Clinical implications of endoscopic ultrasound

The American Endosonography Club Study

N. J. Nickl, M. S. Bhutani, M. Catalano, B. Hoffman, R. Hawes, A. Chak, L. D. Roubein, M. Kimmey, M. Johnson, John Paul Affronti, M. Canto, M. Sivak, H. W. Boyce, C. J. Lightdale, P. Stevens, C. Schmitt

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Background: Despite increased clinical use of endoscopic ultrasound (EUS), there are little data regarding complications of EUS or its impact on patient management. Methods: A prospective multicenter study was completed to evaluate clinical outcomes of EUS. Before each EUS examination the endosonographer recorded further theoretical patient management plans as if EUS was unavailable. After the EUS, endosonographers recorded actual management plans based on EUS results. The actual management plan after EUS was compared to the theoretical management before EUS. Complications were assessed in short-term follow-up. Results: Four hundred twenty-eight subjects were enrolled. Of subjects able to be evaluated, EUS changed the treatment plan in 74%. Management changes of major importance occurred in 120 patients (31% of subjects able to be evaluated) and included decisions regarding surgery (62 patients), decisions regarding nonsurgical invasive management (36 patients), and decisions regarding further follow-up (22 patients). When there was a change in management, the change was to less costly, risky, or invasive management in 55%, to more costly/risky/invasive in 37%, and to equally costly/risky/invasive in 8%. Short-term follow-up was completed in 81% of subjects, with six complications identified (1.7%). Three complications were mild, two were moderate, one severe, and none fatal. Conclusions: (1) Changes in management plan may occur in the majority of patients based on EUS results. (2) The management changes are often of major importance with regard to health care costs and safety, and are more often in the direction of less costly, risky, and invasive management. (3) EUS is safe in experienced hands.

Original languageEnglish (US)
Pages (from-to)371-377
Number of pages7
JournalGastrointestinal Endoscopy
Volume44
Issue number4
DOIs
StatePublished - Jan 1 1996

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Endosonography
Health Care Costs
Multicenter Studies
Prospective Studies
Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Nickl, N. J., Bhutani, M. S., Catalano, M., Hoffman, B., Hawes, R., Chak, A., ... Schmitt, C. (1996). Clinical implications of endoscopic ultrasound: The American Endosonography Club Study. Gastrointestinal Endoscopy, 44(4), 371-377. https://doi.org/10.1016/S0016-5107(96)70083-4

Clinical implications of endoscopic ultrasound : The American Endosonography Club Study. / Nickl, N. J.; Bhutani, M. S.; Catalano, M.; Hoffman, B.; Hawes, R.; Chak, A.; Roubein, L. D.; Kimmey, M.; Johnson, M.; Affronti, John Paul; Canto, M.; Sivak, M.; Boyce, H. W.; Lightdale, C. J.; Stevens, P.; Schmitt, C.

In: Gastrointestinal Endoscopy, Vol. 44, No. 4, 01.01.1996, p. 371-377.

Research output: Contribution to journalArticle

Nickl, NJ, Bhutani, MS, Catalano, M, Hoffman, B, Hawes, R, Chak, A, Roubein, LD, Kimmey, M, Johnson, M, Affronti, JP, Canto, M, Sivak, M, Boyce, HW, Lightdale, CJ, Stevens, P & Schmitt, C 1996, 'Clinical implications of endoscopic ultrasound: The American Endosonography Club Study', Gastrointestinal Endoscopy, vol. 44, no. 4, pp. 371-377. https://doi.org/10.1016/S0016-5107(96)70083-4
Nickl, N. J. ; Bhutani, M. S. ; Catalano, M. ; Hoffman, B. ; Hawes, R. ; Chak, A. ; Roubein, L. D. ; Kimmey, M. ; Johnson, M. ; Affronti, John Paul ; Canto, M. ; Sivak, M. ; Boyce, H. W. ; Lightdale, C. J. ; Stevens, P. ; Schmitt, C. / Clinical implications of endoscopic ultrasound : The American Endosonography Club Study. In: Gastrointestinal Endoscopy. 1996 ; Vol. 44, No. 4. pp. 371-377.
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abstract = "Background: Despite increased clinical use of endoscopic ultrasound (EUS), there are little data regarding complications of EUS or its impact on patient management. Methods: A prospective multicenter study was completed to evaluate clinical outcomes of EUS. Before each EUS examination the endosonographer recorded further theoretical patient management plans as if EUS was unavailable. After the EUS, endosonographers recorded actual management plans based on EUS results. The actual management plan after EUS was compared to the theoretical management before EUS. Complications were assessed in short-term follow-up. Results: Four hundred twenty-eight subjects were enrolled. Of subjects able to be evaluated, EUS changed the treatment plan in 74{\%}. Management changes of major importance occurred in 120 patients (31{\%} of subjects able to be evaluated) and included decisions regarding surgery (62 patients), decisions regarding nonsurgical invasive management (36 patients), and decisions regarding further follow-up (22 patients). When there was a change in management, the change was to less costly, risky, or invasive management in 55{\%}, to more costly/risky/invasive in 37{\%}, and to equally costly/risky/invasive in 8{\%}. Short-term follow-up was completed in 81{\%} of subjects, with six complications identified (1.7{\%}). Three complications were mild, two were moderate, one severe, and none fatal. Conclusions: (1) Changes in management plan may occur in the majority of patients based on EUS results. (2) The management changes are often of major importance with regard to health care costs and safety, and are more often in the direction of less costly, risky, and invasive management. (3) EUS is safe in experienced hands.",
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AU - Hoffman, B.

AU - Hawes, R.

AU - Chak, A.

AU - Roubein, L. D.

AU - Kimmey, M.

AU - Johnson, M.

AU - Affronti, John Paul

AU - Canto, M.

AU - Sivak, M.

AU - Boyce, H. W.

AU - Lightdale, C. J.

AU - Stevens, P.

AU - Schmitt, C.

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N2 - Background: Despite increased clinical use of endoscopic ultrasound (EUS), there are little data regarding complications of EUS or its impact on patient management. Methods: A prospective multicenter study was completed to evaluate clinical outcomes of EUS. Before each EUS examination the endosonographer recorded further theoretical patient management plans as if EUS was unavailable. After the EUS, endosonographers recorded actual management plans based on EUS results. The actual management plan after EUS was compared to the theoretical management before EUS. Complications were assessed in short-term follow-up. Results: Four hundred twenty-eight subjects were enrolled. Of subjects able to be evaluated, EUS changed the treatment plan in 74%. Management changes of major importance occurred in 120 patients (31% of subjects able to be evaluated) and included decisions regarding surgery (62 patients), decisions regarding nonsurgical invasive management (36 patients), and decisions regarding further follow-up (22 patients). When there was a change in management, the change was to less costly, risky, or invasive management in 55%, to more costly/risky/invasive in 37%, and to equally costly/risky/invasive in 8%. Short-term follow-up was completed in 81% of subjects, with six complications identified (1.7%). Three complications were mild, two were moderate, one severe, and none fatal. Conclusions: (1) Changes in management plan may occur in the majority of patients based on EUS results. (2) The management changes are often of major importance with regard to health care costs and safety, and are more often in the direction of less costly, risky, and invasive management. (3) EUS is safe in experienced hands.

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