Evidence-based recommendations for establishing and implementing an EUS program: Recommendations for sustainable success and improved clinical outcomes across the continuum of care

摘要

“Since its introduction, in the 1980s, endoscopic ultrasonography has been shown to be a safe and effective diagnostic and therapeutic tool for the evaluation of hepatobiliary and gastrointestinal conditions.”[ ] Interventional endoscopy, which includes ERCP and EUS, can provide both diagnostic and therapeutic benefits to many types of patients. EUS has been adopted into numerous interventional techniques and strategies that promise to improve diagnosis and management of gastrointestinal (GI) cancers. EUS has matured beyond its conventional role in locoregional staging of GI cancers and should be a standard of care recognized as a well-established procedure. EUS can assist gastroenterology providers with the detection of intraductal extension of adenomas and the detection and staging of pancreatic cancer and can serve as an adjunct to traditional imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI). EUS has been proven to be clinically superior to CT, MRI, and transabdominal ultrasound for tumor staging in multiple clinical studies. It is also a tremendous clinical asset for staging GI cancers such as gastric, ampullary, rectal, cholangiocarcinoma, and esophageal and other cancers such as lung cancer. EUS is well documented in assessing for chronic pancreatitis and evaluating thick gastric folds and pancreatic lesions, masses, stones, and strictures. The addition of an EUS program to an existing core and/ or interventional gastroenterology program can be advantageous for healthcare facilities, interventional endoscopists, patients, and communities. In an effort to drive quality and value in endoscopy, PENTAX Medical (Canada) held an advisory board in September 2018 during the Forum for Canadian endoscopic UltraSound (FOCUS) in Montreal, Canada. The goal of this panel discussion was to develop a framework to assist physicians in establishing an EUS program in their hospital. In attendance were physicians with a wide range of experience, who either had well-established programs with high patient volumes or were aiming to implement a new program at their facility. The considerations for discussion were personal experiences and challenges with EUS programs, considerations before starting new EUS programs, building a business case to start new EUS programs, and EUS training program requirements.