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UTHSC physician offers technique called endoscopic ultrasonography

San Antonio (July 24, 2003) — Riaz Chowdhury, M.D., Ph.D., and other world leaders in the medical specialty of gastroenterology are improving the care of cancer patients through a major advance in the field — an imaging technique called endoscopic ultrasonography (EUS). This minimally invasive procedure is hailed as a safe way to diagnose cancers of the upper and lower gastrointestinal tracts and more accurately set treatment strategy.

Dr. Chowdhury, assistant professor of medicine at The University of Texas Health Science Center at San Antonio (UTHSC), uses endoscopic ultrasonography to locate and study esophageal, stomach and duodenal tumors in the upper GI tract, and colon and rectal tumors in the lower tract. Thanks to EUS, he can determine the size of a tumor and the extent of its invasion into surrounding tissue — both important factors for advising patients on treatment options. Studies show EUS is more accurate than traditional approaches including CT scans. Users can even image tumors as small as 2 or 3 millimeters in diameter.

UTHSC, in collaboration with the Cancer Therapy and Research Center (CTRC), is the first civilian institution to offer endoscopic ultrasonography in San Antonio and South Texas. Dr. Chowdhury, who is performing the technique on five to six patients a week at CTRC's Grossman Cancer Center, recently presented an EUS update for university and community physicians.

By using an instrument called a linear echoendoscope, Dr. Chowdhury can see five layers of digestive tract anatomy — a view not possible with CT scans. The procedure also is useful for studying organs such as the pancreas and gallbladder, which are next to the GI tract. "EUS is a very good tool when there is unexplained pain in the area of pancreas," Dr. Chowdhury said.

The procedure costs a little more than regular endoscopy ($800 vs. $600), but Dr. Chowdhury said the benefits to patients far outweigh the extra cost. He has done about 100 cases since March and is the first physician in a civilian institution in San Antonio to do the procedure. "A patient called me and said he was going to another city for EUS, but he heard I was doing it and asked if I could help him," Dr. Chowdhury said. "I recently performed EUS on this patient."

Dr. Chowdhury presented data from the medical literature showing EUS is more effective than CT scanning and other techniques for diagnosis and preoperative staging of esophageal, pancreatic, rectal, gastric and colon cancer, and even lung cancer. Physicians also can use EUS to establish a celiac plexus block for the relief of abdominal cancer pain. A fine needle may be incorporated to the EUS instrument for acquiring biopsies of lymph nodes. EUS has been used for about five years in practice in other areas of the country.

"This technology allows multidisciplinary oncology teams, such as the UTHSC thoracic and GI oncology teams, to more accurately determine the sequence of surgery, chemotherapy, radiation and other therapies," said Charles R. Thomas Jr., M.D., associate professor and vice chairman of the Health Science Center's department of radiation oncology. "The usefulness of EUS in assessing individual tumors enables specialists to develop the most-effective plan of treatment for each patient."

Contact: Will Sansom