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REFERRAL PATTERNS FOR ENDOSCOPIC ULTRASOUND (EUS) AND EUS-GUIDED FINE NEEDLE ASPIRATION (EUS-FNA) IN A CANADIAN CENTER: A PROSPECTIVE ANALYSIS OF THE FIRST 798 CASES OF THE YEAR 2000
C Vincent, M Boivin, RG Lahaie, M Lemoyne, V Plourde, P Poitras, AV Sahai
Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Québec
BACKGROUND: The spectrum of possible indications and potential caseload for EUS in a Canadian context is unclear. EUS and EUS-FNA have been available at CHUM since late 1999.
AIMS: The aims were to determine the spectrum of EUS indications (including EUS-FNA) and referring physicians, and to determine changes occurred with time.
METHODS: Information on all EUS referrals was recorded prospectively starting on 01/01/2000. Procedure indications were classified according to the suspected or proven diagnosis. The exam purpose was classified as “diagnosis” and/or “staging”. Data for the first and second half of the study period were compared.
RESULTS: Between 01/01/2000 and 24/10/2000, 148 physicians (55.1% gastroenterologists, 26.4% other internists, and 18.4% surgeons) requested 798 EUS procedures (345 in the first half and 453 in the second [mean 21.6/week]; 67.5% for diagnosis, 16.7% for staging, and 15.8% for both. EUS-FNA was performed in 29%. Indications were:
Between the first and second half of the study period, EUS volume increased by 31.3% and the number of referring physicians by 36.1%. There was no significant change in the frequency of indications, however referrals for diagnosis and/or staging of suspected or proven tumors of the ampulla, pancreas, or bile ducts increased from 23.5% to 34.0% of referrals.
CONCLUSIONS: 1) The spectrum of possible indications for EUS and EUS-FNA in Canada is large but appears to be related primarily to diseases of the pancreas and bile ducts. 2) Once available, EUS volume and the number of referring physicians increase rapidly. 3) EUS-FNA is may be useful in up to 1/3 cases.