DIAGNOSTIC AND OPERATING ENDOSCOPIC ULTRASOUND (EUS) SERVICE

In the light of technological innovation and the continuous diagnostic/therapeutic updating by Don Calabria Sacro Cuore Hospital, the Diagnostic and Operating Endoscopic Ultrasound (EUS) Service, headed by Dr. Paolo Bocus has recently been established.

The service is organized around two endoscopic halls equipped with the most modern instruments and technologies currently available. It is also fully computerized and regaled with the possibility of autonomously realizing live events (courses, congresses etc) and broadcasting them both in videoconference and in web streaming.

Dr. Paolo Bocus is additionally qualified by the Radiofrequency European Academy (RFA Academy) to carry out, through radiofrequency, ablation treatments of oesophagus lesions at an early stage (Barrett’s oesophagus).

The Endoscopy centre is a seat of continuous Endoscopy teaching addressed to teachers and nurses.

What is Endoscopic Ultrasound (EUS)?

Endoscopic Ultra-Sonography (EUS) makes it possible to carry out a high resolution ultrasound of the digestive tract wall (oesophagus, stomach, duodenum and rectum) and the adjoining structures (mediastinum, pancreas, bilious ways) through the utilization of a digestive endoscope, at the extremity of which a small ultrasound transducer has been affixed. The last generation instruments, with sectoral scanning, further enable the realization of ultrasound-guided fine needle aspirations (FNA), so as to conduct a cytological, biochemical or immunohistochemical examinations of the visualized lesions. Since 1980, the year in which the first instrument was conceived and built, the publication of hundreds of scientific works has proved the accuracy, the favourable clinical impact and the safety of this methodology. The precise staging of the digestive neoplasms makes it possible to steer every patient towards the most appropriate therapy, be it endoscopic, surgical, oncological or palliative.

The exam is carried in an outpatient clinic and/or after admission to either hospital or day hospital.

It is utilized for the following:

§ local-regional staging of the neoplasms of the digestive tract: (oesophageal carcinoma, carcinoma and gastric lymphoma, rectal carcinoma). It is on the precise staging of these neoplasms that both the prognosis and the therapeutic choices depend. The Endoscopic Ultrasound (EUS) enables an accurate assessment of the parietal neoplasm (The T, or tumour size, of TNM), which would not be obtained by pursuing the other methodologies currently available. The visualization of the structures surrounding the digestive tract makes it additionally possible to suspect the presence of metastasis in local-regional lymph nodes (The N, or presence or absence of palpable lymph glands, of TNM) and to carry out on them a corroborating cytological sample-taking (FNA: Fine Needle Aspiration). Such an assessment might prove useful even to ascertain the response (down-staging) after a neoadjuvant therapy.

§ differential diagnosis of the subepithelial lesions of the digestive tract: on the basis of the ultrasound condition and the parietal layer of origin, it is possible to figure out the type of formation in question (leiomyoma, stromal tumour (GIST: Gastrointestinal Stromal Tumor), neuroendocrine tumour, lipoma, ectopic pancreas, cyst, varix etc); in unclear cases, the assessment of the Doppler signal and the execution of the Fine Needle Aspiration makes it possible to obtain a more accurate differential diagnosis.

§ differential diagnosis of the solid pancreatic lesions: (carcinoma, chronic focal pancreatitis, euroendocrine tumour, linfoma, metastasis) through an ultrasound assessment and a cytological corroboration; local-regional staging (after excluding distance metastasis) in the event of malignant tumours, so as to embark on a choice oscillating between surgery and palliation.

§ differential diagnosis of the cystic pancreatic lesions (serous cystadenoma, mucinos cistodenoma, cystadenocarcinoma, intraductal papillary mucinos tumour (IPMT), neuroendocrine tumour or metastasis with a liquid component, pseudocyst) through ultrasound, cytological and biochemical assessment; subsequent assessment of the indications provided by the surgical and endoscopic (draining of pseudocysts) therapies or limited purely to the follow up.

§ search for early alterations associated with chronic pancreatitis

§ search for bile duct stones, including small-sized ones, especially in the event that, in the light of the clinical, lab and transabdominal ultrasound picture, the likelihood of such a pathology is not found to be sufficiently high to justify the immediate implementation of an Endoscopic Retrograde Cholangio-Pancreatography (ERCP).

§ diagnosis and local-regional staging of the neoplasms of the extrahepatic bilious way: with the possibility of carrying out a corroborating Fine Needle Aspiration, especially after a non-diagnostic transpapillary brushing.

§ staging of the lung carcinoma not in small cells: the visualization and the possibility of carrying out the Fine Needle Aspiration (FNA) of mediastintal lymph modes (even in stations not accessible through bronchoscopy) is rendering Endoscopic Ultra-Sonography (EUS) an indispensable tool to define the therapeutic decisions to be pursued, even after neoadjuvant radio-chemotherapy. The easy approach to the mediastinum makes Endoscopic Ultra-Sonography (EUS) and Fine Needle Aspiration (FNA) advisable even in the study of lymphadenopathy (TBC, sarcoidosis, Hodgkin’s lymphoma).

§ operating endoscopic ultrasound: draining of pancreatic pseudocysts (an easier and safer procedure than the one conducted in the dark) and block/neurolysis of the celiac plexus (due to pain from chronic pancreatitis and pancreatic carcinoma).

The Service, situated on the third floor of Sacro Cuore Hospital (Entry G, lifts 38 and 39), is equipped with new and modern premises, suitably structured in order to carry out diagnostic and therapeutic investigations.
Two endoscopic halls are open and active throughout the day, Monday to Friday.

 

Bookings and secretary’s office:

Tel.: +39 045.60.13.248

Monday to Friday 8.30 am -1.00 pm and 2.30 pm – 4.00 pm
Saturday 8.30 am – 12.00 pm

Endoscopic examinations:

The examinations which can be booked pursuant to referral from the National Health Care Serviceissued by the GP or by a specialist are:

· 45.16 ESOPHAGO-GASTRODUODENOSCOPY [EGD] WITH BIOPSY.

· 45.23 COLONOSCOPY WITH FLEXIBLE ENDOSCOPE.

· 45.23.1 COLONOSCOPY – RETROGRADE ILEOSCOPY.

· 45.24 SIGMOIDOSCOPY WITH FLEXIBLE ENDOSCOPE.

Subject to prior direct agreements with the doctor prescribing the examination, the following can be booked:

· 44.19.3 ESOPHAGO-GASTRODUODENAL ENDOSCOPIC ULTRASOUND.

· 45.29.5 ENDOSCOPIC ULTRASOUND OF THE COLON.

· 48.29.2 ENDOSCOPIC ULTRASOUND OF THE RECTUM-SIGMOID COLON.

· HI 52.13 BILIOPANCREATIC ENDOSCOPIC ULTRASOUND.

We additionally remind you to equip yourself with:

· Health card (if need be, tax code as well)

· The referral for the endoscopic examination: + POSSIBLE BIOPSIES AS WELL

· The referral for the histological examination plus possible I.C.H.’s as well.

· Any possible previous examinations

Only as regards Ecoendoscopic Ultrasound:

By Regional Council Decree no. 2058 of 03.11.2014, the Veneto Region has undertaken a revision of outpatient clinic performances which could not have been rendered to citizens outside Veneto based on a “health ticket” regime (being the performances marked with “regional note 2”). By virtue of this revision, effectively from 1 January 2015 the Endoscopic Ultrasound performances will no longer display this limitation. Accordingly, they might be rendered on the basis of a “health ticket” regime both to patients from Veneto and from outside Veneto.

· red referral for the “histological” examination

· red referral for “endoscopic ultrasound + conscious sedation”


Independent Practitioners:

The doctors operating in the Endoscopic Ultrasound Service carry out an independent professional activity outside normal working hours.
For any information or bookings, please approach the secretary’s office of the service.

Collection of reports – Payment of the health ticket:

The endoscopic report is directly written and printed by the doctor at the end of the procedure.

The report is then handed directly to the interested party at the secretary’s office of the Service.
In the event that the need arises to take samples of the mucous tissue (histological examination) it will be necessary to simultaneously pay the health ticket pertaining to the histological examination.

The histological report might be sent directly to the patient’s home address at the cost of 1 Euro, alternatively, it might be collected from the secretary’s office of the Service by submitting the apposite slip handed to the patient together with the endoscopic report.

For any information, please contact: Diagnostic and Operating Endoscopic Ultrasound Service. Via Don Sempreboni, 5 – Negrar (VR), 37024 – Tel.: +39 045 601 32 48 – FAX: +39 045 601 32 71
mail: eus@sacrocuore.it

http://www.sacrocuoredoncalabria.it

 

Downloadable documents

Informed consent to EUS (Endoscopic Ultrasound)