Endoscopic Ultrasound

What is EUS?

Endoscopic ultrasonography (EUS) allows your doctor to examine your oesophageal and stomach linings as well as surrounding structures such as the pancreas and biliary system (gall bladder etc). We will use a thin, flexible tube called an endoscope that has a built-in miniature ultrasound probe. The endoscope will be passed through your mouth to the area to be examined. Your doctor then will use the ultrasound to use sound waves to create visual images of the digestive tract.

Why is EUS done?

EUS is used to evaluate known abnormalities, including lumps or lesions, which were detected at a prior endoscopy or were seen on x-ray tests, such as a computed tomography (CT) scan. EUS provides a detailed image of the lump or lesion, which can help your doctor determine its origin and help treatment decisions. An endoscopic ultrasound can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive or conflicting.

How should I prepare?

For an endoscopic ultrasound of the upper gastrointestinal tract, you should have nothing to eat or drink, usually for six hours before the examination. You will be told when to start this fasting and whether it is advisable to take your regular prescription medications.

What can I expect during EUS?

Most often you will receive intravenous sedation or a full anaesthetic in order to complete the EUS. You will most likely begin by lying on your left side. When you are relaxed and/or asleep your endoscopist will pass the ultrasound endoscope through your mouth, oesophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes 30 to 60 minutes depending on whether additional procedures such as fine needle biopsy is performed.

What happens afterwards?

After the procedure you will be monitored in the recovery area until most of the sedative medication’s effects have worn off. After upper EUS, your throat might be a little sore. You might feel bloated because of the air and water that were introduced during the examination. You’ll be able to eat after you leave the procedure area, unless you’re instructed otherwise.

Your doctor generally can inform you of the preliminary results of the procedure that day, but the results of some tests, including biopsies, may take several days.

Can EUS be used to take a biopsy?

Yes – if required at the time of EUS, a fine needle aspirate (FNA) or biopsy (FNB) can be taken by passing a thin needle through the endoscope and directly into the target lesion under direct ultrasound guidance. This can further clarify the type of lesion and assist in further management.

Do I need to take antibiotics?

Antibiotics are not generally required before or after EUS examinations. However, your doctor might prescribe antibiotics if you are having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance.

What about my current medications or allergies?

You can take most medications as usual until the day of the EUS examination. Tell your doctor about all medications that you’re taking and about any allergies you have. Blood thinners such as warfarin, Xarelto, Pradaxa, Clopidogrel and even aspirin and fish oil may need to be adjusted or stopped before the procedure. Check with your doctor in advance regarding these recommendations.

Why is EUS used for patients with cancer?

EUS helps your doctor determine the extent of spread of certain cancers of the digestive. 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 a needle biopsy of a lump or lesion to help your doctor determine the proper treatment.

Should I arrange for help after the examination?

You will not be allowed to drive after the procedure for twenty four hours. You should arrange a ride home in advance. You should also plan to have someone stay with you at home after the examination, because the sedatives could affect your judgment and reflexes for the rest of the day.

What are the possible complications?

Although complications can occur, they are rare and you can be reassured that the doctor performing your EUS has been trained and credentialed by a national body in the procedure. Bleeding might occur at a biopsy site, but it’s usually minimal and rarely requires follow-up.

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.

The possibility of complications increases slightly if a needle biopsy is performed during the EUS examination, including an increased risk of pancreatitis or infection. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.

If you have any concerns or questions please feel free to ring 8921 9188 speak to one of our endosonographers (Drs Kwok, Gupta or Herba) before the test is performed.

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