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What is Endoscopic Ultrasound

This procedure uses a specialised endoscope with an ultrasound probe at its tip. Utilizing high-frequency sound waves, this technique generates intricate images of the digestive system as well as various organs and tissues, including the lungs, pancreas, gallbladder, liver, and lymph nodes.

Endoscopic ultrasound (EUS) is instrumental in detecting diseases affecting these organs and the digestive tract. In certain instances, a small needle may be connected to the tube. This apparatus is employed to extract fluid or tissue samples for laboratory analysis. Such samples are referred to as biopsies. The procedure is known as EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy. Additionally, EUS can facilitate the drainage of fluid from a lesion or the targeted delivery of medication within the body.

Why is it done
Endoscopic ultrasound (EUS) is a diagnostic procedure utilized to evaluate conditions affecting the digestive system and adjacent organs and tissues. An EUS probe is inserted through the throat to obtain images of the esophagus, stomach, and sections of the small intestine. In certain instances, the EUS probe may be introduced through the anus, which serves as the exit point for stool from the digestive tract. This approach allows for imaging of the rectum and portions of the large intestine, known as the colon.

EUS is also capable of capturing images of various other organs and surrounding tissues, including:

• Lymph nodes located in the central chest area
• Liver
• Gallbladder
• Bile ducts
• Pancreas

In some cases, needles are employed during EUS-guided procedures to examine or treat organs adjacent to the digestive tract. For instance, a needle may be inserted through the esophageal wall to access nearby lymph nodes, or it may penetrate the stomach wall to administer medication to the pancreas.

EUS and its guided procedures can be utilized for several purposes, including:

• Assessing tissue damage resulting from inflammation or disease
• Determining the presence of cancer and its potential spread to lymph nodes
• Evaluating the extent of a malignant tumor's invasion into surrounding tissues
• Identifying the cancer stage
• Providing detailed information regarding lesions detected by other imaging modalities
• Extracting fluid or tissue samples for analysis
• Draining fluids from cysts
• Administering medication to a specific area, such as a malignant tumor.

Preparation Guidelines Your healthcare team will provide specific instructions to prepare for your Endoscopic Ultrasound (EUS). These instructions typically include:

• Fasting. You may be required to refrain from eating or drinking for a minimum of six hours prior to the procedure to ensure that your stomach is empty.
• Colon cleansing. If the EUS is to be performed through the anus, it will be necessary to cleanse your colon. You may be instructed to use a colon cleansing solution or adhere to a liquid diet accompanied by a laxative.
• Medications. Your healthcare team may advise you to discontinue certain medications before the EUS. It is essential to inform them about all prescription and over-the-counter medications you are currently taking, including any herbal supplements or dietary aids.
• Post-Procedure Transportation. If you receive medications to help you relax or sleep during the EUS, you may experience some grogginess or impaired cognitive function afterward. It is advisable to arrange for someone to drive you home and remain with you for the remainder of the day.

What to expect during the procedure

• If anesthesia is administered, you will not be conscious during the procedure. If a sedative is used, you may experience some discomfort; however, many individuals tend to fall asleep or remain in a semi-conscious state throughout the EUS.
• You will likely be positioned on your left side during the procedure. The physician will insert a thin, flexible tube through your throat or anus, depending on the specific organs or tissues being examined.
• At the end of the tube is a small ultrasound device that utilizes sound waves to generate images. Additional instruments, including a needle for tissue sampling, will also be introduced through a channel in the tube.
• The duration of the EUS is generally less than one hour, although an EUS-guided procedure may take longer.
• After an upper EUS, you may experience a sore throat. Throat lozenges can provide relief for this discomfort.

Risks
Endoscopic Ultrasound (EUS) is typically a safe procedure when performed at a facility with a skilled healthcare team. It is usually conducted by a physician who specializes in gastroenterology and possesses specific training in EUS techniques.

Your healthcare team will discuss the potential risks associated with EUS. These risks are often linked to fine-needle aspiration and may include:

• Bleeding 3-4%.
• Infection 2-3%
• Perforation of an organ wall 0.1 – 1%
• Pancreatitis, which can occasionally occur following fine-needle aspiration of the pancreas. 3-4%

To minimize the likelihood of complications, it is essential to adhere to the instructions provided by your healthcare team in preparation for the EUS.