In June 2009, Jill Vroegindewey of Kalamazoo had her gallbladder removed. A year later, she was still experiencing gastrointestinal issues so she had an endoscopy. Her gastroenterologist William Hanavan, MD was puzzled that the endoscopy gave no new clues about the source of her ongoing pain. He recommended a more advanced endoscopy that also uses ultrasound. He said he was currently referring patients out of town, since the closest place to offer the procedure was in Grand Rapids.
Jill preferred to have the test as close to home if possible. She checked at Bronson and found out the same technology was recently installed. They were ready for a patient. She fit the bill. “It fit together perfectly, and it saved me a trip to Grand Rapids,” Jill says.
Endoscopic ultrasound, also called EUS, offers a 360-degree, cross-sectional image of the gastrointestinal tract and nearby organs, including the gallbladder and pancreas. If a needle biopsy is required, the doctor can easily guide a needle into place during the procedure to perform a biopsy. This technology allows the doctor to accurately diagnose and to stage cancer if the issue is a tumor. What previously may have involved invasive surgery can now be done in a minimally invasive way—a huge benefit to patients. The procedure is performed under conscious sedation. There is virtually no pain or recovery time, and the patient typically has no memory of the procedure.
Nathan Landesman, DO, the first doctor to perform endoscopic ultrasound at Bronson, performed Jill’s procedure. “It’s a real benefit keeping people local, especially if someone has a tumor,” says Dr. Landesman. “It’s stressful already, and then they have to travel on top of everything else. Furthermore, if the physician there recommends treatment at that location, it means even more travel and stress. Keeping patients here allows us to provide continuity of care with minimal stress to them and to their loved ones.”
Dr. Landesman is fellowship-trained in gastroenterology, with an additional fellowship in advanced endoscopic ultrasound. Jill appreciated his additional one-year advanced training solely in endoscopic ultrasound. “It made a huge difference to me that he is fellowship-trained in the procedure,” Jill says.
According to Dr. Landesman, the technology is appropriate for patients who have had a CT scan or MRI of the intestines, abdominal organs or lungs that shows a tumor or area of concern. Endoscopic ultrasound offers accurate diagnosis of the problem and an opportunity for biopsy at the same time as the procedure. It also helps doctors formulate a plan for treatment.“Without endoscopic ultrasound, some people may have gone straight to exploratory surgery, especially when they were anxious about a tumor,” explains Dr. Landesman. “This way, we can tell if it’s something simple and benign, or if patients need to consider chemotherapy or radiation. In addition, we sometimes find things we didn’t intend to—such as a bile duct stone or cyst in the pancreas—when we were looking at something else in the abdomen.”
Jill had the procedure in July 2010 and appreciated that Dr. Landesman followed up with her regular gastroenterologist that same day. “Dr. Hanavan knows my whole history, so it was nice to add the endoscopic ultrasound results to my medical records and see the whole picture immediately,” says Jill.
Overall, Jill says she could not have been happier. “I was really grateful to stay at the hospital of my choice, in the city of my choice.”
Currently, Dr. Landesman uses the technology on between five and seven patients a week. “Giving people peace of mind goes a long way. It makes me feel good to be able to do that.”