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Outpatient Procedure Used to Diagnose Life-Threatening Disease

HCA Midwest Physicians October 17, 2013

Dr. Syed Jafri, gastroenterologist with Kansas City Gastroenterology and Hepatology Physicians Group

by Linda Cruse, special sections contributing writer | Paid Advertising Supplement, Kansas City Star Magazine

An outpatient procedure called endoscopic ultrasound can detect life-threatening digestive tract and lung diseases early, thus helping save patients' lives.

One such patient is Igor Boulatnikov, 46, a senior research scientist at the University of Kansas Medical Center. He underwent an endoscopic ultrasound (EUS) in 2002 after several months of experiencing discomfort while swallowing food.

Boulatnikov, of Lenexa, was diagnosed with stage 0 esophageal cancer. Because the cancer was caught so early, he underwent successful surgery and has been cancer-free for 11 years.

"My cancer was caught in its initial stage before it had the opportunity to spread," he said. "I don't believe any other method would have been able to detect it so early. I believe the EUS may have saved my life."

Boulatnikov's physician, Dr. Mojtaba Olyaee, division director of gastroenterology at the University of Kansas Hospital, said EUS combines the technologies of endoscopy and ultrasound.

EUS improves a physician's ability to diagnose and assess gastrointestinal (GI) cancers, he said, because specialists can examine not only the lining, but also the entire thickness of the wall of the upper or lower gastrointestinal tract. The result is early detection of cancer, which allows for better treatment options.

Olyaee said EUS is effective because high-frequency sound waves provide detailed images of the lining and walls of the gastrointestinal tract as well as nearby organs including the lungs, stomach, pancreas, liver and gallbladder.

"EUS allows us to see behind the GI walls to the nearby organs," said Olyaee. "The technology not only allows us to do better diagnosis and staging of cancers, the high-resolution views assist with conducting biopsies and delivering treatment."

EUS assesses the depth of the cancer and can diagnose the spread of cancer to adjacent lymph glands, he said. Also, EUS-guided, fineneedle aspiration can be used to obtain biopsies and deliver treatment, including chemotherapy and pain medication.

EUS advances

Physicians said improved imaging techniques, a growing awareness of the effectiveness of EUS as a diagnostic tool and the practice of convening groups of specialists to analyze and make recommendations regarding individual cases are resulting in earlier diagnoses, better outcomes and fewer invasive surgeries.

Dr. Syed Jafri, gastroenterologist with Kansas City Gastroenterology and Hepatology Physicians Group, part of Midwest Physicians, said new equipment and elastography, a new imaging technique, allows for better detection of cancerous versus non-cancerous tissue. Elastography is used both at Menorah and KU.

"By updating our equipment several months ago we have even greater diagnostic capability," he said. Jafri said EUS allows physicians to diagnose the cause of pain in the digestive tract and view tumors in the pancreas, bile ducts and chest cavity.

Dr. Nicholas Szary, gastroenterologist at Kansas City Gastroenterology and Hepatology Physicians Group, said EUS is used daily to diagnose GI issues. Recently, the use of EUS resulted in a pancreatic cancer diagnosis for one patient, while another patient was spared invasive surgery when a EUS procedure determined that her lesions were not cancerous.

"EUS is being used more often because it's the most sensitive way to diagnose GI diseases," he said. "The probe can be placed right next to an organ and ultrasound technology provides detailed views to the physician."

Szary underwent one year of special EUS training and was involved in numerous studies involving the use of EUS to diagnose pancreatic diseases, including cancer. "Thanks to EUS we're finding diseases of the pancreas much earlier, which is resulting in better outcomes," he said.

Two patient's stories

One patient recently diagnosed with pancreatic cancer by EUS is Debbie, a 55-year-old Overland Park nurse. Because she wants to keep her diagnosis private, Debbie asked that only her first name be used.

Debbie said that she had GI symptoms for some time and in October 2012 had her gallbladder removed . "But I didn't improve after the surgery," she said . "I still felt a tightness like a big rubber band around my upper abdomen."

Debbie was referred to a GI specialist, who conducted a CT scan. The scan revealed a mass, so she was referred to Jafri.

"He performed a biopsy as part of the EUS, and the diagnosis was pancreatic cancer," she said . "I started chemotherapy with in a week and I'm currently in my fourth week of treatment." Debbie is scheduled to undergo seven weeks of chemotherapy and 28 weeks of radiation.

Jafri said Debbie's EUS results enabled physicians to determine the stage and type of Debbie's cancer. "The tumor had attached itself to the stomach wall but had not spread to other organs, so the decision was made to start chemo right away," he said.

Debbie said she was fortunate because the EUS indicated there was no evidence that the cancer had metastasized and spread to other areas. "I'm realistic, but I'm going to remain positive until I'm told otherwise," she said.

Another patient, 71-year-old Lenora Hunter of Kansas City, received good news after undergoing EUS. She entered the hospital earlier this year after having problems breathing.

Test results revealed that she had a spot on her pancreas and lung. She was referred to Szary, who performed a EUS procedure at Menorah Medical Center. During the procedure a EUS-guided fine-needle aspiration biopsy was performed.

"The results indicated that I don't have cancer," she said . "I'm very fortunate because I won't require treatment. And the EUS procedure will be used in the future so they can keep monitoring me."

Both women said they remember very little of the EUS procedure. They were sedated using a technique called conscious sedation, which involves a combination of relaxation and pain medication.

"I remember laying on a table and then waking up and talking to the doctor," Debbie said . "I didn't experience any pain or discomfort. And I felt confident the procedure had given my physician the information he needed to make the correct diagnosis."

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