A novel EUS system (EndoSound EVS) that converts a standard endoscope was evaluated in a retrospective study of 61 patients. The system demonstrated high clinical effectiveness, with a 90% procedural success rate and 100% sampling success for interventions involving the esophagus, stomach, and duodenal bulb. Fourteen patients required fine needle aspiration or biopsy, which were all successfully completed without any adverse events. The study suggests this technology has the potential to improve patient access to EUS evaluations by reducing equipment costs and procedural complexity.
https://www.endosound.com/wp-content/uploads/2025/04/Featured_Image_Gross_ACG2024.jpg4811200Mariano Francohttp://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.pngMariano Franco2025-04-04 10:53:302025-04-08 07:20:58Endoscopic Ultrasound (EUS) Functionality for a Standard Upper Endoscope: Initial US Experience
When a patient presents with abdominal pain or dyspepsia, physicians may choose from a variety of diagnostic tests to uncover the underlying cause. While standard EGD (esophagogastroduodenoscopy) is frequently utilized, Echo-EGD, which enhances traditional endoscopy with ultrasound, holds the promise of greater diagnostic accuracy. It should be noted that Echo-EGD is distinguished from typical EUS indications, namely abnormalities noted on prior endoscopy or imaging for further evaluation.
The choice between standard EGD and Echo-EGD depends on the indication. The follow-up and/or evaluation of lesions such as Barrett’s, gastric ulcers, etc. are common EGD indications. However, there is also significant overlap i.e. patients referred for diagnostic evaluation of abdominal pain or dyspeptic symptoms which there is a significant percentage of patients. Of the 8 million EGDs performed annually in the United States, many patients could fall into the diagnostic category and could benefit from the enhanced visualization that Echo-EGD provides. Indeed, many of these patients come to EUS after EGD and other diagnostic testing has been uninformative.
Standard EGD (Figure 1a) only visualizes the inner lining of the upper digestive tract. Adding ultrasound (Echo-EGD, or Echo-Endoscopy) allows physicians to visualize both the digestive tract lining and the surrounding tissues and organs during a single examination (Figure 1b).
Figure 1. (a) Illustration on left is of organs seen with standard EGD. (b) Illustration on right is of organs examined with Echo-EGD. This comprehensive view can improve diagnostic accuracy and potentially reduce the need for follow-up imaging.
Compelling Clinical Data
Echo-EGD is not a new concept. There are significant data dating back to 2000 showing clinical benefits (Table 1). Echo-EGD has not been widely adopted, primarily due to the high costs of traditional endoscopic ultrasound (EUS) systems and their limitations in the hospital setting. However, with new technology like the EndoSound Vision System™ (EVS™), which can convert any endoscope into an EUS device at a lower price point, Echo-EGD has become more feasible.
Title
Authors and Reference
Implications for Echo-EGD (EE)
EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia
Sahai et al., Gastrointest Endosc 2000;52:153-9.
EE demonstrated that 40% (51/156) of dyspepsia patients had evidence of pancreatic disease
An assessment of the potential value of endoscopic ultrasound as a cost-minimizing tool in dyspeptic patients with persistent symptoms
Sahai et al., Endoscopy 2001; 33: 662–667
Dyspepsia evaluation had a lower cost with EE based approach
EUS in the management of uninvestigated dyspepsia
Lee et al., Gastrointest Endosc 2002; 56: 842–848
EE changed management in 25% of dyspepsia patients
EUS compared with endoscopy plus transabdominal US in the initial diagnostic evaluation of patients with upper abdominal pain
Chang et al., Gastrointest Endos 2010; 72: 967-74
38% of patients with upper abdominal pain had a diagnosis made (66/172) (38%); of those 48% were EE based
Endosonography For Right-sided and Acute Upper Intestinal Misery: the EFRAIM study
Jung et al., United European Gastro Journal 1(5) 329–334
223 patients with abdominal pain. EE had a higher diagnostic yield than the combination of transabdominal US and EGD (62.3 vs. 50.7%; p = 0.001).
Table 1. Echo-EGD clinical publications
Why Echo-EGD Matters
In the US approximately 8 million standard EGDs are performed annually
Many of these are performed for diagnostic indications (e.g. abdominal pain, and/or dyspepsia) and these patients could benefit from the enhanced diagnostic capabilities where pathology was identified in as many as 35% of patients (Sahai et al., 2000).
Clinical evidence suggests that Echo-EGD as a first line diagnostic could be more effective in discovery of disease or the causes of the patient’s presentation.
Lastly, the procedure can be safely performed in ambulatory surgical centers (ASCs), and because of the introduction of the EVS, access to care can be improved and costs are reduced.
Echo-EGD: Time and Money
Figure 2. Comparison between patient flow on right with standard EGD first and Echo-EGD on left side. Both time and money are saved with Echo-EGD.
When a patient comes in with abdominal pain and/or dyspepsia, they face two potential diagnostic paths – and the difference in both time and money is striking.
Standard EGD (“Traditional Approach”) (Figure 2 right side), often involves a multi-step diagnostic journey:
Week 1: Patient presents with upper abdominal pain
Week 5: Additional imaging like CT or MRI (Insurance cost: $2,000, Patient cost: $600)
Week 10: Hospital-based EUS (Insurance cost: $1,700, Patient cost: $340)
The standard EGD patient flow may stretch over 10 weeks, with total costs reaching $5,700* for insurance and $1,340* for the patient. The process requires multiple appointments, procedures, and recovery periods.
With Echo-EGD (Figure 2, left side), patients can benefit because it offers a streamlined diagnostic process. After the initial presentation of upper abdominal pain, by week 2, patients can receive a comprehensive examination that costs insurance $1,100 and the patient just $200. Clearly a more simplified path. This single procedure combines traditional endoscopy with ultrasound imaging, leading to a diagnosis within two weeks. Total cost: $1,320.*
The Bottom Line
In this example, the difference is clear – Echo-EGD saves:
8 weeks of diagnostic time
$4,600 in insurance costs
$1,120 in patient out-of-pocket expenses
Multiple medical visits and procedures
These numbers are based on CMS national averages and are likely much higher for private payers. Finally, this change in patient flow has the potential to reduce healthcare costs and improve patient’s lives.
Beyond the numbers, this represents less time spent uncertain, fewer medical procedures, and a more efficient path to treatment for patients seeking answers about their health.
As noted by Dr. Leonardo Sosa at IHU de Strasbourg, France, in his textbook titled Pancreatic Endoscopic Ultrasound: Current Practice and Clinical Applications 1st Edition, he states that the EVS is a:
“new and revolutionary upper endoscopy solution [that] offers the promise of “democratizing” internal sonography while performing EGD, making Echo-EGD [or Echo-Endoscopy] widely available to all patients with upper digestive symptoms. One could imagine a time when internal sonography will maximize the diagnostic yield of every upper endoscopy, providing visualization of luminal features and at the same time, adjacent, extra-luminal structures. This new device will probably increase the number of second-intention EUS worldwide for precision diagnostics and it will compete with tomography and abdominal ultrasound.”
The EVS enables physicians to perform Echo-EGD in the ASC, making this powerful diagnostic tool accessible to all patients with upper digestive symptoms. This innovation could transform standard endoscopy patient pathways by integrating enhanced imaging earlier in the diagnostic process. Revised clinical algorithms that incorporate Echo-EGD more frequently can deliver significant benefits to all stakeholders—reducing diagnostic timelines for patients, lowering overall healthcare costs for insurers, and creating more efficient workflows for providers.
*Cost estimates based on CMS, Google search. Actual costs could be higher or lower in your state and clinic.
https://www.endosound.com/wp-content/uploads/2025/04/steinberg_hero_banner.jpg294835Mariano Francohttp://www.endosound.com/wp-content/uploads/2023/08/Endosound-New-web-logo-no-tag2023.pngMariano Franco2025-04-04 10:38:582025-04-08 07:05:04The Evolution and Promise of Echo-EGD: Enhancing Standard Endoscopy with Ultrasound
Endoscopic ultrasound (EUS) has long been a valuable diagnostic and therapeutic tool in gastroenterology, traditionally confined to hospital settings due to high costs and technical requirements. This white paper introduces the EndoSound Vision System™ (EVS™), a groundbreaking solution that makes EUS accessible and profitable for Ambulatory Surgical Centers (ASCs) and smaller hospitals. By addressing traditional barriers to EUS adoption in outpatient settings, EVS is poised to transform the landscape of advanced endoscopy, improving patient care, physician satisfaction, and ASC profitability.
Background: EUS in Gastroenterology
Endoscopic ultrasound (EUS) has been a cornerstone of advanced gastroenterology for over three decades. This hybrid technique combines endoscopy with high-frequency ultrasound, allowing for detailed imaging of the gastrointestinal tract and adjacent structures. EUS has proven invaluable for:
Diagnosis and staging of gastrointestinal cancers
Evaluation of submucosal lesions
Assessment of pancreaticobiliary disorders
Guided fine-needle aspiration (FNA) and biopsy procedures
Therapeutic interventions such as pseudocyst drainage and celiac plexus neurolysis
Despite its clinical utility, EUS has primarily been confined to hospital-based settings due to several limiting factors.
Traditional Barriers to EUS in ASCs
Historically, several factors have prevented the widespread adoption of EUS in the ASC:
High Capital Costs: Traditional EUS systems require substantial upfront investment, often exceeding $200,000 for the ultrasound hardware alone.
Additional Scope Requirements: Conventional EUS systems necessitate the purchase of specialized echoendoscopes, which can cost over $80,000 each. This represents a significant additional expense beyond the ultrasound hardware.
Extensive Training: The complexity of traditional EUS systems demands extensive training for endoscopy technicians, increasing operational costs and potential scheduling difficulties
Space Constraints: Many ASCs lack the physical space to accommodate bulky EUS equipment, limiting their ability to offer this service.
These barriers have effectively relegated EUS to larger hospital settings, limiting access for patients and potentially increasing healthcare costs.
The EVS Solution
The EVS represents a paradigm shift in EUS technology, specifically designed to overcome the traditional barriers to ASC adoption. Key advantages include:
Low Capital Cost: The EVS is offered at a fraction of the cost of traditional EUS systems, making it accessible to a wider range of healthcare providers. Furthermore, making the case for Echo-Endoscopy, the concept of combining upper endoscopy with EUS to maximize the diagnostic yield, is possible.
Compatibility with Existing Endoscopes: Unlike traditional systems, EVS works with standard endoscopes already in use at ASCs. This eliminates the need for additional expensive echoendoscopes, allowing for immediate implementation regardless of the current scope vendor.
High-Quality Imaging: Despite its cost-effectiveness, EVS provides high-resolution ultrasound images comparable to those produced by many traditional systems.
Minimal Additional Training: The system’s user-friendly interface and compatibility with existing endoscopes minimize the learning curve for endoscopy technicians.
Compact Design: The EVS’s small footprint allows for easy integration into existing ASC environments without requiring additional space. Additionally, it can be easily moved between room and can potentially be shared across facilities due to its compact size.
Financial Benefits for ASCs
Implementing the EVS can drive significant financial benefits for ASCs:
Expanded Procedure Offerings: ASCs can now offer EUS procedures, attracting new patients and retaining existing ones who would otherwise be referred to hospitals.
Increased Revenue: EUS procedures are reimbursed at the higher end of the EGD CPT code table, providing a new revenue stream for ASCs.
Improved Utilization: The addition of EUS can help optimize underutilized ASC capacity, increasing overall procedure volume and profitability. As the EVS works directly with your existing equipment, setup and room turnover is minimal, allowing EUS exams to be performed within the standard block schedule without delay.
Physician Satisfaction: By enabling gastroenterologists to perform advanced procedures in the ASC setting, the EVS can improve physician satisfaction and potentially attract new practitioners to the facility.
Case Study: Realizing the EVS Advantage
To illustrate the real-world impact of the EVS, consider the following case study from a current user:
An established gastroenterologist implemented the EVS in his ASC practice, with the following results:
Pre-Implementation (2023):
112 EUS cases performed over 8.5 months in a hospital endoscopy suite.
Post-Implementation (2024):
96 EUS procedures performed at the hospital endoscopy suite
88 EUS cases performed at the ASC using the EVS
Total EUS Volume:
With EUS now available at the ASC, more patients were scheduled for expanded indications including chronic abdominal pain and diarrhea, pancreatic cancer screenings, pancreatic cyst surveillance, dilated bile ducts, small gastric submucosal lesions, and others.
Case Study—Key Outcomes:
1. Practice Growth through Echo-Endoscopy:
The physician didn’t simply shift volume but significantly expanded his EUS practice.
This was accomplished by screening more patients with EUS, a term called Echo-Endoscopy meaning “Ultrasound-Enhanced Endoscopy”.
Using EUS in conjunction with regular EGD has the potential to enhance diagnostic yield and data from this case study confirms that result.
2. ASC Revenue Boost:
EUS procedures code with higher reimbursement
Increased volume of EGD and colonoscopy procedures on days allocated for EUS. When physicians schedule EUS exams, they will often perform additional EGD and colonoscopy cases to fill out their schedule.
3. Improved Efficiency:
The EVS allowed for efficient scheduling and performance of EUS procedures in the ASC setting.
4. Enhanced Patient Experience:
Patients benefited from the convenience and typically lower costs associated with ASC-based procedures.
This case study demonstrates that implementing EVS can be a win-win situation for gastroenterologists, ASCs, and patients alike.
A New Paradigm for EUS
The introduction of the EVS has the potential to create a new standard for EUS delivery, aligning it more closely with common procedures like EGD and colonoscopy. This shift promises several key benefits:
Conclusion
The EVS represents a significant advancement in making endoscopic ultrasound more accessible, efficient, and profitable in the ASC setting. By addressing the traditional barriers to EUS adoption, this innovative technology opens new possibilities for gastroenterologists, ASCs, and patients alike. As demonstrated in the case study, implementing EVS can lead to practice growth, increased ASC profitability, and improved patient care. Furthermore, with Echo-Endoscopy the practice used ultrasound with a standard EGD to drive more clinical results and increase volume.
The future of EUS lies in its broader adoption in outpatient settings, aligning with the ongoing shift towards value-based care. The EVS is at the forefront of this transformation, promising to revolutionize the delivery of advanced endoscopic services in gastroenterology.
Endoscopic Ultrasound (EUS) Functionality for a Standard Upper Endoscope: Initial US Experience
Academic PosterA novel EUS system (EndoSound EVS) that converts a standard endoscope was evaluated in a retrospective study of 61 patients. The system demonstrated high clinical effectiveness, with a 90% procedural success rate and 100% sampling success for interventions involving the esophagus, stomach, and duodenal bulb. Fourteen patients required fine needle aspiration or biopsy, which were all successfully completed without any adverse events. The study suggests this technology has the potential to improve patient access to EUS evaluations by reducing equipment costs and procedural complexity.
The Evolution and Promise of Echo-EGD: Enhancing Standard Endoscopy with Ultrasound
White PaperWhen a patient presents with abdominal pain or dyspepsia, physicians may choose from a variety of diagnostic tests to uncover the underlying cause. While standard EGD (esophagogastroduodenoscopy) is frequently utilized, Echo-EGD, which enhances traditional endoscopy with ultrasound, holds the promise of greater diagnostic accuracy. It should be noted that Echo-EGD is distinguished from typical EUS indications, namely abnormalities noted on prior endoscopy or imaging for further evaluation.
The choice between standard EGD and Echo-EGD depends on the indication. The follow-up and/or evaluation of lesions such as Barrett’s, gastric ulcers, etc. are common EGD indications. However, there is also significant overlap i.e. patients referred for diagnostic evaluation of abdominal pain or dyspeptic symptoms which there is a significant percentage of patients. Of the 8 million EGDs performed annually in the United States, many patients could fall into the diagnostic category and could benefit from the enhanced visualization that Echo-EGD provides. Indeed, many of these patients come to EUS after EGD and other diagnostic testing has been uninformative.
Figure 1. (a) Illustration on left is of organs seen with standard EGD. (b) Illustration on right is of organs examined with Echo-EGD. This comprehensive view can improve diagnostic accuracy and potentially reduce the need for follow-up imaging.
Compelling Clinical Data
Echo-EGD is not a new concept. There are significant data dating back to 2000 showing clinical benefits (Table 1). Echo-EGD has not been widely adopted, primarily due to the high costs of traditional endoscopic ultrasound (EUS) systems and their limitations in the hospital setting. However, with new technology like the EndoSound Vision System™ (EVS™), which can convert any endoscope into an EUS device at a lower price point, Echo-EGD has become more feasible.
Table 1. Echo-EGD clinical publications
Why Echo-EGD Matters
Echo-EGD: Time and Money
Figure 2. Comparison between patient flow on right with standard EGD first and Echo-EGD on left side. Both time and money are saved with Echo-EGD.
When a patient comes in with abdominal pain and/or dyspepsia, they face two potential diagnostic paths – and the difference in both time and money is striking.
Standard EGD (“Traditional Approach”) (Figure 2 right side), often involves a multi-step diagnostic journey:
The standard EGD patient flow may stretch over 10 weeks, with total costs reaching $5,700* for insurance and $1,340* for the patient. The process requires multiple appointments, procedures, and recovery periods.
With Echo-EGD (Figure 2, left side), patients can benefit because it offers a streamlined diagnostic process. After the initial presentation of upper abdominal pain, by week 2, patients can receive a comprehensive examination that costs insurance $1,100 and the patient just $200. Clearly a more simplified path. This single procedure combines traditional endoscopy with ultrasound imaging, leading to a diagnosis within two weeks. Total cost: $1,320.*
The Bottom Line
In this example, the difference is clear – Echo-EGD saves:
These numbers are based on CMS national averages and are likely much higher for private payers. Finally, this change in patient flow has the potential to reduce healthcare costs and improve patient’s lives.
Beyond the numbers, this represents less time spent uncertain, fewer medical procedures, and a more efficient path to treatment for patients seeking answers about their health.
As noted by Dr. Leonardo Sosa at IHU de Strasbourg, France, in his textbook titled Pancreatic Endoscopic Ultrasound: Current Practice and Clinical Applications 1st Edition, he states that the EVS is a:
“new and revolutionary upper endoscopy solution [that] offers the promise of “democratizing” internal sonography while performing EGD, making Echo-EGD [or Echo-Endoscopy] widely available to all patients with upper digestive symptoms. One could imagine a time when internal sonography will maximize the diagnostic yield of every upper endoscopy, providing visualization of luminal features and at the same time, adjacent, extra-luminal structures. This new device will probably increase the number of second-intention EUS worldwide for precision diagnostics and it will compete with tomography and abdominal ultrasound.”
The EVS enables physicians to perform Echo-EGD in the ASC, making this powerful diagnostic tool accessible to all patients with upper digestive symptoms. This innovation could transform standard endoscopy patient pathways by integrating enhanced imaging earlier in the diagnostic process. Revised clinical algorithms that incorporate Echo-EGD more frequently can deliver significant benefits to all stakeholders—reducing diagnostic timelines for patients, lowering overall healthcare costs for insurers, and creating more efficient workflows for providers.
*Cost estimates based on CMS, Google search. Actual costs could be higher or lower in your state and clinic.
Revolutionizing Endoscopic Ultrasound in Ambulatory Surgical Centers: The EVS™ Advantage
White PaperEndoscopic ultrasound (EUS) has long been a valuable diagnostic and therapeutic tool in gastroenterology, traditionally confined to hospital settings due to high costs and technical requirements. This white paper introduces the EndoSound Vision System™ (EVS™), a groundbreaking solution that makes EUS accessible and profitable for Ambulatory Surgical Centers (ASCs) and smaller hospitals. By addressing traditional barriers to EUS adoption in outpatient settings, EVS is poised to transform the landscape of advanced endoscopy, improving patient care, physician satisfaction, and ASC profitability.
Background: EUS in Gastroenterology
Endoscopic ultrasound (EUS) has been a cornerstone of advanced gastroenterology for over three decades. This hybrid technique combines endoscopy with high-frequency ultrasound, allowing for detailed imaging of the gastrointestinal tract and adjacent structures. EUS has proven invaluable for:
Despite its clinical utility, EUS has primarily been confined to hospital-based settings due to several limiting factors.
Traditional Barriers to EUS in ASCs
Historically, several factors have prevented the widespread adoption of EUS in the ASC:
These barriers have effectively relegated EUS to larger hospital settings, limiting access for patients and potentially increasing healthcare costs.
The EVS Solution
The EVS represents a paradigm shift in EUS technology, specifically designed to overcome the traditional barriers to ASC adoption. Key advantages include:
Financial Benefits for ASCs
Implementing the EVS can drive significant financial benefits for ASCs:
Case Study: Realizing the EVS Advantage
To illustrate the real-world impact of the EVS, consider the following case study from a current user:
An established gastroenterologist implemented the EVS in his ASC practice, with the following results:
With EUS now available at the ASC, more patients were scheduled for expanded indications including chronic abdominal pain and diarrhea, pancreatic cancer screenings, pancreatic cyst surveillance, dilated bile ducts, small gastric submucosal lesions, and others.
Case Study—Key Outcomes:
1. Practice Growth through Echo-Endoscopy:
2. ASC Revenue Boost:
3. Improved Efficiency:
4. Enhanced Patient Experience:
This case study demonstrates that implementing EVS can be a win-win situation for gastroenterologists, ASCs, and patients alike.
A New Paradigm for EUS
The introduction of the EVS has the potential to create a new standard for EUS delivery, aligning it more closely with common procedures like EGD and colonoscopy. This shift promises several key benefits:
Conclusion
The EVS represents a significant advancement in making endoscopic ultrasound more accessible, efficient, and profitable in the ASC setting. By addressing the traditional barriers to EUS adoption, this innovative technology opens new possibilities for gastroenterologists, ASCs, and patients alike. As demonstrated in the case study, implementing EVS can lead to practice growth, increased ASC profitability, and improved patient care. Furthermore, with Echo-Endoscopy the practice used ultrasound with a standard EGD to drive more clinical results and increase volume.
The future of EUS lies in its broader adoption in outpatient settings, aligning with the ongoing shift towards value-based care. The EVS is at the forefront of this transformation, promising to revolutionize the delivery of advanced endoscopic services in gastroenterology.
Further Information:
References:
1Procedure price lookup for outpatient services. Procedure Price Lookup for Outpatient Services. Accessed September 25, 2024. https://www.medicare.gov/procedure-price-lookup/cost/43259/.