What is Endoscopic Ultrasound (EUS)?
EUS is a procedure that allows your doctor to examine the lining and the walls of your upper and lower gastrointestinal tract. The upper tract includes the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that exist next to the gastrointestinal tract, such as the gall bladder, bile ducts and pancreas.
To achieve this, your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound device to produce sound waves that create ultrasound images of the digestive tract. This typically produces high quality images of the digestive tract wall and the surrounding structures and organs.
Why am I referred for EUS?
Your doctor has referred you for EUS because it provides more detailed images of your digestive tract compared to some of the standard X-rays. Your doctor can use information obtained from EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. EUS can also be used to rule out certain conditions. Examples of indications for EUS procedure include:
- Evaluating and staging of cancer (like esophagus, stomach, rectum, pancreas and, recently, lung). EUS allows your doctor to accurately assess the cancer's depth and whether it has spread to adjacent lymph glands or nearby vital structures such as major blood vessels. In some patients, EUS can be used to obtain tissue samples to help your doctor determine the proper treatment.
- Evaluating chronic pancreatitis and other disorders of the pancreas.
- Studying abnormalities or tumors in organs including the gallbladder, bile ducts and liver.
- Studying nodules (bumps) in the gut wall.
What should I do/know before a scheduled EUS procedure?
Your procedure will be arranged in coordination with your referring physician's office. For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink at least six hours before the examination. For EUS of the rectum or colon, you will be instructed to either consume a large volume of a special cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. This information will be provided to you by our staff who call you to confirm the appointment.
As far as your routine medicines, we strongly recommend that discuss the discontinuation of blood thinners prior to EUS (like Coumadin and Plavix for example) at least 5 days prior to your scheduled test. Although it can be safe to continue to take aspirin and non-steroidal anti-inflammatory drugs (Motrin, Advil, Aleve, etc.) before an EUS examination, but it's always best to discuss their use with your doctor. Check with your doctor about which medications you should take the morning of the EUS examination, and take essential medication with only a small cup of water.
Please plan on arriving at least one hour prior to your scheduled procedure. Upon checking in, please make the EUS lab staff aware of any latex allergies and about the rest of your drug allergies during the pre-EUS assessment done by our nurses. Also inform our staff about any antibiotics you routinely take prior to any dental or other procedures, or if you think you may be pregnant or if you are diabetic. After a discussion about the procedure, you will be asked by the doctor or his assistant to sign a consent form indicating you were informed about the procedure, its alternatives, and its risks. It is best if you ask any questions or relay concerns in regards to the procedure at this time and prior to the sedation.
What happens during EUS?
Prior to starting your EUS examination of the upper gastrointestinal tract, you will be given the chance to ask any questions to the doctor or his assistant. Then you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. For your continued safety, you will be monitored during the entire procedure for your heart rate and rhythm, oxygen levels and blood pressure. After you receive sedatives, your doctor will pass the ultrasound endoscope through your mouth, and down to your stomach and into the duodenum. The instrument does not interfere with your ability to breathe. The EUS examination generally takes between 30 to 60 minutes, but on occasions may take a slightly longer time if fine needle aspiration is performed.
An EUS examination of the lower digestive tract (rectum mainly) is performed after receiving a sedative. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the lower digestive tract last less than 30 minutes.
What happens after EUS?
After completing your EUS procedure you will be transferred to the GI recovery area. You will be monitored for an additional time (could be up to 1 hour or longer at times) to make sure you are emerging safely from the sedatives. You will be given something to drink once your gag reflex is intact. Your family can join you in the recovery area. The physician who performed your procedure will be there to explain the findings and address any questions or concerns you or your family may have. You will be given a copy of the procedure report and your referring doctors will be sent copies of the same report. Biopsies could take up to 7 business days to become available from the pathology lab. You will be sent a copy of the final pathology results within approximately 2-3 weeks of the procedure.
Due to the possible prolonged sedation effects, you cannot drive for 24 hours. You need to arrange for an adult companion to be available with you the day of the procedure.
You may receive a phone call from one of our nurses within the first 2-3 days after the procedure to check on you.
What are the possible complications of EUS?
Before leaving the GI lab, our recovery nurses will inform you about certain symptoms that you will need to report to us if felt and could represent a complication from the procedure. Although complications can occur, they are generally rare. Our doctors specialize in EUS and have a wide experience in this field. Bleeding might occur at a biopsy site, but it's usually minimal and generally resolves spontaneously. You might have a sore throat for a day or two. Nonprescription anesthetic-type throat lozenges and painkillers help relieve the sore throat. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; aspiration of stomach contents into your lungs; infection; and complications from heart or lung diseases. One major, but very uncommon, complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair. Another rare complication is pancreatitis after fine needle aspiration from the pancreas. Your doctor will discuss these risks with you prior to the procedure.
Before leaving home, you will be provided with a phone number to call in case of excessive pain or bleeding, vomiting, fevers or any other unexpected symptom after the procedure. A separate copy of the report will be sent directly to your referring physician's office.
What about the results of the test?
Before leaving the GI lab, you will be given a copy of the procedure report and the doctor will discuss the findings with you directly. In case of a biopsy or fine needle aspirate, the final pathology report can take up to 10 days to become available. Your doctor can discuss with you the preliminary findings but those are not final and could potentially change. You and your referring physician will receive the final report in the mail or as soon as it becomes available.