ENDOSCOPIC ULTRASOUND (EUS)

Your doctor has requested this procedure to help investigate and manage your medical condition.

WHAT IS ENDOSCOPIC ULTRASOUND?

Endoscopic ultrasound (EUS) is a procedure that combines the ability to look directly at the lining of the gut, with ultrasound, that allows the operator to see structures beneath the surface. It also provides excellent pictures of your pancreas, bile ducts and organs in your chest. A special endoscopy/ultrasound scope is used which is a long flexible tube (thinner than your little finger) with a light at the end and a built in miniaturised ultrasound probe. Endoscopy carries the state of art technology giving us an overview of what’s happening inside the lumen as well as outside the lumen. EUS guided fine needle aspiration has become the safest and most accurate way of obtaining tissues from suspected tumors, especially which are inaccessible to the abdominal ultrasound and CT scan. EUS has also been employed in the treatment of cystic lesions, nerve blocks and fudicial placements which enhances the efficacy of radiation therapy.
WHY HAVE AN EUS?

EUS is used for a variety of indications:

  • diagnose and stage tumours of the esophagus, stomach, duodenum, ano-rectum, pancreas & bile ducts
  • diagnose some tumours of the lung
  • diagnoses diseases of internal organs: pancreatitis or cysts of the pancreas
  • detect bile duct stones, including gall stones
  • assess abnormalities of the walls (inside and outside) of the gut
  • drainage of abscess and pseuocyst

WHAT IS THE ADVANTAGE OF EUS FNA OVER CONVENTIONAL CT GUIDED FNA?

EUS FNA is more accurate and precise than conventional FNAC. The real time guidance provided by the “EUS echoendoscope” helps in visualizing the structures inside and outside the lumen at the same time. Using real time imaging as a guidance we can avoid damage to the blood vessels and other important structures near the lesion. Also to mention that the lesion can be accessed from the nearest point of approach; this is in fact the greatest advantage of using EUS.

WHAT PRECAUTIONS NEED TO BE TAKEN?

  • Bring a list of all prescribed, over the counter and herbal medication you take.
  • Bring any relevant x-rays.
  • Do not drink any alcohol and/or take recreational drugs 24 hours before the procedure.
  • Please ensure you make arrangements for someone to drive you home after the procedure. It is not safe to drive until the following day after having sedation or an anaesthetic.
  • Inform your doctor if you are taking medications like Aspirin, Clopidogrel, Warfarin or any other medications for thinning your blood. You need to stop them for a week if your are undergoing a therapeutic procedure like FNAC.
  • If you are a diabetic avoids taking the tablet or insulin dose on the day of the procedure. Kindly bring all your medications along with you so that you could take them after the procedure as advised by the physician.
  • If you have high blood pressure or heart disease, you can take your medications in the morning at 5 am with few sips of water.

GETTING READY FOR THE PROCEDURE

  • Wear loose fitting washable clothing and leave valuables at home.
  • On arrival at the department, we will explain the procedure to you and ask you to sign a consent form. You can change your mind about having the procedure at any time.
  • We will give you a sedative (by injection into a vein) to make you relaxed and sleepy. The sedative will not put you to sleep (this is not a general anaesthetic). This means you not be aware of the procedure. The injection will continue to have a mild sedative effect for up to 24 hours and may leave you unsteady on your feet for a while.

WHAT WILL HAPPEN DURING THE PROCEDURE?

In the procedure room, we will ask you to remove false teeth, glasses and hearing aids in the left ear. We will make you comfortable on a couch lying on your left side. A mouth guard will be put gently between your teeth so that you do not bite and damage the instrument. As the instrument is gently passes the tube through your mouth you may gag slightly, this is quite normal and will not interfere with your breathing. Minimal restraint may be appropriate during the procedure. However, if you make it clear that you are too uncomfortable the procedure will be stopped.

The scope is passed into the mouth and on down the gullet (oesophagus) and stomach into the duodenum to see structures in the upper abdomen. The procedure is performed under sedation (not a general anaesthetic). The level of sedation is such that generally no discomfort should be experienced. It can take around 20 minutes, but if it takes longer, you should not worry.

Sometimes EUS is used to take a fluid or tissue samples; the same EUS echoendoscope allows a fine needle biopsy (sample) of tissue to be taken inside or outside the wall of the gut. This needle is passed through the scope, and using the ultrasound as a guide, it is passed into the tissue of concern this is done by passing a small needle through the scope to obtain the samples which are sent to the laboratory for analysis. In certain conditions EUS is also used to guide a special injection as treatment for severe pain, this is called a coeliac plexus neurolysis (CPN). EUS may also be used to guide other procedures such as cyst or abscess drainage.

WHAT HAPPENS AFTER THE EUS?

  • You will usually be allowed to have a regular diet straight away. Depending on the procedure you may only be allowed to have a clear liquid diet for the remainder of that day.
  • Your doctor will inform you of the results prior to you leaving the recovery area
  • Any tissue samples taken will be sent to a pathologist. The results of these tests may take several days, follow-up of these results will be made with you
  • Again, please ensure you make arrangements for someone to drive you home after the procedure. Do NOT drive any type of vehicle or operate machinery until the next day. Do NOT drink alcohol and/or take other recreational drugs. They may react with the sedation drugs. Do NOT make important decisions or sign a legal document for the first 24 hours. Have an adult with you on the first night after your procedure
  • Notify Continental Hospital on 04067000000 at anytime and connect to the emergency room straight away if you have:
    • severe ongoing abdominal pain.
    • black tarry motions or bleeding from the back passage.
    • a fever
    • sharp chest or throat pain

WHAT ARE THE POSSIBLE COMPLICATIONS?

Diagnostic endoscopic ultrasound procedures carry a very small risk (1 in 10,000 cases) of haemorrhage (bleeding) or perforation (tear) of the gut following which surgery may be necessary. The use of guided needle sampling slightly raises the risk of haemorrhage but the risk remains very slight. The risk of perforation is about 1 in 1,000 when using an endoscope to take samples with EUS. There is a similar risk of causing inflammation of the pancreas (pancreatitis). Infection can rarely occur during aspiration of cysts, so you may be given antibiotics to reduce the chance of this happening.

If you have had a coeliac plexus neurolysis (CPN) we will observe your blood pressure for a while after the procedure. CPN may temporarily lower your blood pressure, but this is very unusual. Some patients may have diarrhoea for a few days after the procedure. A very small number may experience a temporary increase in pain.

As with all endoscopic procedure there may be a slight risk to teeth, crowns or dental bridgework; you should tell the nurses if you have either of these. Other rare complications include aspiration pneumonia (inflammation of the lungs caused by inhaling or choking on vomit) and adverse reactions to intravenous sedative drugs and, when used, antibiotic treatment.

Like all test this procedure will not always show up all abnormalities and, on rare occasions, a significant abnormality may not be identified. If you have any questions about this please ask either at the time of your procedure or the person who referred you.

WHAT IF I DON’T HAVE THE PROCEDURE?

Your symptoms may become worse and your doctor will not be able to give you the correct treatment.

ARE THERE OTHER TESTS I CAN HAVE INSTEAD?

Generally not. X-ray tests will assist in many of the diagnoses, however, in certain indications is not as accurate as EUS. Additionally, the Radiologist’s may be able to perform a needle biopsy of certain lesion through your skin. These options can be discussed.