Endoscopic Ultrasound
Better Safe Than Sorry
After watching her parents struggle with colon cancer and her grandmother with esophageal cancer, JoAnn Pike of Norfolk feared a similar scary diagnosis might loom in her own future. As a result, she made sure to remain under the close supervision of a gastroenterologist. Last winter, thanks to her proactive attitude and the careful attention of her doctors, JoAnn had a precancerous lesion removed from her small intestine, which never would have been found had she taken a passive stance toward her health.
“It was an easy procedure and if they hadn’t done it, I would’ve ended up with some kind of cancer down the road,” she notes.
JoAnn, 70, a retired teacher, underwent an endoscopic ultrasound (EUS) at Milford Regional. This procedure allows a doctor to obtain images and information about the digestive tract and the surrounding tissue and organs.
JoAnn had been seeing Gastroenterologist Albert A. Crimaldi, MD, for ten years, since relocating from Oklahoma. She initially needed care for liver issues, which were resolved but required occasional blood tests as a precaution. Due to her family history, JoAnn continued to see Dr. Crimaldi for follow-ups. Last winter, her acid reflux symptoms caused Dr. Crimaldi to order endoscopy testing that revealed a small hernia and polyps near the gall bladder. The polyps were removed, but to obtain a broader view on another suspicious lump, he referred JoAnn to Stephen Rotman, MD, his colleague at Milford Gastroenterology Associates, Inc., for an endoscopic ultrasound. Upon the recommendation of her trusted longtime gastroenterologist, JoAnn didn’t hesitate to make an appointment with Dr. Rotman. She was not disappointed.
Dr. Rotman is just a really personable, nice man,” JoAnn states. “He explains everything really well. He was very patient, and you can tell he knows what he is talking about. Sometimes when you get a doctor, they have one hand on the doorknob… not this doctor. The physician group and their staff are first-rate. It feels like family as I’ve been going there for so long.”
Dr. Rotman describes the EUS procedure as ultrasound technology from the inside, as opposed to traditional ultrasound which creates images from outside the body. Like with an endoscopy, the doctor passes a thin, flexible tube through the patient’s mouth and into the digestive tract. A small ultrasound device in the tube produces sound waves that create a precise image of internal organs such as the pancreas, liver, bile ducts, and lymph nodes, which are then projected onto a large computer screen.
“An endoscopy looks inside the GI tract, while the EUS lets us see outside of it behind the wall of the stomach or small intestine to the organs that are deeper,” explains Dr. Rotman. “The detail is much finer than with other tests like a MRI, CAT scan, or a regular ultrasound. People can have lumps and bumps in the GI tract, and the ultrasound gives us a tool to see where those are sitting and to see underneath the lining. It’s also a very sensitive way of looking for gallstones, and if we find any we can take them out at the same time.”
Dr. Rotman used the EUS technology to determine that JoAnn’s three-centimeter lesion wasn’t deep in the wall and performed an endoscopic mucosal resection while she was still under sedation. This additional procedure removes early-stage cancer and precancerous growths from the lining of the digestive tract.
“We were able to see that it was superficial and safe to remove, so we were able to take it out right then and there rather than take a sample,” he says.
Ultimately, since the lesion was precancerous, no other doctors needed to get involved. Depending on the findings from EUS, patients may be referred to a surgeon and/or oncologist. Dr. Rotman notes that reasons for undergoing an endoscopic ultrasound include family history of pancreatic cancer, a history of inflammation or cysts in the pancreas, or if another test shows an abnormality as in JoAnn’s case. Many patients will first undergo an endoscopy, often for symptoms such as pain or bleeding, and be scheduled for the ultrasound if their doctor wants further evaluation. Other times, Dr. Rotman performs both the endoscopy and the ultrasound during the same session.
“We see people in their twenties with pancreatic cysts we have to figure out, and people in their nineties with new growths and stones,” relates Dr. Rotman. “Some cysts are benign and others are not. With the ultrasound, you can measure it, determine where it is, whether there is anything inside it, and take a sample.”
Patients typically undergo deep sedation as they would for a colonoscopy or endoscopy and go home the same day. According to Dr. Rotman, most of the ultrasounds take between 30-to-60-minutes. In addition to being a diagnostic tool, EUS can also be helpful in other ways.
“You can place little markers inside of a tumor to give the radiation doctors a target to see what they’re treating, or you can drain fluid collection,” Dr. Rotman says. “Some people with pancreatic cancer have abdominal pain, and we can do a nerve block to numb the sensation of pain. The list of therapeutic opportunities has grown significantly.”
After JoAnn’s lesion was determined to be benign, the next step was scheduling her for the PillCam SB, an ingestible capsule device equipped with a miniature video camera to visualize the small intestine.
“There’s about 20-30 feet of the small intestine that you can’t see even with EUS,” explains Dr. Rotman. “We did the PillCam to check and make sure there were no other polyps in the small intestine.”
That test showed no additional problems. JoAnn is thankful to have Milford Gastroenterology Associate’s physicians following her so closely to monitor any other abnormalities that might occur. She also praises the hospital for making her feel safe and comfortable during all her procedures.
“My husband and I have both been to Milford Regional for a number of things, and we’ve been so pleased with the care we’ve gotten and the people we’ve encountered at the hospital,” she says. “They make it easy from the minute you walk in the door. We went to another hospital when my husband fell in Boston, and there’s a difference . . . everything took forever.”
JoAnn relishes time spent with her grandchildren and hiking with her husband at Stony Brook Wildlife Sanctuary. She encourages others to not take such peaceful times for granted.
“If something comes up, don’t be afraid to go get it examined,” she says. “I’m very grateful for the care that I received, and think being proactive is always better.”
Read more about Stephen Rotman, MD
