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Message: <blockquote data-quote="task" data-source="post: 400125" data-attributes="member: 8578">Yep, EUS is Endoscopic Ultrasound.  The images generated by EUS are pretty amazing and don't require the use of fluoro.  EUS can be used to guide both diagnostic and therapeutic procedures like biopsy, psudocyst drainage, and even stent placement.  I've only seen a few cases, but it does require proficiency with side viewing endoscopes (pretty challenging) and interpretation of the images takes A LOT of experience.  Many in GI feel this will be as revolutionary as ERCP is, if not more so.With regards to capsule endoscopy, the real utility will be for lesions beyond the reach of an endoscope, for lesions farther along the small bowel.  GIs are pioneering the use of capsule endoscopes.  The problem is the amount of time it takes to review the images generated by a capsule endoscope -- this won't change as the technology advances.  Who will take the time to sit and read the images generated is a topic of some debate, but right now GIs seem to have the area well in their turf.  The issue will be what to do with lesions seen beyond the endoscope in the upper GI tract.  Do they need to be referred on for some from of surgical biospsy?  Some faculty in my department seem to believe that visualizing the lesion will be sufficient in most cases, and only if the worry for malignancy is extremely high  (past the duodenum is pretty rare anyway) would any tissue be warranted.I suppose PCPs could do virtual endoscopies, but this may come down to a matter of reimbursement.  For example, residents coming out of my Medicine program are expert at placement of central lines, chest tubes, S-G catheters, etc.  But let's say one of these residents goes into private practice as a general Internist.  Is it worth his/her time or risk to do one of these procedures.  Absolutely not.  First of all, a general Internist's reimbursement schedule is optimized for the delivery of outpatient care.  A half hour seeing 2 or 3 patients pays far better than a half hour putting in a subclavian, let alone extra time and effort spent to place a chest tube if he/she drops a lung.  Why even pay the malpractice to cover doing invasive procedures if you don't get reimbursed well for them?  So the Internist calls the Critical Care, Cardiologist or Surgeon to place the line.  They have the malpractice coverage for the procedure, and they can actually bill at a higher rate of reimbursement for the line than the Internist can.  You can see how the logic would follow for capsule endoscopy -- time spent administering and interpreting the images would not pay as much for a general Internist compared to the GI doc.  The PCP's time is better spent (from a fiscal standpoint) seeing patients.  Advances in minimally invasive screening will be beneficial for GIs in many ways.  Most people don't realize the absolute overload of screening procedures GI currently faces.  Any technologies which will decrease the procedural screening load and allow GIs to focus on going after things to biopsy or treat will eventually balance out to more, not less, overall for GIs in terms of procedures and overall compensation.  It pays more to acutally do something like biopsy or treat than a screening, so from a resource allocation standpoint, GIs will benefit as well. Look at it this way -- many folks don't go for screening colonoscopy because of the fear and discomfort of have the scope put in your butt.  Send all these people for a minimally invasive screen (who wouldn't have gone for an endoscopy in the first place), tell them there's a polyp there, and you bet they'll be in the GI lab sooner than you can blink asking for a colonscopy with biopsy.</blockquote>

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