Kenneth J ChangMD

Endoscopic ultrasonography (EUS) was first developed in the early 1980s by investigators in Japan, Germany, and the United States, predominantly because of the limitations of transabdominal ultrasonography (US) in imaging the pancreas. However, prior to the development of EUS-guided fine needle aspiration (FNA), EUS as an imaging modality (without biopsy or intervention capabilities) had major limitations. For example, EUS alone cannot distinguish high specificity metastatic lymph nodes from benign inflammatory nodes. Likewise, focal chronic pancreatitis can mimic pancreatic cancer on EUS. EUS was also not considered a "therapeutic" procedure. Now, two decades later, many of these limitations have been overcome with the adjunctive capabilities of EUS-guided FNA (Chang et al, 1994; Wiersema et al, 1994) and more recently, EUS-guided fine-needle injection (FNI) (Chang et al, 2000; Hecht et al, 2003; Chang et al, 2004) and other interven-tional EUS procedures. Thus, EUS has become a powerful tool for gastroenterologists in the diagnosis, staging, and treatment of gastrointestinal (GI), pancreaticobiliary, and pulmonary lesions. I will review the current indications for EUS and FNA.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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