endoscopic ultrasound procedures at the Medical College of Virginia, of Virginia Commonwealth University. He spent several years in Iowa before coming to the Pittsburgh region. He lives in Peters Township with his wife and three children. Dr. Tannous practices with Southwest Gastroenterology Associates.

According to the American Cancer Society, for 2019 the estimated number of newly diagnosed cases of GI cancer in the United States was more than 328,000. “EUS technology enables earlier detection of GI cancers and other diseases, without surgery, leading to better outcomes for patients,” says Dr. Tannous. “It is less invasive and improves diagnostic accuracy. At Washington Health System, we are pleased to be able to offer the EUS system to our patients, right here, in their own community hospital.”

Symptoms of Gastrointestinal Cancer

Many cancers of the gastrointestinal organs do not produce symptoms at the beginning, because the tumors are small and can grow into the empty spaces in the GI tract before they become symptomatic. Cancer can develop in the esophagus, stomach, small intestine, colon, rectum, liver and pancreas. Many of these cancers have the same symptoms because the GI tract is one continuous system.

The following signs or symptoms are general and may indicate cancer:

Rectal bleeding with bright red blood
Narrower than normal stools
Unexplained abdominal pain or swelling
Nausea and vomiting
Unexplained changes in bowel habits
Unexplained anemia
Unexplained weight loss
Weakness and fatigue
Loss of appetite
Difficulty swallowing
Feeling full after a small meal

These symptoms may be caused by other benign diseases such as hemorrhoids, infection or irritable bowel syndrome. Patients who experience any of these symptoms for more than a few days should talk with their PCP or a gastroenterologist.

Risk factors for GI cancers include a family history of GI cancer, obesity, poor diet, high fat diet, smoking, excess use of alcohol, certain polyps, multiple family members with certain other cancers (uterus, bladder, stomach, etc.), age over 60 or a history of inflammatory bowel disease.

Source: American Cancer Society www.cancer.org