Endoscopic Ultrasound

Endoscopic ultrasound (EUS) combines endoscopy and ultrasound in order to examine the digestive tract and the surrounding tissue and organs. By placing an ultrasound machine at the tip of an endoscope tube, the doctor can obtain high-quality ultrasound images of the organs inside the body.

Why Do I Need an EUS?

EUS is used to provide information about the layers of the intestinal wall, nearby organs, or lymph nodes and blood vessels. EUS can also include obtaining tissue samples or biopsies to help in diagnosing enlarged lymph nodes or masses seen on other imaging studies. 

EUS is useful in several situations including, but not limited to:

• Evaluating chronic pancreatitis, masses, or cysts of the pancreas.
• Studying bile duct abnormalities including stones in the bile duct or gallbladder, or cancer of the bile ducts.
• Studying certain submucosal lesions such as nodules or “bumps” that may be hiding in the intestinal wall covered by normal-appearing lining of the intestinal tract.
• Staging (or determining the extent of) certain cancers.

What Are the Benefits of an EUS?

An endoscopic ultrasound allows the doctor to obtain high-quality images of the intestinal tract and surrounding organs. It can provide more exact pictures than routine X-rays, CT scans, or MRI scans when evaluating areas of the GI tract, pancreas, or bile ducts. In addition, tissue samples may be obtained during this procedure.

Is There an Alternative to an EUS?

An alternative may be X-rays, CT scans, or MRI scans. Please be aware out of these tests, only CT scans can sample tissue, but many times the area of interest is not reachable on CT and is only accessible by EUS. 

In most cases the alternative tests will not provide the detailed information that can be obtained by EUS.

Are Their Side Effects and/or Risks to an EUS?

EUS is a safe and well-tolerated procedure, and complications are rare. 

While no procedure is without risk, the complication rate for EUS without the fine needle aspiration (FNA) is about one in 10,000.

• Sometimes, patients can develop reactions such as hives, skin rash or nausea to the medications used during EUS.
•  A lump may appear in the area of the vein where the IV was placed. This usually resolves over time. Should it persist, you should contact your physician. 
• The main complication of serious note is perforation (making a hole in the intestinal wall) that may require surgical repair. This is quite rare, and all precautions are taken to avoid it.

When FNA is performed, complications occur more often but are still uncommon (0.5-1.0%). 

• Passing a needle through the intestinal wall may cause minor bleeding. 
• If unusual bleeding occurs, the patient may be hospitalized 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 FNA is performed on the pancreas, pancreatitis (inflammation of the pancreas) can rarely occur. Pancreatitis requires hospitalization, observation, rest, IV fluid, and medication for abdominal pain. It usually resolves spontaneously in a few days.

What Will Happen When I Arrive for My EUS?

• A brief medical history will be reviewed with you by a nurse.
• You will provide a list of any current medications you are taking along with any allergies you have to medications.
• You will be asked to remove your clothing and change into a patient gown.

What Will Happen During My EUS?

• An intravenous (IV) catheter will be placed in your hand or forearm so that medication can be given for sedation. Most of the effects of the sedation last for 15-60 minutes, and you probably will not be able to recall the procedure afterwards. 
• Once you are sedated, the endoscope will be inserted and the procedure started. You will only feel minimal discomfort, if any, during the entire procedure. 
• The physician will observe the inside of your intestinal tract on a TV monitor and the ultrasound image on another monitor. 
• The entire procedure generally takes 30 to 90 minutes, depending on the complexity and whether fine needle aspiration (FNA) is performed.

What Will Happen After My EUS?

• You will be sleepy for up to one hour after the procedure and will be unable to drink or walk.
• You may feel bloated from the air used during the procedure. 
• The medication given to you during the procedure may affect your reflexes and judgment. 
• Light meals and fluids are allowed for the remainder of the day.
• Following the exam, your physician will discuss the results with you and your loved ones.
• You should not drive a car, operate machinery, or make any legally-binding decisions for the remainder of the day.

What Else Should I Know About My EUS?

• If you are on blood thinner medication, such as Coumadin® or warfarin, it is important to let us know well in advance of your appointment. If you are currently taking these medications and have not already given that information to our office, please call immediately. A nurse will contact you with instructions about taking your Coumadin® prior to this procedure.
• YOU MUST HAVE SOMEONE TO DRIVE YOU HOME, OR THE DOCTOR WILL NOT DO THE PROCEDURE. If your driver does not plan to stay during your procedure, you will need to provide a phone number where that person can be contacted.
• Using a small amount of water, take your prescription medications as you usually do unless you have been instructed to hold off the medication prior to the procedure. 
• It is very important that you take your blood pressure or heart medication as usual.
• Bring your insurance cards with you.
• If you are a diabetic, check your blood sugar at home before your procedure.
• If you have an implanted cardiac defibrillator, it is very important that you bring the card identifying the device manufacturer, model, and serial number.
• You may wear your glasses, dentures, or hearing aids. It is best to leave your jewelry at home.
• If your throat is mildly sore for a day or two, salt-water gargles will provide relief.

How Do I Prepare for My EUS?

Please follow the link below to view the preparations for your EUS: