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An Enhanced Form of Endoscopy Is Changing the Way Certain Gastrointestinal Conditions Are Diagnosed and Treated at Saint Mary's Hospital.

Putting a Lid on Pancreatic Pain

If you still have abdominal pain after acute pancreatitis, or you’re living with chronic pancreatitis, endoscopic ultrasound (EUS) may be able to help you find relief from discomfort.

Occasionally, fluid-filled spaces called pseudocysts develop in or near the pancreas following acute pancreatitis. These areas can become swollen and painful over time. Draining the pseudocysts once required surgery or a procedure to insert a tube through the skin into the accumulated fluid. Attached to the other end of the tube, a drainage bag collected the fluid outside the patient’s body. Now there is a more discreet option.

“With EUS, I’m able to drain the pseudocysts into the center of the stomach or the beginning of the small intestine,” said Dr. Matthew Cohen, gastroenterologist and advanced endoscopist at Saint Mary’s Hospital. “The spaces are decompressed and the fluid drains down the gastrointestinal tract. The procedure leaves no scars, and there’s no need for tubes or bags.”

EUS can also help patients experiencing pain due to pancreatic cancer or chronic pancreatitis. If pain-relieving medications are ineffective, a gastroenterologist with specialized training can use EUS to guide a needle to the nerves behind the stomach and inject medication that blocks pain signals coming from the pancreas.

You probably associate ultrasound— the procedure that produces images of structures in the body by bouncing sound waves off of them—with seeing babies in the womb, but the technology has a wide range of uses. Dr. Matthew Cohen, gastroenterologist and advanced endoscopist at Saint Mary’s, is the only physician in Greater Waterbury currently performing endoscopic ultrasound (EUS).

A VERSATILE TECHNIQUE

Like conventional endoscopy, EUS involves inserting a scope into either the mouth or the rectum and advancing it through the gastrointestinal (GI) tract to a desired location. Once there, an ultrasound probe at the end of the EUS scope provides a in-depth view of the area. “EUS lets us see each layer of the GI tract wall, and structures adjacent to it, including tumors underneath the GI tract lining, with better resolution than Magnetic Resonance Imaging (MRI) or Computed Tomography (CT),” Dr. Cohen said. “The technology provides excellent images of the esophagus, stomach, duodenum, and rectum, as well as the pancreas, bile ducts, and nearby lymph nodes. EUS plays an important role in diagnosing and staging cancers of those structures.”

EUS also helps gastroenterologists diagnose a variety of conditions—such as chronic pancreatitis and gallstones— visually, while other problems are diagnosed by taking tissue or fluid samples. EUS can even help relieve pain (see “Putting a Lid on Pancreatic Pain”).

“This is a multipurpose procedure,” Dr. Cohen said. “EUS enhances the accuracy of diagnostic evaluations and, in certain circumstances, allows us to deliver therapy that improves patients’ quality of life as noninvasively as possible.”

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