"Telemedicine would be a good method to teach EUS"

Endoscopic ultrasound in the short- to mid-term future will continue to be an integral part of staging and diagnosis of cancers of the oesophagus, stomach, pancreatobiliary tract and rectum. Small pancreatic tumours are not always visible on CT scan and MRI and endoscopic ultrasound (EUS) can not only find these tumours that may be solid or cystic in nature but establish a tissue diagnosis in a minimally invasive method by EUS guided fine needle aspiration. We can also deliver therapeutic agents such as alcohol for celiac plexus neurolysis in patients with advanced pancreatic cancer who have significant pain not controlled by narcotic medications. There are other investigational agents being tested for injection directly into tumours using endoscopic ultrasound for direct anti-tumour effect. I think the future of echoendoscopy is bright as there will be more trained physicians around the world realizing the benefits of this technique since it still remains under-utilized in large parts of the world due to lack of equipment or trained physicians. With advances in non-invasive cross sectional techniques, I do think that some of the indications that use EUS purely for imaging purposes may be lost or at least the role of EUS may evolve. However, the potential for gaining indications with newer devices or drugs being developed than can be deployed or delivered under EUS guidance is greater. Endoscopic Ultrasound right now is an accepted standard of care and an integral part of any programme or hospital that wants to take care of patients with gastrointestinal cancers where the application of echoendoscopy is the greatest, although it also has many indications for benign disease. Various books, atlases, videos are available as teaching aids. It is difficult for physicians to get hands-on training in this procedure if they did not learn it during their gastroenterology fellowship or residency programme. The learning curve of EUS is slow, and having dedicated teaching programmes with hands-on training can help increase the number of physicians in the world who are formally trained in this technique. Considering that EUS was originally just a diagnostic technique in the beginning, with clearly now interventional EUS, consisting of fine needle aspiration cytology, fine needle core biopsy, EUS guided drainage etc., the technique is established and not experimental any more. There are some indications for the procedure that lack randomized controlled trials with other conventional techniques. Many new experimental and therapeutic indications are on the horizon that are being studied and researched. Telemedicine would be a good method to teach EUS as this technique requires real-time imaging and the technique is very operator-dependent. I am not aware of a complete training programme in EUS by telemedicine although there are a number of workshops in the world on endoscopy that have live demonstrations which are sometimes done remotely and transmitted to another city where the workshop is. Certainly there is potential to develop this even more in the future.