Listen in as Dr. Pushpak Taunk discusses all things EUS from new applications, identifying treatable disease processes, efficacy of interventional EUS procedures, and comparing efficacy of current approaches.
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Release Date: June 14th, 2022
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Innovations in Endoscopic Ultrasound - The Role of Interventional Endoscopic Ultrasound (EUS) in GI diseases
Featuring:
Pushpak Taunk, MD
Pushpak Taunk, MD is Director of Endoscopy, Morsani Ambulatory Surgery Center Division of Digestive Diseases and Nutrition University of South Florida Morsani College of Medicine
Transcription:
Prakash Chandran: When you see a doctor with a little camera on the end of a long tube, the main question people want to ask is where's this going and why is it necessary? But even though it seems intimidating, endoscopies including innovations in endoscopic ultrasounds are very useful nonsurgical procedures that can find an array of problems.
Here teach us more is Dr. Pushpak Taunk, Director of Endoscopy at the Morsani Ambulatory Surgery Center, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine and Tampa General Hospital.
Welcome to MD cast by Tampa general hospital, a go-to listening location for specialized physician to physician content and a valuable learning tool for world-class healthcare.
I'm your host, Prakash Chandran. So Dr. Taunk, thank you so much for joining me today. I guess I wanted to just start with what is endoscopic ultrasound and how is it typically used for patients?
Pushpak Taunk, MD: Thanks for having me on. Endoscopic ultrasound or EUS is actually a procedure where there's an ultrasound probe attached to the tip of an endoscope. And we then take that endoscope, it goes through the mouth and into the digestive tract and are actually able to see through the layers of the digestive tract as well as all the organs that surround the stomach and the intestines, specifically the liver, the pancreas, the biliary tree.
EUS was actually initially developed to both diagnose and stage a lot of gastrointestinal cancers and tumors. So with endoscopic ultrasound, we can actually look at the depth of various tumors and see their relationship to other organs and blood vessels and all that information that we get helps the surgeons and the oncologist create a good treatment plan for patients.
Prakash Chandran: That is so cool. So, I mean, how long has endoscopic ultrasound been around and what was done before this was invented?
Pushpak Taunk, MD: Yeah, that's a good question. So endoscopic ultrasound was really developed probably over, you know, 25, 30 years ago. But it really didn't come into common practice until the early, you know, 1900s. Before endoscopic ultrasound, it used to be really surgery. Surgeons would often open up the abdomen to kind of look for invasion of tumors into different areas. And obviously, that's a pretty morbid thing to do to sort of diagnose and stage cancers. So, you know, EUS is really cool when it first came out.
Prakash Chandran: Yeah, absolutely. So I'd love for you to tell us about some innovative applications for endoscopic ultrasound that improve patient care at Tampa General Hospital.
Pushpak Taunk, MD: So one of the things that has really evolved with EUS is it has gone from a diagnostic tool to a therapeutic tool. So at first, we used it to sort of just diagnose different conditions with it, but now we can actually treat various GI disorders with it. You know, I'll give you an example. For example, patients that have pancreatitis, which is inflammation of the pancreas, they can often develop these pancreatic fluid collections in the abdomen. They're kind of like abscesses within the abdomen. And they used to be treated surgically, so patients would have to be opened up and that abscess would have to be removed. But now, with endoscopic ultrasound, we can actually put a stent between that collection and the stomach, and that whole thing will sort of drain through that stent into the stomach. And so it's all done internally, which is, you know, really some of the cool stuff that we're doing, is we're doing some of these pseudosurgical procedures but without making any cuts or nicks anywhere on the outside.
Prakash Chandran: Yeah, that sounds incredible. And, you know, apart from what you just described, are there other specific diseases that can be treated with this interventional endoscopic ultrasound?
Pushpak Taunk, MD: Yeah, there are actually a couple, you know, diseases that we can now treat. You know, I guess I'll tell you about a few of the ones that sort of come to mind. One of them is, you know, cancers of the pancreas or the digestive tract, they can often cause a blockage in the intestines known as a gastric outlet obstruction. So patients sometimes can't eat or drink because of these blockages and, in the past, they used to have surgery to kind of bypass the blockage. With EUS, we can now actually create a connection between the stomach and the rest of the intestines that are open to sort of bypass that blockage. And, you know, patients now can eat when they have certain types of tumors and don't necessarily have that nausea and vomiting.
Some of the other diseases are patients that may have a bile duct stone or bile duct blockage, but they have altered anatomy. So that means that they've gotten some sort of gastric bypass surgery in the past. So getting to that area of blockage is often difficult and does sometimes require surgery. With EUS, we can now actually create a tract into that area all done internally, so we can kind of remove those blockages internally.
And then one other disease maybe I'll kind of highlight is something called gastric varices. These are blood vessels in patients with liver disease that can often cause life-threatening bleeding. So with EUS, we can identify these vessels, and we can actually inject them with either coils or glue or a combination of those. And these coils actually have these synthetic fibers that slow down blood flow and promote clot formation, and that actually stops the bleeding. So these are sort of some of the new tools that we have with EUS that we can actually now treat some of these GI disorders.
Prakash Chandran: Yeah, that sounds amazing. And I've also heard that EUS can also be used to treat bile duct stones as well. Is that true?
Pushpak Taunk, MD: Yeah, absolutely. So again, if people have bile duct stones that can't be removed with the traditional route, we can again access the biliary tree using EUS to get us into the bile duct and remove them that way.
Prakash Chandran: So just hearing about this, it seems like this procedure is a lot less invasive than others. So maybe you can talk more broadly just around how EUS procedures compare to other treatment options for patients.
Pushpak Taunk, MD: Sure. A lot of these diseases that we talked about today were treated often with surgery, so patients would often get opened. You know, they would be in the hospital for several days, if not weeks. And they often had a high sort of complication rate because obviously they were very invasive and they were surgical.
The other treatment options were sometimes putting in what are known as percutaneous drains. So these are catheters that can go from the skin into the liver or into collections to drain them. But again, with these catheters, patients often had to keep, you know, a bag on the outside of the skin with something draining that was prone to infection and bleeding. And so with EUS, all of that becomes internal. So, you know, we now have studies that show that patients have lower complication rates. They have shorter hospital stays and definitely improved quality of life by doing all these procedures internally.
Prakash Chandran: Okay, that makes a lot of sense. So yeah, we talked about a lot of the things that the EUS can actually support and treat. What type of expertise is required to perform these complex procedures?
Pushpak Taunk, MD: So typically, people being trained in what we call EUS or interventional EUS have to do an additional year of fellowship after their gastroenterology fellowship. So most gastroenterologists have to do three years of a fellowship before they can practice. And this requires an additional year of training and there's probably about 60 or 70 physicians a year that graduate with this training.
Prakash Chandran: And how long does it take to get good at it? You know, because this is such a complex procedure, at Tampa General, for example, do you have providers that have been doing EUS for a while so patients can feel comforted? Is there a certain minimum level of experience that's needed?
Pushpak Taunk, MD: Yeah, that's a good question. You know, obviously if you come to Tampa General, we do a very high volume of these. So it's not even necessarily how long we've been doing it, but how many we've been doing. So, you know, we do probably the highest volume in the area. And so, you know, we have four providers at Tampa General that do this, including myself. And we've all been doing this for several years. But more importantly, we do a very high volume of this. We spend each two to three days a week, you know, doing specifically this.
Prakash Chandran: So just as we start to close here, Dr. Taunk, is there anything else that you wanted to share with our audience just regarding the role of EUS in GI diseases?
Pushpak Taunk, MD: Yeah. I mean, I would say definitely it is something that's unique. It's innovative and, as I mentioned, it's turning from a diagnostic tool into actually a therapeutic tool. And again, the most important thing is not only just the innovative tools and techniques, but the fact that we work very collaboratively with our surgeons or oncologists and our radiologists really to provide kind of the best options for the patients so we can get them good outcomes.
Prakash Chandran: Well, that's fantastic, Dr. Taunk. Thank you again so much for your time today. I truly appreciate it.
Pushpak Taunk, MD: Thank you so much.
Prakash Chandran: Thank you for listening to MD health cast by Tampa general hospital, which is available on all major streaming services for free to collect your CME. Please click on the link in the description for other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa general hospital, please visit C M E dot T G h.org.
I'm Prakash Chandran. and Thanks so much for listening, and we'll talk next time.
Prakash Chandran: When you see a doctor with a little camera on the end of a long tube, the main question people want to ask is where's this going and why is it necessary? But even though it seems intimidating, endoscopies including innovations in endoscopic ultrasounds are very useful nonsurgical procedures that can find an array of problems.
Here teach us more is Dr. Pushpak Taunk, Director of Endoscopy at the Morsani Ambulatory Surgery Center, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine and Tampa General Hospital.
Welcome to MD cast by Tampa general hospital, a go-to listening location for specialized physician to physician content and a valuable learning tool for world-class healthcare.
I'm your host, Prakash Chandran. So Dr. Taunk, thank you so much for joining me today. I guess I wanted to just start with what is endoscopic ultrasound and how is it typically used for patients?
Pushpak Taunk, MD: Thanks for having me on. Endoscopic ultrasound or EUS is actually a procedure where there's an ultrasound probe attached to the tip of an endoscope. And we then take that endoscope, it goes through the mouth and into the digestive tract and are actually able to see through the layers of the digestive tract as well as all the organs that surround the stomach and the intestines, specifically the liver, the pancreas, the biliary tree.
EUS was actually initially developed to both diagnose and stage a lot of gastrointestinal cancers and tumors. So with endoscopic ultrasound, we can actually look at the depth of various tumors and see their relationship to other organs and blood vessels and all that information that we get helps the surgeons and the oncologist create a good treatment plan for patients.
Prakash Chandran: That is so cool. So, I mean, how long has endoscopic ultrasound been around and what was done before this was invented?
Pushpak Taunk, MD: Yeah, that's a good question. So endoscopic ultrasound was really developed probably over, you know, 25, 30 years ago. But it really didn't come into common practice until the early, you know, 1900s. Before endoscopic ultrasound, it used to be really surgery. Surgeons would often open up the abdomen to kind of look for invasion of tumors into different areas. And obviously, that's a pretty morbid thing to do to sort of diagnose and stage cancers. So, you know, EUS is really cool when it first came out.
Prakash Chandran: Yeah, absolutely. So I'd love for you to tell us about some innovative applications for endoscopic ultrasound that improve patient care at Tampa General Hospital.
Pushpak Taunk, MD: So one of the things that has really evolved with EUS is it has gone from a diagnostic tool to a therapeutic tool. So at first, we used it to sort of just diagnose different conditions with it, but now we can actually treat various GI disorders with it. You know, I'll give you an example. For example, patients that have pancreatitis, which is inflammation of the pancreas, they can often develop these pancreatic fluid collections in the abdomen. They're kind of like abscesses within the abdomen. And they used to be treated surgically, so patients would have to be opened up and that abscess would have to be removed. But now, with endoscopic ultrasound, we can actually put a stent between that collection and the stomach, and that whole thing will sort of drain through that stent into the stomach. And so it's all done internally, which is, you know, really some of the cool stuff that we're doing, is we're doing some of these pseudosurgical procedures but without making any cuts or nicks anywhere on the outside.
Prakash Chandran: Yeah, that sounds incredible. And, you know, apart from what you just described, are there other specific diseases that can be treated with this interventional endoscopic ultrasound?
Pushpak Taunk, MD: Yeah, there are actually a couple, you know, diseases that we can now treat. You know, I guess I'll tell you about a few of the ones that sort of come to mind. One of them is, you know, cancers of the pancreas or the digestive tract, they can often cause a blockage in the intestines known as a gastric outlet obstruction. So patients sometimes can't eat or drink because of these blockages and, in the past, they used to have surgery to kind of bypass the blockage. With EUS, we can now actually create a connection between the stomach and the rest of the intestines that are open to sort of bypass that blockage. And, you know, patients now can eat when they have certain types of tumors and don't necessarily have that nausea and vomiting.
Some of the other diseases are patients that may have a bile duct stone or bile duct blockage, but they have altered anatomy. So that means that they've gotten some sort of gastric bypass surgery in the past. So getting to that area of blockage is often difficult and does sometimes require surgery. With EUS, we can now actually create a tract into that area all done internally, so we can kind of remove those blockages internally.
And then one other disease maybe I'll kind of highlight is something called gastric varices. These are blood vessels in patients with liver disease that can often cause life-threatening bleeding. So with EUS, we can identify these vessels, and we can actually inject them with either coils or glue or a combination of those. And these coils actually have these synthetic fibers that slow down blood flow and promote clot formation, and that actually stops the bleeding. So these are sort of some of the new tools that we have with EUS that we can actually now treat some of these GI disorders.
Prakash Chandran: Yeah, that sounds amazing. And I've also heard that EUS can also be used to treat bile duct stones as well. Is that true?
Pushpak Taunk, MD: Yeah, absolutely. So again, if people have bile duct stones that can't be removed with the traditional route, we can again access the biliary tree using EUS to get us into the bile duct and remove them that way.
Prakash Chandran: So just hearing about this, it seems like this procedure is a lot less invasive than others. So maybe you can talk more broadly just around how EUS procedures compare to other treatment options for patients.
Pushpak Taunk, MD: Sure. A lot of these diseases that we talked about today were treated often with surgery, so patients would often get opened. You know, they would be in the hospital for several days, if not weeks. And they often had a high sort of complication rate because obviously they were very invasive and they were surgical.
The other treatment options were sometimes putting in what are known as percutaneous drains. So these are catheters that can go from the skin into the liver or into collections to drain them. But again, with these catheters, patients often had to keep, you know, a bag on the outside of the skin with something draining that was prone to infection and bleeding. And so with EUS, all of that becomes internal. So, you know, we now have studies that show that patients have lower complication rates. They have shorter hospital stays and definitely improved quality of life by doing all these procedures internally.
Prakash Chandran: Okay, that makes a lot of sense. So yeah, we talked about a lot of the things that the EUS can actually support and treat. What type of expertise is required to perform these complex procedures?
Pushpak Taunk, MD: So typically, people being trained in what we call EUS or interventional EUS have to do an additional year of fellowship after their gastroenterology fellowship. So most gastroenterologists have to do three years of a fellowship before they can practice. And this requires an additional year of training and there's probably about 60 or 70 physicians a year that graduate with this training.
Prakash Chandran: And how long does it take to get good at it? You know, because this is such a complex procedure, at Tampa General, for example, do you have providers that have been doing EUS for a while so patients can feel comforted? Is there a certain minimum level of experience that's needed?
Pushpak Taunk, MD: Yeah, that's a good question. You know, obviously if you come to Tampa General, we do a very high volume of these. So it's not even necessarily how long we've been doing it, but how many we've been doing. So, you know, we do probably the highest volume in the area. And so, you know, we have four providers at Tampa General that do this, including myself. And we've all been doing this for several years. But more importantly, we do a very high volume of this. We spend each two to three days a week, you know, doing specifically this.
Prakash Chandran: So just as we start to close here, Dr. Taunk, is there anything else that you wanted to share with our audience just regarding the role of EUS in GI diseases?
Pushpak Taunk, MD: Yeah. I mean, I would say definitely it is something that's unique. It's innovative and, as I mentioned, it's turning from a diagnostic tool into actually a therapeutic tool. And again, the most important thing is not only just the innovative tools and techniques, but the fact that we work very collaboratively with our surgeons or oncologists and our radiologists really to provide kind of the best options for the patients so we can get them good outcomes.
Prakash Chandran: Well, that's fantastic, Dr. Taunk. Thank you again so much for your time today. I truly appreciate it.
Pushpak Taunk, MD: Thank you so much.
Prakash Chandran: Thank you for listening to MD health cast by Tampa general hospital, which is available on all major streaming services for free to collect your CME. Please click on the link in the description for other CME opportunities, including live webinars, on-demand videos and local events offered to you by Tampa general hospital, please visit C M E dot T G h.org.
I'm Prakash Chandran. and Thanks so much for listening, and we'll talk next time.