Endoscopic Ultrasound

Overview

An endoscopic ultrasound (EUS) examination involves the insertion of a thin tube into the mouth and down into the stomach and the first part of the small intestine. The tip of the tube contains a small ultrasound probe that emits sound waves.

The ultrasound probe is capable of generating detailed images of internal organs such as the oesophagus, stomach, pancreas, bile ducts, and liver.

Reasons you may need an EUS

Endoscopic ultrasound is very useful in evaluating diseases involving the pancreas and bile duct. Examples of conditions in which EUS is helpful include

  • Pancreatic masses and tumours
  • Pancreatic cysts
  • Chronic pancreatitis
  • Recurrent acute pancreatitis
CT or MRI scanning showing abnormalities such as a dilated pancreatic duct, dilated bile duct, suspected bile duct stones or pancreatic stones. EUS can also provide further information on abnormalities detected during gastroscopy or colonoscopy such as tumours and subepithelial lesions (abnormalities that occur below the lining of the gastrointestinal tract)

Preparation

You should not have anything to eat or drink for approximately 8 hours before your EUS. Typically, patients are asked to refrain from eating or drinking after midnight the night before their test. Your physician may ask you to hold any blood thinning for several days prior to the test. Examples include aspirin, Plavix, and warfarin. It is important that you discuss your medications with your physician prior to your test.

Procedure

On the day of your EUS an IV cannula will be placed in your hand or arm so that you can receive intravenous fluids and sedatives during the procedure. Once you are brought into the endoscopy room, you will lay down on a bed, usually on your left side. Monitoring equipment such as a blood pressure cuff will be placed on your arm, an oxygen monitor will be placed on your finger, and ECG leads will be placed on your chest. A small nasal cannula will be placed in your nose to give you oxygen during the procedure. A small plastic “bite block” will be placed in your mouth between your teeth, which protects your teeth and prevents any accidental biting of the scope during the procedure. Sedatives will be injected into your IV before the procedure begins. The echoendoscope will then be used to examine the area of interest. The procedure usually lasts from 20-45 minutes. The vast majority of patients do not feel or experience any discomfort during the procedure, as they are usually asleep during the procedure.

Recovery

EUS is performed as an outpatient procedure. When the procedure is finished, you will be brought to a recovery area where you will lay in bed until you are awake. Recovery is generally between 30min – 2 hours depending on the complexity of the procedure. You will have an opportunity to discuss the results of the examination with your doctor on the day of the examination. You will generally not require admission to hospital.

Complications

Like other endoscopic procedures, EUS is safe and well tolerated. No procedure is without risk, but complications with EUS are quite rare. Complication rate for EUS without the fine needle aspiration is about 1:2000 (similar to the complication rate of other endoscopy procedures). The main complication of serious note is perforation (making a hole in the intestinal wall) that can potentially be repaired endoscopically or may even require surgical repair. This is quite rare and all precautions are taken to avoid it. If a biopsy is performed at the time of your EUS there is a slightly higher risk of complications but still remains uncommon (0.5-1.0%). Passing a needle through the gut wall may cause minor bleeding. If unusual bleeding occurs, the patient may be hospitalised briefly for observation, but blood transfusions are rarely needed. Infection is another rare complication of FNA. Infection can occur during aspiration of fluid from cysts and antibiotics may be given before the procedure. If the FNA is performed on the pancreas, pancreatitis (inflammation of the pancreas) can rarely occur. Pancreatitis calls for hospitalization, observation, rest, IV fluid, and medication for abdominal pain which usually resolves spontaneously in a few days.

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