THERAPEUTIC ENDOSONOGRAPHY

Therapeutic Endosonography

The most advanced and minimally invasive medical techniques today, allowing physicians, like Dr. Michel Kahaleh, to get an up-close and detailed view on patients vital systems. An Endoscopic Ultrasound (EUS) uses safe high-frequency sound waves to produce a detailed image of the patients gastrointestinal tract (GI) and the organs beyond the walls of the GI tract.

EUS-Guided Celiac Plexus Block and Celiac Plexus Neurolysis

A celiac plexus block, or celiac plexus neurolysis, is a procedure intended to alleviate patients with extreme pain caused by pancreatitis or pancreatic cancer. An EUS is used to identify and locate the block of nerves responsible for the pancreas, also known as the celiac plexus. By injecting an anesthetic agent to nullify the nerves, either temporarily (block) or permanently (lysis). During the procedure, the patient will be sedated into a state similar to one if they would be receiving a colonoscopy.     

EUS-Guided Fiducial Placement

For patients who suffer from cancer along the gastrointestinal (GI) tract, radiation therapy is one of the more suggested treatment options. By utilizing an EUS, a patient's physician can identify the exact location of the tumor and increase the success rate of the radiation therapy. Fiducials are small golden cylinders that are implanted around the tumor by way of endoscopic means. These finducials allow for easy identification radiographically, allowing for a precise application of radiation to the tumor.  

EUS-Guided Glue and Coils Injection

For patients who suffer from end-stage liver disease, also known as cirrhosis, run a risk of developing gastric varices, which are dilated blood vessels in the stomach. Gastric varices have a high-risk of causing bleeding into the stomach. By identifying the gastric varices with an EUS, the patient's physician can use an endoscope to inject a type of glue with a metal coil into the dilated blood vessel, allowing it to harden and reduce the chance of internal bleeding.

Endoscopic Transmural Drainage of Pseudocyst and Abscesses

Patients who suffer from pancreatitis, or inflammation of the pancreas, are at risk of developing Pancreatic Pseudocysts, which is a walled off collection of fluid around the pancreas. Of patients who suffer from pancreatitis, an estimated 5% to 15% develop pancreatic pseudocysts. This collection of fluid can cause pain in the patient or result in an internal infection around the pancreas or in other places in the body. Using an Endoscopic Ultrasound, Dr. Michel Kahaleh can identify the location of all the fluid build-up within the body. Either Dr. Michel Kahaleh, or the patient’s physician, will use an endoscope to place a stent, or a tiny tube, to allow the fluid to drain directly into the gastrointestinal tract. So the patient will be able to pass and process the fluid on their own.  

Pancreatic Necrosectomy

It is possible for the fluid build-up caused by pancreatitis (pancreatic pseudocysts) to harden and become a gel-like substance, even after a stent has been implanted. If the build-up solidifies into a gel-like state the fluid will not be able to drain through the stent and into the gastrointestinal tract. To remove the build-up, a necrosectomy must be performed, this involves using an endoscope to pass into where the stent had been implanted, and remove the gel-like build up one small section at a time. While this process can take multiple sessions, it is necessary as to allow the fluid to drain and stop from building-up, which can lead to further complications. 

EUS-Guided Gallbladder Drainage

For patients who cannot remove their gallbladder through surgical means. An endoscopic alternative is to have the gallbladder drain through a stent, which is a tiny tube that connects the gallbladder to the stomach or small intestine. Dr. Michel Kahaleh conducts an EUS to identify where in the gallbladder is the obstruction and where should the stent be placed. This will make the stent implant more successful at draining the bile through the patient’s gastrointestinal tract (GI) tract. 

EUS-Guided Biliary and Pancreatic Duct Drainage

If a patient cannot receive an Endoscopic Retrograde Cholangiopancreatography (ERCP) to remove an obstruction from the pancreatic duct or bile duct, nor have surgery performed to place a drainage center into their skin. Then the patient could consider having the obstruction drain into either the stomach or small-intestine. This procedure, an EUS-Guided Biliary and Pancreatic Duct Drainage, uses an endoscope to identify where the drainage stent needs to be attached and takes minimally invasive means to perform the procedure. 

EUS-Directed Transgastric ERCP (EDGE)

For patients who have developed gallstones after a gastric bypass. Dr. Michel Kahaleh and his Advanced Endoscopy team are the first medical team to perform this internal minimally-invasive gallstone removing operation. An EUS-Directed Transgastric ERCP, or EDGE, creates a stent bridge from the native stomach to the bypassed stomach. By using an EUS, Dr. Michel Kahaleh can perform the operation with great accuracy, being able to locate the gallstones almost immediately. As well as identify the most optimal place to implant the stent, by being guided with the EUS image and endoscope. The stent shortens the distance required to access the ampulla, making gallstone removing much easier. 

EUS-Guided Gastrojejunostomy

When a patient has an obstruction to their gastrointestinal (GI) tract, typically the patient can have an open-and-shut surgery performed to re-route the intestine, around the obstruction. Dr. Michel Kahaleh and his Advanced Endoscopy team have developed a minimally-invasive alternative to surgery. By using an endoscope attached with an EUS device, Dr. Michel Kahaleh can easily identify the obstruction and plan where he will re-route the intestine. By implanting a stent from the small-intestine into the stomach with an endoscope, patients can eat and digest normally without having to undergo an invasive procedure. 

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