Esophageal cancer is one of the less common types of cancer, but, as recent studies have shown the disease to be on the rise in the United States the necessity of developing gastroenterology procedures such as endoscopic ultrasound (EUS) to stage lesions has become increasingly more relevant. Endoscopic ultrasound allows a doctor to predict what type of treatment is necessary for a cancer patient. It is particularly important in determining how far along or metastasized a cancerous lesion has become in order to predict whether surgery or chemotherapy will be effective. For example, if the minimally-invasive endoscopy test shows that an advanced cancer cannot be removed with surgery, then the patent may be able to move forward with radiotherapy without risking any repercussions of initial surgical intervention.

Among gastroenterology students training to practice medicine today, EUS is becoming more of a standard procedure in fellowship curriculum. In fact, due to the introduction of medical imaging and radiology technique in GI, more endoscopy procedures are being taught to young doctors to accommodate the growing body of knowledge within the field of gastroenterology.

“Now programs are much more discriminating,” said Ahmad Cheema, M.D., referring to the fact that advanced endoscopic procedures as EUS and ERCP (endoscopic retrograde cholangiopancreatography) were not normally taught, except to some third-year fellows, while he was in school.

Dr. Cheema completed Gastroenterology and Hepatology Fellowships at Loyola University in Maywood, Illinois and currently practices in Moline, Illinois. He has years of field experience performing ERCP as well as EUS, although he did mention that newer GI students training now receive much more early practice with these complex procedures than was available back then.

Anand Madan, M.D. said that endoscopic ultrasound is particularly useful when ERCP, a very delicate and more invasive procedure, cannot be performed on a patient. Performing EUS allows a physician to determine whether localized radiation will be an effective form of treatment for patients with esophageal, rectal or gastric cancer. In many cases EUS is used before PET/CT scans to see how much a cancerous tumor has advanced. Endoscopic ultrasound is also utilized in draining billiary blockage, draining cysts and staging of pancreatic cancer.

“[EUS] is one of the most non-invasive tests that have come out… it’s becoming a standard of care before surgery,” said Madan, noting that endoscopic ultrasound has multiple uses, some still experimental, and that reimbursements for standard EUS procedures are usually approved by most insurance companies.

Dr. Madan received his medical degree in India. He completed his Residency in Chicago, Illinois at Mercy Hospital and Medical Center and his Fellowship at the Southern Illinois University School of Medicine. He trained to perform ERCP and EUS during an advanced endoscopy fellowship at UC Davis in Northern California. Dr. Madan is now an independent practitioner in Roseville, California.

Written by Gastroenterology.com Administrator 1/26/12