You've been referred to have an endoscopic ultrasonography, or EUS, which will help your doctor evaluate or treat your condition. This brochure answers frequently asked questions about the procedure. If you have additional questions, discuss them with your primary care doctor, your endoscopist or your endoscopy nurse. Endoscopists are highly trained specialists who welcome your questions regarding their credentials, training and experience.
What is EUS?
EUS allows your doctor to examine your stomach lining as well as the walls of your upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gallbladder and pancreas.
Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound attachment to produce sound waves that create visual images of the digestive tract.
Why is EUS Done?
EUS provides your doctor with more information than other imaging tests by providing more detailed pictures of your digestive tract.
EUS is also used to evaluate an abnormality, such as a lump, that was detected at a prior endoscopy. EUS provides a picture of the lump, which can help your doctor determine its nature and help him decide the best treatment.
In addition, EUS can be used to diagnose disease of the pancreas, bile duct and gallbladder when other tests are inconclusive.
Why is EUS Used for Patients With Cancer?
EUS helps your doctor determine the extent of certain cancers of the digestive and respiratory systems. EUS allows your doctor to accurately assess the cancer's depth and whether it has spread to adjacent lymph nodes. In some patients, EUS can be used to obtain biopsies to help your doctor determine the proper treatment.
Fine Needle Aspiration (FNA)
Sometimes, a biopsy (tiny bit of tissue) may be done using a thin needle through the endoscope. This is usually done when there is a mass or enlarged lymph node. When there is a fluid filled cyst, it may be drained or fluid is aspirated for analysis.
How Should I Prepare for EUS?
For EUS of the upper gastrointestinal tract, you should have:
1. Nothing to eat or drink after midnight, not even water.
For EUS of the rectum or colon, your doctor will instruct you to either consume a large volume of a special cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to be rescheduled if you don't follow your doctor's instructions carefully.
Day Before Exam:
1. Light evening meal, no greasy foods, no dairy products and only small portions of food (chicken-rice soup, plain jello and fruit juices are suggested).
2. 6:00 pm take 2 Dulcolax tablets (you do not need prescription).
3. 7:00 pm drink a 10 oz. bottle of magnesium citrate (you do not need a prescription).
4. Drink plenty of clear liquids throughout the evening.
You are to have nothing to eat or drink after midnight. Please check with your physician concerning any medications you are presently taking, including aspirin.
Day of Exam
1. Use 2 fleets enemas (20 minutes apart before you come for the exam).
Please leave jewelry and other valuables at home or with a relative or friend.
You will be asked to sign a consent form authorizing the physician to do the procedure. The principal risks of this procedure are perforation and bleeding. These complications rarely occur.
What About my Current Medications?
You can take most medications as usual until the day of the EUS examination. Tell your doctor about all medications that you're taking and about any allergies you have to medication. Anticoagulant medications (blood thinners, such as Coumadin or heparin) might need to be adjusted before EUS. Insulin also needs to be adjusted on the day of EUS. Check with your doctor in advance regarding these prescriptions and regarding aspirin and non-steroidal anti-inflammatory (ibuprofen, naproxen, etc.). Check with your doctor about which medications you should take the morning of the EUS examination, and take essential medication with only a small cup of water.
If you have an allergy to latex, you should inform your doctor prior to your test. Patient with latex allergies often require special equipment and might not be able to have an EUS examination.
Do I Need to Take Antibiotics?
Antibiotics aren't generally required before or after EUS examinations. But tell your doctor if you take antibiotics before dental procedures. If your doctor feels you need antibiotics; antibiotics might be ordered during the EUS examination or after the procedure to help prevent an infection. Your doctor might prescribe antibiotics if you're having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance. Again, tell your doctor about any allergies to medications.
Should I Arrange for Help After the Examination?
For an EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. Most often, you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe. The actual examination generally takes between 15 to 45 minutes. Most patients consider it only slightly uncomfortable, and many fall asleep during it.
An EUS examination of the lower gastrointestinal tract can often be performed safely and comfortably without medications, but you'll receive a sedative. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the rectum last from 10 to 30 minutes.
What Happens After EUS?
You will be monitored in the recovery area. If you had an upper EUS, your throat might be a little sore. You might feel bloated because of the air and water that were introduced during the examination. You'll be able to eat after you leave the procedure areas, unless you're instructed otherwise.
Your doctor generally can inform you of the results of the procedure that day, but the results of some tests will take several days.
What Are the Possible Complications of EUS?
Although complications can occur, they are rare when doctors with specialized training and experience, such as members of the American Society for Gastrointestinal Endoscopy perform the EUS examination. Bleeding might occur at a biopsy * it's usually minimal and rarely required follow-up. You might have a slight sore throat for a day or so. Nonprescription anesthetic-type throat lozenges help soothe a sore throat.
Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; aspiration of stomach contents into your lungs: infection; and complications from heart or lung diseases. One major, but very uncommon, complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair.
The possibility of complications increases slightly if a deep needle biopsy is performed during the EUS examination. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.
If you have any questions about your need for EUS, alternative approaches to your problem, the cost of the procedure, methods of billing or insurance coverage, do not hesitate to speak to your doctor or doctor's office staff about it.
IMPORTANT REMINDER: The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.
YOU MUST MAKE ARRANGEMENTS FOR SOMEONE TO DRIVE YOU HOME, as the sedation given will not allow you to drive for 12 hours.
Because of the after-effects of the medication you are advised:
Contact your physician immediately if you develop any of the following:
You may develop a lump and/or redness at the site of your I.V. where sedation is given, apply a warm compress to the area to reduce discomfort.