Endoscopic ultrasound (EUS) was initially solely for diagnostic procedures, as it provides unparalleled insight into the structures and organs behind the digestive tract. With more recent innovations that allow active treatment, endoscopic ultrasound increasingly is used as a less invasive alternative to surgery.

Fine-needle aspiration allows your gastroenterologist to use the detailed images from the endoscopic ultrasound to inject medication, drain fluid and collect tissue for biopsy — procedures that often-required surgery in the past.

Therapeutic endoscopic ultrasound procedures are performed while you are sedated and often allow patients to go home the same day.

The board-certified and fellowship-trained gastroenterologists at Norton Healthcare Gastroenterology have been performing therapeutic endoscopic ultrasound for patients in Louisville and Southern Indiana for years.

Endoscopic Ultrasound Celiac Plexus Neurolysis (EUS-CPN)

Pancreatic and stomach tumors can affect the celiac plexus — a bundle of nerves located between the top of the stomach and spine, close to the aorta — causing pain in the upper abdomen and mid-back.

As an alternative to an injection through the skin into the celiac plexus or traditional surgery, the EUC-CPN procedure uses therapeutic endoscopic ultrasound to find the precise cause of the pain. The procedure uses ultrasound to show what is behind the structures. Injections of a corticosteroid and long-lasting local anesthetic are delivered carefully to the exact source of the pain.

Approximately 75% of patients who undergo the EUC-CPN procedure get some degree of pain relief; most patients are able to decrease their need for pain medications, and a few are able to stop them completely.

Endoscopic Ultrasound-guided Drainage

Pancreatitis can cause the flow of digestive juices from the pancreas to become blocked and leak into the abdomen. The body contains the leak by surrounding it with scar tissue, creating a pseudocyst.

A large pseudocyst can lead to pain, nausea and vomiting. Rarely, pseudocysts become infected, bleed and burst.

Pseudocysts may need to be drained with one of three methods: A catheter that drains fluid to the outside of the body, surgery, or endoscopic ultrasound guided drainage.

Endoscopic ultrasound-guided drainage provides the precision needed, as many pseudocysts are close to the stomach and the first part of duodenum. Endoscopic ultrasound-guided drainage also is less invasive and has fewer complications than surgery, doesn’t require a drain coming from the body and has great long-term success rates.

During endoscopic ultrasound-guided pseudocyst drainage, the endoscope and a needle create a pathway from the pseudocyst to the stomach or duodenum, and a stent is used to keep it open. Then, the fluid can resume its normal path into the stomach where it aids digestion.

Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD)

Pancreatic, liver, gallbladder and biliary duct cancers can lead to a blockage of the biliary ducts that carry bile from the liver and gallbladder to the duodenum. Bile helps digest fats, but when the ducts are blocked by tumors the result can be jaundice, which can lead to liver failure.

Endoscopic Retrograde Cholangiopancreatogram (ERCP) commonly is used to drain bile ducts, but in up to 15% of patients the bile duct is blocked by a tumor or previous surgery. Previously, a route that drains the biliary duct to the outside of the body through a catheter or surgery had been the options for treatment.

Endoscopic ultrasound-guided biliary drainage has emerged in the 21^st century as an effective and less invasive alternative. Overall, success rate for this procedure is about 85%, with a 10% to 20% risk of typically mild complications.

The ultrasound-guided endoscope provides images that allow for a precise placement of a stent that will drain bile into the stomach or small intestine.

Endoscopic Ultrasound-guided Liver Biopsy

A liver biopsy may be needed to:

• Diagnose or determine the severity of certain liver diseases (hepatitis B or C, autoimmune hepatitis or nonalcoholic fatty liver disease)
• Determine the amount of cirrhosis — scar tissue — in the liver
• Evaluate a mass seen previously on images such as ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI)
• Monitor a transplanted liver

Traditionally, liver biopsy has been done with a needle inserted through the skin with the patient conscious. After the procedure, the patient would have to remain on their right side for hours and avoid activity for days afterward.

In recent years, better equipment and needles have allowed the use of endoscopic ultrasound to collect tissue samples from liver and elsewhere in the gastrointestinal tract. The endoscopic ultrasound liver biopsy allows the patient to be asleep for the procedure and provides an opportunity to evaluate the upper gastrointestinal tract with the endoscope while also examining the pancreas, gallbladder and bile ducts.

Call your physician if you get a fever, have trouble swallowing, or have pain in the throat, chest or abdomen following this procedure.

If you are unable to keep your appointment or need to reschedule, call our office at (502) 896-4711 at least 48 hours prior to your procedure.

If you are going to be late for your procedure, call the hospital’s endoscopy department. If you are scheduled at Norton Women’s & Children’s Hospital, call (502) 893-1277. If you are scheduled at Norton Brownsboro Hospital, call (502) 446-8200.