Clinical and Physiological Perspectives on Barriers and Facilitators of Endoscopic Ultrasound Use in Resource-Limited Setting

Abstract

Background: Endoscopic ultrasound (EUS) is a pivotal tool in advanced gastroenterology, enabling both structural and functional assessment of gastrointestinal and pancreatic pathology. Despite its clinical value, utilization in low- and middle-income countries is limited due to multiple infrastructural, financial, and training-related barriers.

Methods: A qualitative study was conducted using semi-structured interviews with gastroenterologists in tertiary care hospitals of Peshawar for a period of six months from January 2024 to June 2024. Thematic analysis was employed to explore barriers, facilitators, and potential strategies for improving EUS utilization. Questions explored themes such as autonomic responses, cardiopulmonary tolerance, body habitus, and tissue characteristics. Interview transcripts were thematically analyzed to capture shared physiological perspectives and coping strategies.

Results: Key barriers included limited equipment, scarcity of trained personnel, inadequate training programs, low procedural volume, high costs, and patient apprehension. Facilitators included broad clinical indications, availability of simulation-based training, and mentorship initiatives. Gastroenterologists noted obesity, ascites, poor cardiopulmonary reserve, and stress responses as key physiological barriers to EUS, while optimization of patient status and positioning were seen as important facilitators.

Conclusion: Integrating physiological evaluation with structural imaging enhances the utility of EUS, but access remains restricted by logistical, financial, and educational constraints. Public-private partnerships, policy support, and structured training programs are essential to expand EUS availability and optimize patient care.