Endoscopic ultrasound

My name is Saurabh Chandan, and I'm an advanced endoscopist at Houston Methodist West Hospital in Houston, Texas.

On behalf of my co-authors, I'd like to thank GI Journal for giving me the opportunity to discuss the findings of our recently published article titled Efficacy and Safety of Endoscopic Ultrasound-Guided Choledochoduodenostomy Compared with Endoscopic Ultrasound-Guided Gallbladder Drainage for Palliation of Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis.

Endoscopic retrograde cholangiopancreatography remains the primary palliative modality for malignant distal biliary obstruction.

However, ERCP may not anatomically be feasible in cases with duodenal stenosis causing gastric outlet obstruction, tumor encroachment around the papilla, or challenges in biliary cannulation.

And so this is a summary of the workup and treatment here.

Underwent upper EUS, EGD biopsy, colonoscopy, pathology results confirming adenocarcinoma in the liver, and a transverse colon mass that was invasive adenocarcinoma.

HER2 negative.

The molecular profiles on the bottom there, MSS, a low TMB, essentially RAS, BRAF wild type.

And the, the big problem at the time was really pancreatic cancer diagnosis.

And so I was moving there to learn a new procedure, uh, that they called endoscopic ultrasound.

So you'd be able to put a scope in the mouth into the stomach and small bowel, and then use the ultrasound probe that's embedded in its tip to see the structures just outside the lumen, and you could gain access to them.

You could put a needle in them and, and that held a lot of promise.

We think that physicians are looking at the equivalent of a medical textbook with coloring, but it's not.

It's black and white and gray and beige, and there are certain structures that look different, that are contrasty and look different.

So now with, with endoscopic ultrasound, it's not even color.

It's all gray.

They include endoscopic ablative techniques for Barrett's esophagus with dysplasia and early esophageal adenocarcinoma.

clinical applications of EUS with a particular focus on EUS-guided tissue acquisition, ERCP with a particular interest in cholangioscopy, stent placement, and device reprocessing, and endoscopic mucosal resection.

Dr. Munasamy has also participated in numerous studies involving the development of quality metrics in endoscopy and methods to improve the efficiency of and safety of endoscopy care, including leading a multi-center evaluation of the first single-use duodenoscope.

Prior to his recruitment to UCLA in 2011, he was a faculty member at the University of California Irvine Medical Center.

probably one of the pivotal points in my career, and you know it well because you helped me so much early on, I went back to Indiana University in 1987, excuse me, 1986.

And I told Glenn at that time, I wasn't allowed to do EUS at the Middlesex.

Nobody was.

It was done by a combination of Bill Lees, who was a radiologist.

And could you reach out to Olympus and see if there's any way that we could get involved.

And as it turned out, Olympus was right at a point.

Mike Sivak was the first to have EUS in the US.

Charlie Lightdale was the second.