Therapeutic Endosonography

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.     

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.  

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.

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.  

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. 

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.