Endoscopic Ultrasound (EUS)

What is Endoscopic Ultrasound?
Endoscopic Ultrasound (EUS) is a procedure that looks at your digestive system from the inside. It can be done for either your upper or lower digestive tract. A thin, flexible tube, called an endoscope, with a tiny camera at the end, is gently guided into your digestive system. This tube also has a tiny echo machine at the end that can send out sound waves very similar to an external ultrasound. The use of sound waves allows your doctor to examine and take pictures of your digestive system and the organs and lymph nodes outside of the digestive tract. EUS produces very high resolution pictures that allow your physician to more accurately diagnose and treat your condition.

In addition to the diagnostic capabilities, EUS may be used to treat certain conditions of the digestive tract. In addition, when using EUS, it is possible to inject medicine into certain areas of the GI tract. The EUS scope can also be used to direct a tiny needle into an area of concern and take a sample of tissue. This is called “Fine Needle Aspiration (FNA)”.

What preparation is required?
Your test will be scheduled as an outpatient procedure in most cases. Rarely, you may need to be admitted to a hospital overnight. You will be told if this is possible. Be sure to follow the instructions below before your exam:

Do not eat or drink for 6 hours before your test. Your stomach must be empty. Tell your doctor if you:
Have any allergies
Heart or lung problems
Are or think you may be pregnant
Have had an endoscopy in the past and if you had problems with the medicines or dye used
Take antibiotics before having dental work

If you take medicine to thin your blood, (i.e. Heparin, Coumadin, Plavix or aspirin compounds), tell your doctor. In general, you must stop taking these pills for several days, but in some cases you may continue to take them.

If you are a diabetic, please ask your doctor if you should take your insulin and/or pills before your test. You may take blood pressure and heart medicine as usual the morning of the test. If you take pills in the morning, drink only a small sip of water to help you swallow. Do not take any antacids. Bring with you an updated list of all prescription and over-the-counter medicines you are taking. Bring with you all medical records and X-ray films that relate to your current problem.

Make sure an adult can take you home as you will be sedated for your procedure. The medicines used during the procedure will not wear off for several hours. You will NOT be able to drive. If you travel by public transportation, such as by bus, van or taxi, you will still need an adult to ride home with you. If you come alone, your test will have to be rescheduled.

What should you expect during EUS?
When you come for the EUS, the doctor will talk to you about the test and answer any questions you have. You should know why you are having an EUS and understand the treatment options and possible risks. Your doctor and anesthesia personnel will give you a medication through a vein to make you relaxed and sleepy. Propofol is recommended and is used for anesthesia in our centers. When you are sedated, the doctor will place a thin, flexible tube (endoscope) through your mouth and into your digestive tract. The endoscope has a small video camera on the end that lets the doctor see inside your intestinal tract.

The procedure can take from 30 to 90 minutes, during which patients are kept comfortable and relaxed. The procedure is extremely well tolerated with little or no discomfort. The EUS scope will not interfere with your breathing. The medication usually prevents gagging.

What happens after the EUS?
After the EUS, you will be taken to the recovery area. Your blood pressure and heart rate will be monitored while you recover. You will be able to leave the endoscopic area as soon as most of the effects of the medication have worn off. Your throat may be a little sore for a couple of hours, and you may feel some “gassiness” and fullness in the abdomen for a few minutes right after the procedure because of the air that was introduced to examine your stomach.

You will be able to resume your diet as soon as the EUS is over unless your doctor instructs you otherwise.

The doctor will talk to you about your test before you leave. The nurse will give you written instructions to follow when you go home. If you have any questions, please ask.

Are there complications of EUS?
EUS is safe and associated with low risk when performed by physicians who have been specially trained and are experienced in this endoscopic procedure.

One major complication is perforation, in which a small tear through the wall may allow leakage of digestive fluid. This complication may be managed simply by suctioning the fluid until the opening seals, or it may require surgery.

Bleeding may occur from the site of biopsy or polyp removal. It is usually minimal but rarely may require transfusions or surgery.

Localized irritation of the vein may occur at the site of medication injection. A tender lump develops that may remain for several weeks to several months but goes away eventually.

Although uncommon, aspiration (breathing in) of stomach contents that come up through the esophagus can occur. This could lead to pneumonia and the need for hospitalization.

Death is extremely rare but remains a remote possibility. Other risks include drug reactions.

Call the GI doctor if you have severe pain, vomit or pass blood, have chills or fever above 101 degrees.

What are the reasons for doing the EUS?
EUS ultrasound images provide highly accurate image/picture assessments of the layers of the intestinal wall and the structures immediately adjacent to the GI tract. As such, EUS improves the ability of the gastroenterologist to determine the depth and extent of a cyst, polyp, other growth or cancer of the intestine. Tissue samples from lymph nodes and other areas adjacent to the intestinal wall provide diagnostic information that can allow physicians to properly diagnose and treat patients in many cases. Ultimately, EUS will guide endoscopic therapies in the treatment of cysts, vascular lesions and cancers of the GI tract.

Are there alternatives to EUS?
External ultrasound studies, CT, PET and MRI scans are imaging options that can be used to evaluate GI diseases. EUS complements these studies and in addition allows for obtaining tissue samples and, ultimately, treatment of many GI tract diseases.

Additional important patient information
EUS is an extremely worthwhile and safe procedure that is very well tolerated and is invaluable in the diagnosis and proper management of disorders of the upper digestive tract. Because of the use of intravenous anesthetic agents during the procedure, arrangements must be made for the patient to be picked up at the end of the exam.

Your doctor’s decision to perform this procedure was based upon his/her assessment of your particular problem. If you have any questions about the procedure or your need for an EUS, do not hesitate to discuss them with your gastroenterologist. Both of you share a common goal – your good health – and it can only be achieved through mutual trust, respect, and understanding.

This information is provided as an educational service of Gastrointestinal Associates, P.C. The content is limited and is not a substitute for professional medical care.