Endoscopic Ultrasound (EUS)
Care Before the Procedure
- Pre-Procedure Evaluation:
- Review of prior imaging (CT, MRI) to target areas of interest.
Blood tests (coagulation profile) if FNA is planned.
- Review of prior imaging (CT, MRI) to target areas of interest.
- Fasting:
- Upper EUS: No food or drink for 6–8 hours.
- Lower EUS (rectal): Bowel prep similar to colonoscopy.
- Medication Adjustments:
- Hold anticoagulants (e.g., warfarin, clopidogrel) 5–7 days prior if FNA is anticipated.
- Adjust diabetes medications due to fasting.
- Arrangements:
- Arrange transportation post-procedure due to sedation.
Care During the Procedure
- Setting: Performed in a hospital endoscopy suite or radiology department.
- Anaesthesia: Typically performed under conscious sedation or monitored anaesthesia care (MAC).
- Process:
- The endoscope is passed through the mouth into the duodenum.
The ampulla is identified, and a catheter is used to inject contrast dye into the ducts. - X-ray images are taken to identify abnormalities.
- Therapeutic interventions (e.g., stone extraction, stent placement, sphincterotomy) are performed as needed.
- The endoscope is passed through the mouth into the duodenum.
- Duration: 30–90 minutes, depending on complexity.
- Patient Experience:
- Sedation ensures comfort; patients may feel slight bloating or pressure.
- Vital signs are monitored throughout.
Care After the Procedure
- Immediate Recovery:
- Monitor for 1–2 hours until sedation wears off.
- Temporary throat discomfort (upper EUS) or bloating may occur.
- Post-Procedure Instructions:
- Resume diet once swallowing returns to normal.
- Avoid driving, operating machinery, or alcohol for 24 hours.
- Biopsy Results:
- Preliminary findings may be discussed same day; pathology results take 3–7 days.
- Complications (Rare):
- Watch for severe pain, fever, vomiting, or bleeding (especially with FNA).
- Pancreatitis risk (1–3%) after FNA of pancreatic lesions.
- Follow-Up:
- Repeat EUS may be needed to monitor cysts or treatment response.
Integration of results with oncology, surgery, or gastroenterology plans.
- Repeat EUS may be needed to monitor cysts or treatment response.
- Note: EUS is a highly specialized procedure that improves diagnostic accuracy and reduces invasive surgeries. It should be performed by experienced endosonographers at high-volume centers. Patients should discuss risks (e.g., bleeding, infection, perforation) and benefits with their provider to ensure optimal outcomes.
Eligibility
- EUS may be recommended for:
- Cancer staging: Oesophageal, gastric, pancreatic, rectal, or lung cancers.
- Pancreatobiliary disorders: Unexplained pancreatitis, bile duct stones, or pancreatic cysts.
- Submucosal tumours: Suspected gastrointestinal stromal tumours (GISTs) or lipomas.
- Lymph node evaluation: For malignancy or infection.
- Therapeutic needs: Pseudocyst drainage, celiac plexus block, or fiducial placement for radiation therapy.
- Pre-Procedure Evaluation:
- Review of prior imaging (CT, MRI) to target areas of interest.
Blood tests (coagulation profile) if FNA is planned.
- Review of prior imaging (CT, MRI) to target areas of interest.
- Fasting:
- Upper EUS: No food or drink for 6–8 hours.
- Lower EUS (rectal): Bowel prep similar to colonoscopy.
- Medication Adjustments:
- Hold anticoagulants (e.g., warfarin, clopidogrel) 5–7 days prior if FNA is anticipated.
- Adjust diabetes medications due to fasting.
- Arrangements:
- Arrange transportation post-procedure due to sedation.
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