Interventional EUS Research Articles

EUS in combination with fine-needle injection celiac plexus neurolysis from within a Wallstent stent

Increasingly, EUS has become integrated into the management of GI tumors over the past decade.1,2 The development of EUS-guided fine-needle aspiration3-5 and, more recently, EUS-guided fine-needle injection (EUS-FNI) has expanded the clinical utility of interventional EUS.6 EUS is traditionally not used to stage cancers in patients with esophageal or enteral self-expandable metallic stent (SEMS) because such patients have unresectable malignant disease. There is also a commonly held belief that EUS cannot be performed through an SEMS (Fig.

EUS instrumentation and accessories: A primer

Advances in therapeutic interventional EUS and new applications for EUS have led to a number of new devices and accessories for EUS. US systems currently available for endoscopic applications include those that are endoscope-based and those that are catheter-based. The endoscope-based systems are of two basic design types: mechanical radial scanning devices and electronic curved array devices. This article provides an overview of the currently available devices as well as those in development.

3368 Training in endoscopic ultrasound (eus) for practicing gastroenterologists (pgi). the role of tutorial courses.

Introduction: The increased interest in EUS training among PGI has increased the demand for small group EUS tutorial courses. The role of the tutorials in EUS training of PGI is unknown. Aims: To determine 1) a relationship between the characteristics of the referral base and the need for EUS training, 2) the role of the tutorials in development of EUS skills of the attendants, 3) obstacles to developing EUS in clinical practice and 4) methods to improve EUS skills. Methods:Twenty six EUS tutorial courses were conducted at our institution from 4/95-8/99.We surveyed attendants of the tutorials in 10/99. Results:Forty eight percent (63/131) of the attendants completed the questionnaire. The size of their referral base was; 1 million for 27%. Seventy seven percent had a cancer center within the referral base. Most PGI took our course prior to performing any EUS examinations. Thirteen percent had a preference for didactic lectures with direct observation of cases, 12% for animal laboratory training and 75% found both useful. The median number of monthly EUS procedures increased from 0 (Range 0-25) before the course to 4 (Range 0-40) after the course. Forty one percent performed both diagnostic and interventional EUS after the course, compared to only 5% before the course. Seventy five percent sought additional EUS training, either before the course (47%) or after the course (52%); 46% attended additional tutorials, 46% observed additional cases, 72% reviewed books, 74% used CD-ROMs and 20% had hands-on training with an expert. Obstacles to developing EUS in the practice were reported by the attendants; not enough referrals (52%), need for additional training (48%), lack of time (37%), insufficient equipment (34%) and insufficient reimbursement (15%). The attendants also rated methods to improve their EUS skills; hands-on training with an expert (48%), observation of cases (48%), EUS tutorials (47%), CD-ROMs (38%) and video tapes (34%). Conclusions: 1) Most PGI interested in EUS training have a large referral base with a cancer center. 2) The tutorial courses play an important role in their EUS training. 3) The major obstacles to developing EUS in their practice are lack of referrals and need for additional training. 4) The participants rated hands-on training with an expert and direct observation of cases as the most valuable methods to improve EUS skills.

4600 Can a “hands-on” animal course help in learning endoscopic ultrasound.

Purpose: The purpose of this study was to assess the ability of a hands-on animal course in learning EUS as there is a lack of objective data on the utility of animal models for learning EUS. Methods: The first ASGE "hands-on" course in Endosonography was held in 1997 that combined didactic teaching in EUS with hands-on experience in a swine model under the supervision of EUS experts. All 38 attendees were mailed a survey in 1999 (about 2 years after the course). The survey asked detailed questions of about overall usefulness of the course as well as the number and kind of EUS exams being performed by each participant prior to 1997 and over the next two years after attending the course. Results: So far 18 participants of the ASGE endosonography course have responded. 22% (4/18) of respondents have started performing EUS since attending the course, while they were not performing any EUS prior to the course. 39% (7/18) of the respondents were not performing EUS prior to the course and are still not performing EUS. 39% (7/18) of the respondents were performing EUS prior to the course and have continued to perform EUS since then. Among the respondents who were already performing EUS, 43% (3/7) have increased the number of EUS exams per year since attending the course. 57% (4/7) of the respondents already performing EUS prior to attending the course improved the type of exams from luminal EUS only to pancreatobiliary or from diagnostic EUS only to include EUS guided fine needle aspiration. Overall, 50% (9/18) of the respondents either started doing EUS after the ASGE course or if they were already doing EUS, increased the complexity of EUS (e.g. diagnostic only to interventional EUS) or increased the number of EUS exams per year. 94.4% of respondents stated that the course was useful in their EUS education. 77.7% of the respondents stated that both the didactic and hand-on sections of the course were useful. 72% of the respondents stated that they were willing to take a similar course in the future. Conclusions: Hands-on EUS training in an animal model in the presence of experts when combined with didactic education in EUS is a promising method to increase the number of physicians performing EUS. This is especially important since formal hands-on training opportunities in patients are limited and EUS is available only to a small percentage of physicians in United States.