Endoscopic Ultrasound (EUS) Be the difference between maybe and definitely.

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1 (EUS) Be the difference between maybe and definitely.

2 Maybe? Definitely. EUS lets you be certain in uncertain cases.

3 Why EUS? EUS combines ultrasound technology with endoscopy to gain an internal vantage point to obtain higher resolution ultrasound images. While conventional endoscopy only provides a view of the innermost lining of the digestive tract, or its wall, the addition of ultrasound allows the physician to see beyond that wall to visualize all five layers of the GI tract as well as surrounding tissue and organs. EUS plays an important role in diagnosing diseases of the pancreas, bile duct, liver, spleen and gallbladder as well as the staging of cancers. Predictable and Accurate Competing techniques are computed tomography (CT) and magnetic resonance imaging (MRI), but these technologies offer lower image resolution and therefore lower detection rates of small lesions when compared to EUS. 1,2 EUS SENSITIVITY % EUS SPECIFICITY % n EUS provides greater sensitivity than other imaging modalities for diagnosing and staging cancers located in the esophagus, stomach, pancreas and rectum PREDICTIVE VALUE ANALYSIS 3 % Negative Predictive Value % Positive Predictive Value n The strong predictive value of EUS prevents the need for more expensive diagnostic procedures. 5 Minimally Invasive and Theraputic Benefits EUS provides a minimally invasive means for biopsy and is utilized in therapeutic applications such as the aspiration of cells, cyst drainage and biopsies of lymph nodes making it an ideal, alternative to exploratory surgery. 6 EUS-guided Fine Needle Aspiration (EUS-FNA) collects tissue and cellular samples when a suspicious area of interest is found. n EUS-FNA enables evaluation of viscosity, cytology, chemistry, tumor markers, molecular markers and genetic mutations. 7 B Mode Brightness FLOW Modes Color, Power and High Resolution PW Mode Pulse Wave Doppler THE Mode Tissue Harmonic Echo ELST Mode Elastography n EUS-FNA use is supported by The American Society for Gastrointestinal Endoscopy and the European Society of Gastrointestinal Endoscopy. 7

4 Why EUS? Care Continuum Referring patients to other tertiary institutions for additional care affects patient retention and could delay treatment due to an unwillingness to travel. EUS can assist in solidifying the care continuum within your institution and build a support strategy that keeps patients within your network. A stronger care continuum provides a service to your patients by providing them with quality care and management close to home. The addition of EUS to your institution s care continuum could provide financial benefits not only in Gastroenterology, but in other departments such as Oncology, Radiology and Surgery. 8,9 Downstream Revenue Endoscopic ultrasound s complete financial benefit may not be realized at the time of the procedure, but further downstream when additional patient care could be needed. The downstream revenue is being derived from not only the EUS procedures themselves, but from the treatments and care provided post procedure and keeping the patients in the facility s continuum of care. The EUS Calculator can assist you in identifying how EUS combined with downstream revenue may provide incremental and additional financial returns. Operating Cost Reimbursement Downstream Revenue IMAGING EUS EVALUATE PATIENTS with symptoms of diseases like pancreatitis, pancreatic cysts or bile duct stones STAGE CANCERS such as esophageal, gastric, rectal and pancreatic cancers 1 Downstream Revenue Projections ONCOLOGY RADIOLOGY PATHOLOGY ASPIRATE FLUID SAMPLES from areas of interest 1 COLLECT BIOPSIES from lesions accessible through the GI tract 1 DELIVER ANTI-CANCER MEDICATION with EUS-guided injection 7 Best results are obtained when your business information (i.e. volume projections, revenue, expenses, etc.) is included. When site specific information is unknown, we offer industry values and/or corporate intelligence to assist with your decision.

5 The Most Comprehensive Solution The PROSOUND F75, Olympus ergonomic premier ultrasound processor, offers the highest quality ultrasound imaging available from Olympus. The processor offers forward and backward compatibility with most EUS and EBUS endoscopes.the adjustable height and depth of the keyboard and monitor accommodates different users to provide ergonomic comfort. The EU-ME2 PREMIER PLUS version of the EU-ME2 provides outstanding image quality and functionality, comparable to a large radiology processor, in a compact body. It was designed to meet and exceed the needs of gastroenterologists performing a wide range of EUS procedures. Advanced imaging features improve visualization and assist in diagnostic, therapeutic, and interventional procedures, leading to improved quality of patient care. CURVED LINEAR ARRAY (curvilinear array): These echoendoscopes are useful for therapeutic applications such as tissue sample collection, cyst drainage, biopsies of lesions/lymph nodes and injection for pain management. 1 Olympus offers three curvilinear scopes to meet your needs and preferences: GF-UCT1, curvilinear transducer offers increased imaging depth which lets you step up to the next level in ultrasound imaging and performance GF-UC14P-AL5, a slim curvilinear scope with advanced insertion capability TGF-UC1J, the first and only forward-viewing curvilinear scope pioneering new opportunities in EUS-guided treatment 1 o The versatile EU-ME2 is forward and backward compatible with a wide range of Olympus EUS and EBUS scopes as well as ultrasound miniature probes. Since the processor is appropriate for gastroenterology, pulmonary and thoracic surgery departments, it offers healthcare facilities with a cost-effective resource that can be shared across specialties. RADIAL ARRAY: The diagnostic GF-UE16-AL5 radial array echoendoscope is used to assess anatomy of the GI tract and surrounding structures. It provides a 36, cross-sectional view of the GI tract and is primarily used for screening. 11 The EZ SHOT 3 PLUS single-use aspiration needle is designed to be used with an ultrasound endoscope for EUS-FNA of submucosal and extramural lesions within the gastrointestinal tracts (e.g., pancreatic masses, mediastinal masses, perirectal masses and lymph nodes). Flexibility of the EZ Shot 3 Plus provides uncompromised access to difficult-to-approach anatomy, even when the end of the scope is tightly curved. MINIATURE PROBES generate 36 high-resolution images in the near field for excellent visualization of submucosal areas. To target lesions, Olympus offers 11 mechanical radial scanning ultrasound probes with multiple features including guide wire, dual plane reconstruction and rigid rectal probes.

6 Olympus Services and Resources At Olympus, our partnership doesn t end after the product is shipped. The point of transition signals a new phase of the relationship with our customers one that is built on the trust and confidence we offer through a dedicated and committed team of support personnel. Field and Clinical Support Field Service Engineers Installs your product as well as conducts in-service training for your clinical staff to get up and running Endoscopy Account Managers Consultants for all your Olympus endoscopy product and service needs FSE EAM ESS Clinical Application Specialists Registered diagnostic medical sonographers providing support for EUS and EBUS products CAS MES CES Clinical Endoscopy Specialists Field-based nurses or GI technicians with advanced ERCP, EUS, ESD and EBUS clinical experience Olympus Customer Service Phone: Olympus Technical Assistance Center Phone: Specialists are available 24/7 to respond to calls and assist you in diagnosing and troubleshooting your entire range of Olympus products. OlympusConnect.com Web: olympusconnect.com OlympusConnect.com is a web portal for Olympus customers to access corporate intelligence in order to improve business and clinical operations. This passwordprotected site contains a vast amount of resources including case studies, product catalogs and businessbuilding marketing materials. Financing Options Phone: Web: medical.olympusamerica.com/customer-resources/ financing. For more than 2 years, Olympus has been providing lease financing programs that are affordable, flexible and customized for our healthcare technology users. Service Agreements Phone: service.contracts@olympus.com Olympus provides comprehensive coverage for all endoscope and processor repairs, whether caused by daily use or accidental damage. Our 24/7 technical support provides on-site options to meet your facility's needs. Reimbursement Guidelines Hotline Phone: olympusreimbursement@reimbursementiq.com Olympus has a full collection of reimbursement materials to help healthcare providers be more informed and to make better economic decisions. Coding experts are available to help answer your reimbursement questions. Olympus University and Professional Education Phone: Web: olympusuniversity.com Product training and education programs provide safe and effective product use training on Olympus equipment and devices to healthcare professionals (HCPs), particularly physicians and nurses. Endoscopy Support Specialists Perform on-site reprocessing, care and handling, and asset management training Medical Education Specialists Field-based nurses or GI technicians providing product and procedure training and in-services

7 (EUS) A comprehensive solution for diagnosing and staging cancer. References: 1. Palazzo L, Roseau G, Gayet B, et al. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 1993;25: Fusaroli P, Kypraios D, Caletti G, et al. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol 212;18: Sivak MV Jr. EUS for bile duct stones: how does it compare with ERCP? Gastrointest Endosc. 22;56(6)(suppl):S175-S177. doi:1.167/mge Parada KS, Peng R, Erickson RA, et al. A resource utilization projection study of EUS. Gastrointest Endosc. 22;55(3): doi:1.167/mge Alhayaf N, Lalor E, Bain V, McKaigney J, Sandha GS. The clinical impact and cost implications of endoscopic ultrasound on the use of endoscopic retrograde cholangiopancreatography in a Canadian university hospital. Can J Gastroenterol. 28;22(2): Endoscopic ultrasound. Mayo Clinic website Accessed February 1, Nakai Y, Isayama H, Itoi T, et al. Role of endoscopic Ultrasound in pancreatic cystic neoplasms: where do we stand and where will we go? Dig Endosc. 214;26(2): doi:1.1111/den Faigel DO. Economic realities of EUS in an academic practice. Gastrointest Endosc. 27;65(2): doi:1.116/ j.gie Harewood GC, Stemmer W, Roth J, Waxman I. Resource-intensive endoscopy: revenue source or cash drain? Gastrointest Endosc. 29;(2): doi:1.116/j.gie American Society for Gastrointestinal Endoscopy (ASGE). Media backgrounder, endoscopic procedures. PressroomIndex.aspx?id= Tierney WM, Adler DG, Chand B; American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee. Technology Status Evaluation Report. Echoendoscopes. Gastrointest Endosc. 27;66(3): doi:1.116/j.gie Olympus is a registered trademark of Olympus Corporation, Olympus America Inc., and/or their affiliates. Corporate Parkway, PO Box 61, Center Valley, PA 134 For more information, contact your Olympus sales representative, or call Olympus America Inc. All rights reserved. Printed in USA OAIEUS117BRO23996