Guest guest Posted March 4, 2004 Report Share Posted March 4, 2004 I hope this info help.....Mark EUS (Endoscopic Ultrasound) This is a test that combines ultrasound(sound waves) with an endoscope. The doctor places the tube (endoscope) into the stomach and the ultrasound machine (which is on the endoscope) is used to direct sound waves to the pancreas. The aim of this section is to help you understand how Endoscopic Ultrasound (EUS) can benefit you and what you can expect before, during, and after your procedure. Jump links to questions: Click image for larger version Dr. Muthusamy performing an EUS procedure. 1. What is an EUS? 2. What is EUS intended to see? 3. How Do I Prepare for the Procedure? 4. What Happens When I Arrive at the Endoscopy Suite ? 5. What Can I Expect During My EUS? 6. What Type of Diagnostic Tests and Therapy Can Be Performed During My EUS 7. What are the Possible Complications from an EUS? 8. What Can I Expect After My EUS? 9. What Symptoms Should I Look For After My Procedure That I Need to Contact the Doctor For? 10. Summary 1. What is an EUS? The term EUS stands for Endoscopic UltraSound. Endoscopic refers to the use of an instrument called an endoscope - a thin, flexible tube with a tiny video camera and light on the end. The high quality picture from the endoscope is shown on a TV monitor; The resulting image gives your physician a clear, detailed view of your digestive tract. The endoscope is used by a highly trained medical specialist, a gastroenterologist, to diagnose and treat various problems of the GI tract. Ultrasound refers to an imaging technique that uses sound waves to produce pictures. This principle is similar to using sonar to detect submarines. Traditionally, this procedure has been performed by radiology doctors, who move ultrasound probes over the skin of the abdomen to obtain images of various organs. However, as sound waves do not travel well through air, occasionally certain abdominal organs are not well seen due to air in the digestive tract. Endoscopic ultrasound combines an ultrasound processor on the tip of an endoscope, allowing for improved ultrasound imaging of the GI tract and the abdominal organs adjacent to it. This is a result of the closer proximity of the probe to the organs of interest as well as the ability to remove the air from within the digestive tract via the endoscope. The combination of the ultrasound probe and an endoscope have led to the development of EUS scopes, or echoendoscopes. These instruments allow examination of both the lining of your digestive tract with the endoscope, but also of the wall of the tract and its surrounding structures such as the liver, pancreas, bile ducts, and lymph nodes. Many other structures can also be seen. Because of these unique capabilities, EUS can sometimes detect abnormalities or obtain information other imaging tests cannot. EUS procedures can be done via the mouth (Upper EUS) or via the rectum (Rectal or Lower EUS). Echoendoscopes use ultrasound frequencies to generate images. The lower the frequency number (say 5 megahertz), the greater the depth of penetration of the sound waves into the abdominal tissues. However, the clarity of the image is somewhat reduced. In contrast, the higher frequencies (typically 12 MHz) allow for greater detail in the images, but offer more limited tissue penetration abilities. Thus, they are not as useful for looking at structures outside the GI tract. Most current echoendoscopes and the processors on which the images are generated allow your doctor to choose from a range of imaging frequencies to optimize the images obtained. It is also possible to study the flow of blood in vessels by a process known as Doppler ultrasound or pass a small needle down the endoscope and direct it, under ultrasound guidance, into structures within or adjacent to your digestive tract, such as lymph nodes or suspicious masses. In this way, tissue can be aspirated for analysis by a pathologist. This technique is known as fine needle aspiration aspiration (FNA). Recently, small flexible catheters have been developed that can be passed through a regular endoscope. They are referred to as " miniprobes " or " catheter probes " . They provide high frequency ultrasound images (12-30 MHz), which allow for very detailed images of the wall of the gastrointestinal tract. Thus, EUS is a method of combining endoscopy and ultrasound imaging to obtain high quality images of the digestive tract and its adjacent structures. When lesions are seen, they can often be diagnosed via a fine-needle aspiration. However, this procedure, like ERCP, requires much skill and training and is best performed by trained experts. EUS with fine-needle aspiration also carries a slightly increased procedure risk compared to standard endoscopy. It is important to understand these risks and the indications for this test, as well as possible alternatives to this procedure. Top 2. What is EUS intended to see? EUS procedures can provide a variety of information. The indications for EUS are still undergoing development as its use is becoming more widespread. It is primarily used to detect suspected cancers or to evaluate how far a previously diagnosed cancer has spread in order to determine the appropriate therapy. This latter process is called staging, and EUS is used to stage cancers of the esophagus, stomach, pancreas, and rectum. Spread to adjacent lymph nodes and blood vessels can be determined by the imaging and fine-needle aspiration capabilities of EUS. EUS gives partial, but incomplete, information regarding the spread of these tumors to adjacent organs due to its limited depth of penetration. However, recent imaging enhancements allow for greater evaluation of adjacent organs than previously possible. EUS is also useful in identifying the nature of " lumps " and " bumps " seen on a previous endoscopic exam. These bumps may represent an adjacent structure compressing the GI tract or represent a mass or fluid collection within the wall of the digestive tract. EUS can help differentiate between these possibilities. EUS also plays a role in evaluating disorders of the pancreas and bile ducts (the tubes that drain bile from your liver and gall bladder). Visualization of the bile ducts is easily accomplished, and the pancreas can be evaluated for the presence of masses, cysts, or changes that suggest chronic inflammation. More recent applications have been to evaluate patients with fecal incontinence, stage lung cancers, and to evaluate for clots in the vessels of the abdomen with the use of Doppler. New applications appear each year, but many are not yet widespread. For a more complete list of the conditions in which EUS may be helpful, please click here (link to referral indications page for EUS). Top 3. How Do I Prepare for the Procedure? Regardless of the reason you are undergoing this procedure, there are important steps you can take to prepare for and participate in your test. First, if your doctor has not already reviewed them, bring any x-rays or other relevant tests you have undergone with you. When you arrive at the endoscopy unit, be sure to give your doctor a complete list of all the medicines you are taking and any allergies you have to drugs or other substances. You should specifically mention to your medical team if you are taking any aspirin containing products, arthritis medicines such as ibuprofen, anticoagulants ( " blood thinners " ), or diabetic medications. The medical staff will also want to know if you have heart, lung, or other medical conditions that may need special attention before, during, or after your procedure. You will be given instructions in advance that will outline what you should and should not do in preparation for your procedure. Be sure to read and follow these instructions carefully. They are available in the procedure preparation section of the Patient Information section of this website. Make sure you identify the preparation specific to your doctor's office. One very important step in preparing for your procedure is that you should not eat or drink within six hours of your procedure. Food in the stomach will block the view through the endoscope. In addition, you could develop pneumonia if the food enters your lung as a result of vomiting (due to the effects of the sedative medicines) during or after the procedure, a time your gag reflex may not have returned to its normal state. Top 4. What Happens When I Arrive at the Endoscopy Suite ? Our EUS procedures are usually done at the endoscopy unit at Mt. Zion Hospital. Upon arriving, you will change into a hospital gown and remove any glasses, contacts, and dentures you may have. An intravenous needle (IV) will be placed (typically in your arm) into which your sedative medications will be injected when the procedure begins. A detailed medical history will be obtained by the medical staff and you'll be asked to sign a form that verifies your consent to proceed with the test and your understanding what is involved. After signing the consent form, you will be taken to the specially equipped procedure room and be connected to monitors that will measure your heart rate, blood pressure, and the oxygenation levels of your blood throughout the procedure. You will be asked to turn onto your left side and a plastic guard will placed into your mouth to protect your teeth (this is only done if you are having an Upper EUS). The sedation will then be administered through your IV. Complete anesthesia is rarely necessary. The medications are used to provide relief from discomfort as well as to cause " amnesia " , which usually results in your not remembering much, if anything, about the test. At this point, the procedure will begin. Top 5. What Can I Expect During My EUS? During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. You will be relaxed and drowsy, but you will remain awake enough to cooperate. You will not, however, be completely anesthetized as in a surgery. As the echoendoscope is slowly and carefully inserted, air is introduced through it to help your doctor see better. As this is done, you should feel some slight pressure but no pain and it should not interfere with your breathing. The echoendocope is carefully advanced into the duodenum (for upper EUS) or the sigmoid colon (for rectal EUS). At this time, after the endoscopic images have been obtained, the GI tract is suctioned to remove surrounding air and the echoendoscope is withdrawn and the appropriate structures are imaged. If an abnormality is seen, a fine needle aspiration may be performed. Once the appropriate images/tissue are obtained, the procedure is completed. Typically, an EUS procedure lasts between 30 and 90 minutes. Top 6. What Type of Diagnostic Tests and Therapy Can Be Performed During My EUS? Depending on the abnormality seen, your doctor may elect to collect some tissue samples during the procedure. This can be done with a biopsy forceps or via the fine needle aspiration (FNA) procedure. If a fluid collection is seen, it can be suctioned through the scope and the fluid sent for analysis. Occasionally, if there is a large cyst in the pancreas that needs drainage, your doctor may place a stent through the stomach or small bowel into the pancreatic cyst. This process is called a cyst-gastrostomy or a cyst-duodenostomy. For patients with pancreatic cancer and severe pain, medications can be injected into the nerves responsible for transmitting this pain. This serves to lessen the pain in these patients for a period of up to several months. This is called a celiac-plexus blockade. Based on current evidence, it appears to work better for patients with pancreatic cancer than it does for patients with chronic pancreatitis. Top 7. What are the Possible Complications from an EUS? EUS has been shown to be a safe procedure, similar to other types of endoscopy. The risks are similar to regular endoscopy except when fine needle aspiration is performed. First, there is a small risk of having a reaction to the sedative medications or antibiotics that may be given prior to your procedure. This usually results in nausea or a skin rash and usually goes away quickly. In addition, the medications used for sedation may cause alterations in your heart rate or blood pressure. This is why you are monitored throughout your procedure and during your recovery period. Medications to reverse the effects of the sedatives are available, if necessary. For patients undergoing EUS without FNA (also known as diagnostic EUS), the risks of endoscopy are about 0.05%. This is about a 1 in 2000 chance of a significant complication. The During these procedures, the major risks are perforation (a puncture of the intestinal wall), which could require surgical repair, and bleeding, which could require transfusion. Again, these complications are unlikely. They typically occur from passing the scope through a large tumor or " stretching " or dilating a tumor before or during the EUS procedure. For patients undergoing EUS with FNA, complications still only occur between 0.5% - 1.0% of the time (this corresponds to a risk of 1 in 100 to 1 in 200). The risks associated with FNA include bleeding, pancreatitis (rarely, and only if the pancreas undergoes FNA), or infection. In patients undergoing a rectal FNA or FNA of any cystic lesion, intraprocedural antibiotics are given and followed up with a 5 day course of oral antibiotics after the procedure. Be aware that, occasionally, minor problems may persist, such as a mild sore throat, bloating, or cramping. These symptoms typically disappear in 24 hours or less. Be sure to discuss any specific concerns you may have with your doctor. Top 8. What Can I Expect After My EUS? When your EUS is completed you'll be cared for in a recovery area until most of the effects of the medication have worn off. Typically, this takes 1-2 hours, which is longer than for standard endoscopy. This is because more medications are needed to sedate you adequately for a longer procedure such as EUS. You may have a mild sore throat or bloating. Patients can usually eat once they are awake and alert. Your doctor will also inform you about the results of the procedure and provide any additional information you need to know. EUS procedures do not require in-hospital observation except in rare circumstances, so you will likely be going home after the procedure. You will be given a prescription for a 5 day course of oral antibiotics if an FNA of a cyst or rectal lesion was performed. You will also be given guidelines for resuming your normal activity before leaving the endoscopy unit. By the time you're ready to go home, you should feel stronger and more alert. Nevertheless, you should plan on resting for the remainder of the day. This means not driving, so you'll need to have a family member or friend take you home. Top 9. What Symptoms Should I Look For After My Procedure That I Need to Contact the Doctor For? Occasionally, minor problems may persist, such as a mild sore throat, bloating, or cramping; these should disappear in 24 hours or less. Should you experience severe abdominal pain, difficulty swallowing, fever, vomiting up blood, bloody bowel movements, or extreme dizziness/weakness, please contact your physician regarding these symptoms. Early recognition of possible complications is important. Top 10. Summary EUS is an advanced procedure that is performed comfortably with light to moderate sedation. The procedure provides significant diagnostic information upon which further treatment is usually based. In select cases, therapy can be administered directly through the echoendoscope. Serious complications rarely occur as a result of this procedure. Upcoming EUS/Block > Now that I have all my ducks in a row and have decided to go ahead > with it. Can anyone tell me exactly what the EUS part will be like? I > am starting to worry about that. I am a worry wart by nature and my > track record with Medical procedures is not a good one. > > Any positive comments would surely help! > > Thanks so much ahead of time. Cyndi > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2004 Report Share Posted March 5, 2004 Thanks Jim. for the info. I have been thru enough Endoscopies and ERCPs in the past 20 months. Don't know why it bothers me so! I am just concerned about the combination of EUS and Nerve Block. Will the EUS allow the Dr. to observe exactly how much damage has occured? The Dr. keeps saying that inflammation is present but never a clu as to how much damage has been done. I have been diabetic for 12 years. Only got the CP diagnosis 20 months ago. Anybody else you know that had Diabetes long before CP? Thanks, Cyndi Quote Link to comment Share on other sites More sharing options...
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